Multimorbidity and Whole Health among Adults in the United States: Evidence from the NHIS and BRFSS

PUPROSE Whole health is a patient-centered approach that promotes self-management of what matters to the patient. Whole health focuses on mind-body, recharge(sleep), healthy diet, emotional health, and movement, all of which are critical for those with multimorbidity. We examined the association of multimorbidity with good whole health among adults in the United States. METHODS We conducted a cross-sectional design. As no one dataset provided information on all components of whole health, we analyzed mind-body therapies, recharge, emotional health, and movement from the 2017 National Health Interview Survey (NHIS), and healthy diet from the 2017 Behavioral Risk Factor Surveillance System (BRFSS). Multimorbidity was defined as the co-occurrence of two or more chronic conditions. Recharge was measured by adequate duration of sleep and the Kessler Psychological Distress Scale (K6) was used to measure emotional health. All unadjusted and adjusted analyses were conducted using the SAS survey procedures. The samples from NHIS (N=25,134) and BRFSS (N=347,029) represented 213 million and 183 million adults, respectively. RESULTS Prevalence of the whole health components varied from 24.4% (mind-body therapies use), 55.7% (healthy-diet), 57.1% (movement), 63.9% (adequate sleep), and good emotional health (78.4%). Based on NHIS, only 3.4% reported good health in all four components. A lower percentage of adults with multimorbidity used mind-body therapies (22.9% vs 25.2%), had adequate sleep (58.2% vs 67.1%), good emotional health (71.8% vs 82.1%), adequate movement (16.2% vs 28.2%), and healthy diet (54.5% vs 56.5%) compared to those without multimorbidity (p < .001). Adjusted analyses revealed that those with multimorbidity were less likely to engage in whole health practices compared to those without multimorbidity. CONCLUSIONS Seven in 10 adults had poor health in two or more components of whole health. Adults with multimorbidity were found to have poorer health in all components of whole health. Nationally representative data surveys should strive to collect information on all components of whole health with standardized measures.