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Chowdhury SR, Chandra Das D, Sunna TC, Beyene J, Hossain A. Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis. EClinicalMedicine 2023; 57:101860. [PMID: 36864977 PMCID: PMC9971315 DOI: 10.1016/j.eclinm.2023.101860] [Citation(s) in RCA: 110] [Impact Index Per Article: 110.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Knowing the prevalence of multimorbidity among adults across continents is a crucial piece of information for achieving Sustainable Development Goal 3.4, which calls for reducing premature death due to non-communicable diseases. A high prevalence of multimorbidity indicates high mortality and increased healthcare utilization. We aimed to understand the prevalence of multimorbidity across WHO geographic regions among adults. METHODS We performed a systematic review and meta-analysis of surveys designed to estimate the prevalence of multimorbidity among adults in community settings. We searched PubMed, ScienceDirect, Embase and Google Scholar databases for studies published between January 1, 2000, and December 31, 2021. The random-effects model estimated the pooled proportion of multimorbidity in adults. Heterogeneity was quantified using I2 statistics. We performed subgroup analyses and sensitivity analyses based on continents, age, gender, multimorbidity definition, study periods and sample size. The study protocol was registered with PROSPERO (CRD42020150945). FINDINGS We analyzed data from 126 peer-reviewed studies that included nearly 15.4 million people (32.1% were male) with a weighted mean age of 56.94 years (standard deviation of 10.84 years) from 54 countries around the world. The overall global prevalence of multimorbidity was 37.2% (95% CI = 34.9-39.4%). South America (45.7%, 95% CI = 39.0-52.5) had the highest prevalence of multimorbidity, followed by North America (43.1%, 95% CI = 32.3-53.8%), Europe (39.2%, 95% CI = 33.2-45.2%), and Asia (35%, 95% CI = 31.4-38.5%). The subgroup study highlights that multimorbidity is more prevalent in females (39.4%, 95% CI = 36.4-42.4%) than males (32.8%, 95% CI = 30.0-35.6%). More than half of the adult population worldwide above 60 years of age had multimorbid conditions (51.0%, 95% CI = 44.1-58.0%). Multimorbidity has become increasingly prevalent in the last two decades, while the prevalence appears to have stayed stable in the recent decade among adults globally. INTERPRETATION The multimorbidity patterns by geographic regions, time, age, and gender suggest noticeable demographic and regional differences in the burden of multimorbidity. According to insights about prevalence among adults, priority is required for effective and integrative interventions for older adults from South America, Europe, and North America. A high prevalence of multimorbidity among adults from South America suggests immediate interventions are needed to reduce the burden of morbidity. Furthermore, the high prevalence trend in the last two decades indicates that the global burden of multimorbidity continues at the same pace. The low prevalence in Africa suggests that there may be many undiagnosed chronic illness patients in Africa. FUNDING None.
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Affiliation(s)
- Saifur Rahman Chowdhury
- Department of Public Health, North South University, Dhaka, Bangladesh
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Dipak Chandra Das
- Department of Public Health, North South University, Dhaka, Bangladesh
| | | | - Joseph Beyene
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Ahmed Hossain
- College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Global Health Institute, North South University, Dhaka, Bangladesh
- Corresponding author.
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Polypharmacy and Multimorbidity in the Urogynecology Population and Their Effect on Pelvic Floor Symptoms. UROGYNECOLOGY (HAGERSTOWN, MD.) 2023; 29:80-87. [PMID: 36548108 DOI: 10.1097/spv.0000000000001262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Polypharmacy and multimorbidity are common in older adults but has not been well studied in the urogynecologic patient population. OBJECTIVES The objective of this study was to determine the prevalence of polypharmacy and multimorbidity in a diverse outpatient urogynecologic population and to examine whether polypharmacy and/or multimorbidity were associated with lower urinary tract symptoms, pelvic organ prolapse, defecatory distress, and/or female sexual dysfunction. STUDY DESIGN This is a secondary analysis of a dual-center cross-sectional study of new patients presenting for evaluation of pelvic floor disorders at 2 urban academic outpatient urogynecology clinics. Baseline demographics and clinical characteristics were obtained from the electronic medical record. Validated surveys were administered to determine severity of lower urinary tract symptoms (Overactive Bladder Validated 8-Question Screener, Urogenital Distress Inventory-6), pelvic floor dysfunction (Pelvic Organ Prolapse Distress Inventory-6, Colorectal-Anal Distress Inventory-8), and sexual dysfunction (6-item Female Sexual Function Index). Standard statistical techniques were used. RESULTS One hundred ninety-seven women with mean age 58.8 years (SD, 13.4 years) were included, and most were of minority race/ethnicity (Black, 34.0%; Hispanic, 21.8%). The majority of participants met criteria for polypharmacy (58.4%) and multimorbidity (85.8%), with a mean prescription number of 6.5 (SD, ± 4.9) and mean number of medical comorbidities of 4.9 (SD, ± 3.3). Polypharmacy and multimorbidity were significantly associated with higher CRADI-8 scores. Specifically, polypharmacy was associated with straining with bowel movements and painful stools, whereas multimorbidity was associated with incomplete emptying and fecal urgency. There was no significant association between polypharmacy and multimorbidity with urinary symptoms, prolapse, or sexual dysfunction. CONCLUSIONS Polypharmacy and multimorbidity are common in the urogynecologic population. There is a relationship between greater defecatory distress and polypharmacy and multimorbidity.
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Bastos-Silva Y, Aguiar LB, Pacello P, Baccaro LF, Orcesi Pedro A, Costa-Paiva L. Self-care agency and associated factors in postmenopausal women. Menopause 2021; 28:1369-1373. [PMID: 34469935 DOI: 10.1097/gme.0000000000001852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aging process in women is marked by several changes, including the transition to menopause. The evaluation of self-care management is essential and has great relevance for public health. The aim of the present study was to evaluate self-care management and associated factors in postmenopausal women. METHOD This study was a cross-sectional study performed with 260 postmenopausal women who attended routine consultations at the Menopause Outpatient Clinic of the Hospital of the State University of Campinas-SP. Women aged 50 years or older with amenorrhea for at least 12 months were included. The women were interviewed by a researcher during the routine consultation, and the self-care agency assessment was performed using the Appraisal of Self-Care Agency Scale-Revised questionnaire. RESULTS The average total self-care score for the women in this study was 62.27 (± 9.64). Higher Appraisal of Self-Care Agency Scale-Revised scores were associated with performing outdoor activities, better self-perceived health, and a higher score on knowledge about vitamin D. Active smoking was associated with a lower self-care score. CONCLUSION We observed that the self-care management of postmenopausal women was satisfactory and was associated with lifestyle, self-perceived health, and knowledge about vitamin D.
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Affiliation(s)
- Yasmin Bastos-Silva
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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Huaquía-Díaz AM, Chalán-Dávila TS, Carrillo-Larco RM, Bernabe-Ortiz A. Multimorbidity in Latin America and the Caribbean: a systematic review and meta-analysis. BMJ Open 2021; 11:e050409. [PMID: 34301665 PMCID: PMC8311299 DOI: 10.1136/bmjopen-2021-050409] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To estimate the pooled prevalence of multimorbidity (≥2 non-communicable diseases in the same individual) among adults of the general population of Latin American and the Caribbean (LAC). DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, Embase, Global Health, Scopus and LILACS up to 1 July 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES The outcome was the prevalence of multimorbidity. Reports were selected whether they enrolled adult individuals (age ≥18 years) from the general population. DATA EXTRACTION AND SYNTHESIS Reviewers extracted relevant data and assessed risk of bias independently. A random-effects meta-analysis was conducted to report pooled prevalence estimates of multimorbidity; pooled estimates by pre-specified subgroups (eg, national studies) were also pursued. RESULTS From 5830 results, we selected 28 reports, mostly from Brazil and 16 were based on a nationally representative sample. From the 28 selected reports, 26 were further included in the meta-analysis revealing a pooled multimorbidity prevalence of 43% (95% CI: 35% to 51%; I2: 99.9%). When only reports with a nationally representative sample were combined, the pooled prevalence was 37% (95% CI: 27% to 47%; I2: 99.9%). When the ascertainment of multimorbidity was based on self-reports alone, the pooled prevalence was 40% (95% CI: 31% to 48%; I2: 99.9%); this raised to 52% (95% CI: 33% to 70%; I2: 99.9%) for reports including self-reported and objective diagnosis. CONCLUSIONS Our results complement and advance those from global efforts by incorporating much more reports from LAC. We revealed a larger presence of multimorbidity in LAC than previously reported. PROSPERO REGISTRATION NUMBER CRD42020196177.
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Affiliation(s)
| | | | - Rodrigo M Carrillo-Larco
- Department of Epidemiology and Bisotatistics, School of Public Health, Imperial College London, London, UK
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabe-Ortiz
- Universidad Científica del Sur, Lima, Peru
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
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Sousa Rodrigues Guedes T, Patrocínio da Silva Barros C, Dantas de Oliveira NP, Martins Holanda A, Albuquerque Reis M, Rocha E Silva BL, Barbosa Otoni Gonçalves Guedes M, Jerez-Roig J, Bezerra de Souza DL. Social support in the healthcare of women submitted to breast cancer treatment. Women Health 2020; 60:899-911. [PMID: 32522099 DOI: 10.1080/03630242.2020.1767263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study aimed to verify the prevalence of low social support (LSS) and associated factors in women submitted to breast cancer (BC) treatment. A cross-sectional study was carried out with 101 female residents of the municipality of Natal (Northeast Brazil), diagnosed with BC and submitted to oncological treatment. Data collection took place between July/2015 and May/2016 from medical records and individuals' interviews, and from the Medical Outcome Study-Social Support Survey. Descriptive, bivariate and multivariate statistics were carried out through Poisson's regression with robust variance and significance level 0.05. Prevalence of LSS in women with BC was 22.8% with confidence interval 14.6-39.94. Type of access to public services (p < .03), prevalence ratio (PR) 1.84 and negative self-rated health (p < .001), PR 4.47 were associated with LSS. These results were obtained after adjustments by the variables age and presence of chronic diseases. The associations established herein could have been mostly related to fragilities of the Brazilian health system, and can contribute to the planning of actions directed to the studied population.
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Affiliation(s)
| | | | | | - Ayrton Martins Holanda
- Department of Public Health, Federal University of Rio Grande do Norte (UFRN) , Natal, Northeast Brazil
| | - Mariane Albuquerque Reis
- Department of Public Health, Federal University of Rio Grande do Norte (UFRN) , Natal, Northeast Brazil
| | | | | | - Javier Jerez-Roig
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC) , Vic, Spain.,Department of Collective Health, Graduate Program in Collective Health, Federal University of Rio Grande do Norte (UFRN) , Natal, Northeast Brazil
| | - Dyego Leandro Bezerra de Souza
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC) , Vic, Spain.,Department of Collective Health, Graduate Program in Collective Health, Federal University of Rio Grande do Norte (UFRN) , Natal, Northeast Brazil
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Bernardes GM, Mambrini JVDM, Lima-Costa MF, Peixoto SV. [Multimorbidity profile associated with disability among the elderly living in the Metropolitan Region of Belo Horizonte, Brazil]. CIENCIA & SAUDE COLETIVA 2019; 24:1853-1864. [PMID: 31166518 DOI: 10.1590/1413-81232018245.17192017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/03/2017] [Indexed: 11/22/2022] Open
Abstract
The scope of this paper was to investigate the associations of disability in three domains (BADL, IADL and mobility) with cardiovascular diseases, diabetes and multimorbidity profile, among the elderly living in the Metropolitan Region of Belo Horizonte (MRBH). A cross-sectional study was conducted with a representative sample of 2,172 elderly persons (60 years and over). Disability, for each domain (BADL, IADL and mobility), was assessed as reporting great difficulty or need for help to perform at least one activity among those investigated, and self-reported diseases included arterial hypertension, myocardial infarction or angina, stroke, diabetes, and combinations of these diseases. Adjusted Poisson regression was used, and the attributable population fraction was also estimated. A major contribution of Cerebral Vascular Accidents (strokes) to disability in all domains was observed, especially BADLs, as well as the presence of infarction or angina in disability in IADLs and mobility, especially when combined with diabetes and hypertension. The multimorbidity profile can be used to identify vulnerable groups, which should be the target of prevention and rehabilitation, reducing the financial and social cost of this event among the elderly.
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Affiliation(s)
- Gabriella Marques Bernardes
- Programa de Pós-Graduação em Saúde Coletiva, Instituto René Rachou, Fiocruz. Av. Augusto de Lima 1715, Barro Preto. 30190-009 Belo Horizonte Brasil.
| | - Juliana Vaz de Melo Mambrini
- Programa de Pós-Graduação em Saúde Coletiva, Instituto René Rachou, Fiocruz. Av. Augusto de Lima 1715, Barro Preto. 30190-009 Belo Horizonte Brasil. .,Instituto René Rachou, Fiocruz. Belo Horizonte MG Brasil
| | - Maria Fernanda Lima-Costa
- Programa de Pós-Graduação em Saúde Coletiva, Instituto René Rachou, Fiocruz. Av. Augusto de Lima 1715, Barro Preto. 30190-009 Belo Horizonte Brasil. .,Instituto René Rachou, Fiocruz. Belo Horizonte MG Brasil
| | - Sérgio Viana Peixoto
- Programa de Pós-Graduação em Saúde Coletiva, Instituto René Rachou, Fiocruz. Av. Augusto de Lima 1715, Barro Preto. 30190-009 Belo Horizonte Brasil. .,Instituto René Rachou, Fiocruz. Belo Horizonte MG Brasil.,Escola de Enfermagem, Universidade Federal de Minas Gerais. Belo Horizonte MG Brasil
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Brown L, Bryant C, Brown V, Bei B, Judd F. Self-compassion, attitudes to ageing and indicators of health and well-being among midlife women. Aging Ment Health 2016; 20:1035-43. [PMID: 26147901 DOI: 10.1080/13607863.2015.1060946] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Attitudes to ageing exert a powerful influence on health and well-being, yet surprisingly little research has examined factors that contribute to the formation of these attitudes. The aim of this study was to consider the potential role of self-compassion in predicting attitudes to ageing, which in turn contribute to positive and negative mental well-being and self-reported health. METHOD This was a cross-sectional study using data from 517 midlife women aged between 40 and 60. Structural equation modelling was used to examine the relationships between self-compassion, three facets of attitudes to ageing and well-being outcomes. RESULTS Together, self-compassion and attitudes to ageing explained between 36% and 67% of the variance in well-being. Self-compassion was a strong predictor of attitudes towards psychosocial loss, physical change and psychological growth (β range: .22-.51). Furthermore, the relationship between self-compassion and well-being outcomes was partially mediated by attitudes to physical change. CONCLUSION Self-compassion may be a modifiable internal resource to promote healthy attitudes to ageing in midlife, when ageing becomes personally relevant. Moreover, attitudes towards physical change may help explain how self-compassion promotes well-being among midlife women.
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Affiliation(s)
- Lydia Brown
- a School of Psychological Sciences, Redmond Barry Building , University of Melbourne , Melbourne , Australia
| | - Christina Bryant
- a School of Psychological Sciences, Redmond Barry Building , University of Melbourne , Melbourne , Australia.,b Centre for Women's Mental Health , Royal Women's Hospital , Parkville , Australia
| | - Valerie Brown
- a School of Psychological Sciences, Redmond Barry Building , University of Melbourne , Melbourne , Australia
| | - Bei Bei
- b Centre for Women's Mental Health , Royal Women's Hospital , Parkville , Australia.,c Department of Psychiatry , University of Melbourne, Melbuorne , Australia.,d School of Psychological Sciences , Monash University, Clayton , Australia
| | - Fiona Judd
- c Department of Psychiatry , University of Melbourne, Melbuorne , Australia.,d School of Psychological Sciences , Monash University, Clayton , Australia
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Sorpreso ICE, Soares Júnior JM, Fonseca AMD, Baracat EC. Female aging. Rev Assoc Med Bras (1992) 2016; 61:553-6. [PMID: 26841166 DOI: 10.1590/1806-9282.61.06.553] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 10/23/2015] [Indexed: 12/21/2022] Open
Abstract
Female aging is a process that involves hypoestrogenism time, the individual impact on each woman, and what we can do as experts to reduce morbidity and provide quality of life. This natural process in the female life cycle has been of concern to women after menopause. Changes in different biophysical and psychosocial aspects, and their individual experiences, have repercussions on the lives of patients seeking specialized and multidisciplinary support to reduce the harmful effects of prolonged hypoestrogenism. Overweight and obesity, inadequate living habits and the presence of multi-morbidities cause damage to the quality of life and impact the functional capacity. Behavioral prescription and hormone therapy are among the treatments given to ease symptoms and reduce morbidity. A better understanding of these factors can help identify groups that require more care after menopause.
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Affiliation(s)
- Isabel Cristina Esposito Sorpreso
- Division of Gynecology, Department of Obstetrics and Gynecology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Edmund Chada Baracat
- Division of Gynecology, Department of Obstetrics and Gynecology, FM, USP, São Paulo, SP, Brazil
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