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Tan MMC, Barbosa MG, Pinho PJMR, Assefa E, Keinert AÁM, Hanlon C, Barrett B, Dregan A, Su TT, Mohan D, Ferri C, Muniz‐Terrera G, Prina M. Determinants of multimorbidity in low- and middle-income countries: A systematic review of longitudinal studies and discovery of evidence gaps. Obes Rev 2024; 25:e13661. [PMID: 38105610 PMCID: PMC11046426 DOI: 10.1111/obr.13661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 10/03/2023] [Accepted: 10/07/2023] [Indexed: 12/19/2023]
Abstract
Multimorbidity-the coexistence of at least two chronic health conditions within the same individual-is an important global health challenge. In high-income countries (HICs), multimorbidity is dominated by non-communicable diseases (NCDs); whereas, the situation may be different in low- and middle-income countries (LMICs), where chronic communicable diseases remain prominent. The aim of this systematic review was to identify determinants (including risk and protective factors) and potential mechanisms underlying multimorbidity from published longitudinal studies across diverse population-based or community-dwelling populations in LMICs. We systematically searched three electronic databases (Medline, Embase, and Global Health) using pre-defined search terms and selection criteria, complemented by hand-searching. All titles, abstracts, and full texts were independently screened by two reviewers from a pool of four researchers. Data extraction and reporting were according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Methodological quality and risk of bias assessment was performed using the Newcastle-Ottawa Scale for cohort studies. Data were summarized using narrative synthesis. The search yielded 1782 records. Of the 52 full-text articles included for review, 8 longitudinal population-based studies were included for final data synthesis. Almost all studies were conducted in Asia, with only one from South America and none from Africa. All studies were published in the last decade, with half published in the year 2021. The definitions used for multimorbidity were heterogeneous, including 3-16 chronic conditions per study. The leading chronic conditions were heart disease, stroke, and diabetes, and there was a lack of consideration of mental health conditions (MHCs), infectious diseases, and undernutrition. Prospectively evaluated determinants included socio-economic status, markers of social inequities, childhood adversity, lifestyle behaviors, obesity, dyslipidemia, and disability. This review revealed a paucity of evidence from LMICs and a geographical bias in the distribution of multimorbidity research. Longitudinal research into epidemiological aspects of multimorbidity is warranted to build up scientific evidence in regions beyond Asia. Such evidence can provide a detailed picture of disease development, with important implications for community, clinical, and interventions in LMICs. The heterogeneity in study designs, exposures, outcomes, and statistical methods observed in the present review calls for greater methodological standardisation while conducting epidemiological studies on multimorbidity. The limited evidence for MHCs, infectious diseases, and undernutrition as components of multimorbidity calls for a more comprehensive definition of multimorbidity globally.
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Affiliation(s)
- Michelle M. C. Tan
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- Global Public Health, Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaSunway CitySelangorMalaysia
- South East Asia Community Observatory (SEACO)Monash University MalaysiaSunway CitySelangorMalaysia
- Victorian Heart InstituteFaculty of Medicine, Nursing and Health Sciences, Monash University, Clayton CampusClaytonVictoriaAustralia
| | - Matheus G. Barbosa
- Psychogeriatric Unit, Department of Psychiatry, Medical SchoolUniversidade Federal de São Paulo (UNIFESP)São PauloBrazil
| | - Pedro J. M. R. Pinho
- Psychogeriatric Unit, Department of Psychiatry, Medical SchoolUniversidade Federal de São Paulo (UNIFESP)São PauloBrazil
| | - Esubalew Assefa
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT‐Africa)Addis Ababa UniversityAddis AbabaEthiopia
- Department of Economics, College of Business and EconomicsJimma UniversityJimmaEthiopia
- Department of Economics, Faculty of Arts and Social SciencesThe Open UniversityMilton KeynesUK
| | - Ana Á. M. Keinert
- Psychogeriatric Unit, Department of Psychiatry, Medical SchoolUniversidade Federal de São Paulo (UNIFESP)São PauloBrazil
| | - Charlotte Hanlon
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT‐Africa)Addis Ababa UniversityAddis AbabaEthiopia
- Global Mental Health, Centre for Global Mental Health, Institute of Psychiatry, Psychology and NeurosciencesKing's College LondonLondonUK
- Department of Psychiatry, School of Medicine, College of Health SciencesAddis Ababa UniversityAddis AbabaEthiopia
| | - Barbara Barrett
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Alexandru Dregan
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Tin Tin Su
- Global Public Health, Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaSunway CitySelangorMalaysia
- South East Asia Community Observatory (SEACO)Monash University MalaysiaSunway CitySelangorMalaysia
- Victorian Heart InstituteFaculty of Medicine, Nursing and Health Sciences, Monash University, Clayton CampusClaytonVictoriaAustralia
| | - Devi Mohan
- Global Public Health, Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaSunway CitySelangorMalaysia
| | - Cleusa Ferri
- Psychogeriatric Unit, Department of Psychiatry, Medical SchoolUniversidade Federal de São Paulo (UNIFESP)São PauloBrazil
| | - Graciela Muniz‐Terrera
- Edinburgh Dementia PreventionUniversity of Edinburgh and Western General HospitalEdinburghUK
- Department of Social Medicine, Heritage College of Osteopathic MedicineOhio UniversityAthensOhioUSA
| | - Matthew Prina
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
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