PUBLIC HEALTH BURDEN OF MULTIMORBIDITY IN ADULTS: OUT-OF-POCKET EXPENDITURE, WORK PRODUCTIVITY, HEALTHCARE UTILISATION, QUALITY OF LIFE, AND DISEASE MANAGEMENT AND CONTROL

Abstract

Non-communicable diseases (NCDs) have been associated with high morbidity and mortality in high-income and middle-income countries. This thesis aims to examine different aspects of burden on adults with multimorbidity, defined as the presence of two or more NCDs. These aspects include out-of-pocket expenditure (OOPE), work productivity loss, healthcare utilisation, quality of life (QoL), and chronic disease management. The thesis consists of (i) a high quality systematic review on OOPE on medicines, (ii) secondary data analysis of the Household, Income, and Labour Dynamics Australia (HILDA) survey and the Japanese Study of Ageing and Retirement (JSTAR) survey on work productivity loss and healthcare utilisation, (iii) analysis of the World Health Organisation Study on Global Ageing and Adult Health (WHO SAGE) to examine the associations between multimorbidity combinations with healthcare utilisation and QoL, and (iv) analysis of WHO SAGE to investigate the implications of multimorbidity on the diagnosis, management and control of NCDs.