| Summary: | Background As population ageing accelerates and life expectancy increases, multimorbidity and disability pose challenges to health and social care systems worldwide. Although multimorbidity is closely related to disability, there is still a lack of research on the impact of multimorbidity on disability in rural middle-aged and elderly people. Objective To evaluate the influence of multimorbidity on disability in rural middle-aged and elderly people using the propensity-score matching (PSM) , providing a reference for formulating strategies for the management of multimorbidity and disability in this population. Methods The data of 11 088 rural middle-aged and elderly people (≥45 years old) were collected from the 2018 China Health and Retirement Longitudinal Study in March 2022, including demographics, chronic disease prevalence, and disability measured by activities of daily living (ADLs) , and instrumental activities of daily living (IADLs) . Participants were divided into multimorbidity and non-multimorbidity groups by the prevalence of multimorbidity (defined as having ≥2 chronic conditions) , and then matched using PSM with a 1∶1 ratio. Conditional Logistic regression model for paired binary data was used to assess the impact of multimorbidity on ADL disability and IADL disability. Results Of 11 088 ural middle-aged and elderly people with chronic diseases, 2 711 (24.45%) had ADL disability, 4 216 (38.02%) had IADL disability, and 7 673 (69.20%) were multimorbidity patients. The prevalence of ADL disability or IADL disability differed significantly by gender, age, marital status, education level, sleep duration, smoking, drinking, disability status, participation in social activities, and prevalence of multimorbidity (P<0.05) . There were statistically significant differences in gender, age, marital status, education level, sleep duration, smoking, drinking, disability status, and participation in social activities between the two groups before matching (P<0.05) . A total of 3 391 pairs were derived after PSM with matched covariates. Logistic regression analysis showed that multimorbidity prevalence increased the risk of ADL disability by a factor of 2.25〔OR (95%CI) =2.25 (1.96, 2.59) , P<0.001〕 and elevated the risk of IADL disability by a factor of 1.52〔OR (95%CI) =1.52 (1.36, 1.71) , P<0.001〕. Conclusion PSM is beneficial for reducing confounding bias in study groups. Multimorbidity would increase the risk of disability in rural middle-aged and elderly people. It is suggested to value the government input on resources and policies to strengthen the prevention and management of multimorbidity and disability in this group of people.
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