Effect of education and multimorbidity on mortality among older adults: findings from the health, well-being and ageing cohort study (SABE)

Objectives: This study assessed the moderating role of education on the relationship between multimorbidity and mortality among older adults in Brazil. Study design: This was a cohort study. Methods: This study used data from 1768 participants of the Health, Well-Being and Ageing Cohort Study (SABE) who were assessed between 2006 and 2015. The Cox Proportional Risks Model was used to evaluate the association between multimorbidity (two or more chronic diseases) and mortality. An interaction term between education and multimorbidity was included to test the moderating role of education in this association. Results: The average follow-up time was 4.5 years, with a total of 589 deaths in the period. Multimorbidity increased the risk of mortality (hazard ratio [HR] 1.55, 95% confidence interval [CI] 1.27-1.91), and this association was not moderated by education (HR 1.06, 95% CI 1.00-1.13; P value 1/4 0.07). Conclusions: The impact of education and multimorbidity on mortality emphasises the need for an integrated approach directed towards the social determinants of health to prevent multimorbidity and its burden among older adults. (c) 2021 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.