• Adelson Guaraci Jantsch, Ronaldo Fernandes Santos Alves, and Eduardo Faerstein.
• MD, MSc. Doctoral Student, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro (UERJ), and Coordinator, Residency Program in Family and Community Medicine, Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro (RJ), Brazil.
• Sao Paulo Med J. 2018 Jan 1; 136 (1): 515851-58.

BackgroundInformation about multimorbidity is scarce in developing countries. This study aimed to estimate the association of educational attainment with occurrences of multimorbidity in a population of public employees on university campuses in Rio de Janeiro.Design And SettingWe conducted cross-sectional analyses on baseline data (1999-2001) from 3,253 participants in the Pró-Saúde study, conducted in Brazil.MethodsThe prevalence of multimorbidity, defined as a self-reported history of medical diagnoses of two or more chronic conditions, was estimated according to sex, age, smoking, obesity and educational level. The association between education and multimorbidity was estimated using odds ratios (OR) and the relative and slope indices of inequality, in order to quantify the degree of educational inequality among individuals with multimorbidity in this population.ResultsGreater age, female sex, smoking and obesity had direct associations with multimorbidity; and tobacco exposure and obesity also showed direct relationships with poorer educational level. There was a monotonic inverse linear trend between educational level and the presence of multimorbidity among women, with twice the odds (OR 2.47; 95% confidence interval, CI: 1.42-4.40) between extremities of schooling categories. There was excess multimorbidity of 22% at the lowest extremity of schooling, thus showing that women with worse educational status were more affected by the outcome. No trend and no excess multimorbidity was seen among men.ConclusionsEducational inequality is an important determinant for development of multimorbidity. Men and women experience its effect differently. Researchers need to consider that sex may be an effect modifier in multimorbidity studies.

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