The impact of multimorbidity on adult physical and mental health in low- and middle-income countries: What does the study on global ageing and adult health (SAGE) reveal?
International Institute for Population Sciences, Mumbai, India; Department of Community Health, University of Ghana, Accra, Ghana; Shanghai Municipal Center for Disease Control and Prevention (CDC), Shanghai, China; Russian Academy of Medical Sciences (RAMS), Moscow, Russian Federation; National Institute of Public Health (INSP), Centre for Evaluation Research and Surveys, Cuernavaca, Morelos, Mexico; Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, University Road, Southampton, United Kingdom; Indian Institute of Public Health, Bhubaneswar, Public Health Foundation of India, Bhubaneswar, Odisha, India; Ohio University, Department of Social Medicine and Director of Global Health, Athens, OH, United States; Centre for Dementia Studies, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom; University of Oregon, Department of Anthropology, Eugene, OR, United States; World Health Organization, Statistics Measurement and Analysis Unit, Geneva, Switzerland; World Health Organization Study on global AGEing and adult health (SAGE), Geneva, Switzerland; University of Newcastle Priority Research Centre for Gender, Health and Ageing, Newcastle, NSW, Australia
Background: Chronic diseases contribute a large share of disease burden in low- and middle-income countries (LMICs). Chronic diseases have a tendency to occur simultaneously and where there are two or more such conditions, this is termed as 'multimorbidity'. Multimorbidity is associated with adverse health outcomes, but limited research has been undertaken in LMICs. Therefore, this study examines the prevalence and correlates of multimorbidity as well as the associations between multimorbidity and self-rated health, activities of daily living (ADLs), quality of life, and depression across six LMICs. Methods: Data was obtained from the WHO's Study on global AGEing and adult health (SAGE) Wave-1 (2007/10). This was a cross-sectional population based survey performed in LMICs, namely China, Ghana, India, Mexico, Russia, and South Africa, including 42,236 adults aged 18 years and older. Multimorbidity was measured as the simultaneous presence of two or more of eight chronic conditions including angina pectoris, arthritis, asthma, chronic lung disease, diabetes mellitus, hypertension, stroke, and vision impairment. Associations with four health outcomes were examined, namely ADL limitation, self-rated health, depression, and a quality of life index. Random-intercept multilevel regression models were used on pooled data from the six countries. Results: The prevalence of morbidity and multimorbidity was 54.2 % and 21.9 %, respectively, in the pooled sample of six countries. Russia had the highest prevalence of multimorbidity (34.7 %) whereas China had the lowest (20.3 %). The likelihood of multimorbidity was higher in older age groups and was lower in those with higher socioeconomic status. In the pooled sample, the prevalence of 1+ ADL limitation was 14 %, depression 5.7 %, self-rated poor health 11.6 %, and mean quality of life score was 54.4. Substantial cross-country variations were seen in the four health outcome measures. The prevalence of 1+ ADL limitation, poor self-rated health, and depression increased whereas quality of life declined markedly with an increase in number of diseases. Conclusions: Findings highlight the challenge of multimorbidity in LMICs, particularly among the lower socioeconomic groups, and the pressing need for reorientation of health care resources considering the distribution of multimorbidity and its adverse effect on health outcomes. © 2015 Arokiasamy et al.
ADL disability; adult; age; aged; aging; angina pectoris; arthritis; Article; asthma; cerebrovascular accident; China; chronic lung disease; correlation analysis; cross-sectional study; daily life activity; depression; diabetes mellitus; disease association; female; Ghana; health care need; health care system; health status; human; hypertension; India; lowest income group; major clinical study; male; mental health; Mexico; middle aged; morbidity; multimorbidity; physical capacity; prevalence; quality of life; regression analysis; Russian Federation; self evaluation; social status; South Africa; visual impairment; young adult