Adapting to the Challenges of Chronic Non-communicable Diseases: Evidence from Russia

As life expectancies increase and healthcare improves, increasing numbers of the population can expect to live with combinations of two or more chronic noncommunicable diseases (NCDs). Population studies suggest that more than half of older-aged adults report having multiple chronic NCDs (multimorbidities) and twothirds of total health spending in high-income countries is accounted for by patients with multimorbidities. Beyond the need to obviate the growing burden on healthcare systems, the increasing incidence and prevalence of multimorbidity and its effects requires further investigation. Using nationally representative data from a Russian population survey, we examine the impact of chronic NCDs on self-assessed health, explore the prevalence of multimorbidity and, applying an iterative partial proportional odds estimator, examine how different combinations of chronic NCDs interact to influence self-assessed health. Confirming that there are high levels of chronic NCDs and associated multimorbidities, we find that the impact of these on self-assessed health is greater than previous estimates suggested but that, where there are dual morbidities, the effect of the additional disease is weaker than it would have been if experienced as a single condition. We conclude that individuals possess critical adaptive psychological mechanisms which attenuate the incremental health impact of additional chronic NCDs. These are important for understanding the relationship between illness and the quality of life.