Examine the association between key determinants identified by the chronic disease indicator framework and multimorbidity by rural and urban settings

Determinants of self-reported chronic disease diagnoses among older persons in South Africa

BACKGROUND

 Chronic diseases tend to affect the quality of life for older persons worldwide, especially in resource-constrained developing countries. Chronic diseases contribute to a large number of deaths among the population of South Africa.

AIM

 This study examines the determinants of self-reported chronic disease diagnoses among older persons in South Africa.

SETTING

 The study setting was South Africa.

METHODS

 Cross-sectional data from the 2019 South Africa General Household Survey were analysed (n [weighted] = 4 887 334). We fitted a binary logistic regression model to determine the relationship between socio-demographic factors and being diagnosed with self-reported chronic diseases.

RESULTS

 We found that at least 5 in 10 older persons were diagnosed with self-reported chronic disease. The bivariate findings showed that age, population group, sex, marital status, level of education, disability status, household composition and province were significantly associated with self-reported chronic disease diagnoses. At the multivariate level, we found that age, sex, population group, marital status, educational level, disability status, household wealth status, household composition and province were key predictors of self-reported chronic disease diagnoses.

CONCLUSION

 We found that various factors were key determinants of being diagnosed with self-reported chronic diseases. This study offers important insights into the main correlations between older adults and self-reported chronic illness diagnoses. More study is required on the health of the elderly as it will help direct policy discussions and improve the development of health policies about the elderly.Contribution: This study highlights the need for a better understanding of, and continued research into, the determinants health among older populations to guide future healthcare strategies.

Chronic conditions and depressive symptoms in middle-aged and older Chinese adults: Roles of perceived social support and area of residence

BACKGROUND

Many studies have shown that having noncommunicable chronic diseases (NCDs) is strongly associated with depressive symptoms in elderly people; however, the mechanisms of this association are not fully understood. This study aims to investigate whether perceived social support (PSS) mediates the effect of NCDs on depressive symptoms and whether these relationships differ depending on where middle-aged and elderly people live.

METHODS

The study population was from the psychology and behavior investigation of Chinese residents (PBICR). A total of 8732 people aged 45 and older were included in the hypothetical modulated model. Perceived Social Support Scale (PSSS) and Patient Health Questionnaire-9 (PHQ-9) were used to evaluate PSS and depressive symptoms.

RESULTS

NCDs were positively related to depressive symptoms (β = 0.81, p < 0.01) and indirectly mediated through PSS (β = 0.08). Residency moderated the relationship between NCDs and PSS (β = -0.16, p < 0.01) and between NCDs and depressive symptoms (β = 0.29, p < 0.01). Specifically, the effect of NCDs on PSS and depressive symptoms was greater in rural middle-aged and older adults.

CONCLUSIONS

NCDs raise the risk of depressive symptoms in middle-aged and older Chinese, with PSS playing a partially protective role. In addition, the area of residence moderated the connection between the number of NCDs and PSS, NCDs, and depressive symptoms in middle-aged and older adults.

Estimate of the prevalence of subjects with chronic diseases in a province of Northern Italy: a retrospective study based on administrative databases

OBJECTIVE

To find a definition of chronic disease based on literature review and to estimate the population-based prevalence rate of chronicity in a province in Northern Italy.

DESIGN

Retrospective observational study based on administrative databases.

DATA SOURCES/SETTING

Archives of the National Health Service that contain demographic and administrative information linked with the archives of ticket exemptions (2000-2019), the hospital discharge and drug prescriptions (2016-2019).

PARTICIPANTS

Subjects who lived in Vercelli Local Health Authority, a Northern Italian province (Piedmont region), and were alive in December 2019.

MAIN OUTCOME MEASURES

Prevalence of subjects with at least one chronic disease identified by administrative sources and stratification of population according to the number of comorbidities. The pathologies considered were: chronic ischaemic heart disease, congestive heart failure, cardiac arrhythmias, hypertension, stroke, neoplasm, asthma, chronic obstructive pulmonary disease, diabetes, thyroid disorders, osteoporosis, rheumatoid arthritis, chronic kidney disease, dementia, autism spectrum disorder, depression, schizophrenia, hepatitis, HIV and substance use disorders.

RESULTS

Our target population was about 164 344 subjects. The overall prevalence of subjects with at least one chronic condition was 21.43% (n=35 212): 19 541 were female and 15 671 were male with a raw prevalence of 22.96% and 19.77%, respectively. The overall prevalence increases with age until 85 years old, then a decrease is observed. Moreover, 16.39% had only one pathology, 4.30% two diseases and 0.74% had a more complex clinical condition (more than three diseases).

CONCLUSIONS

Despite the difficulty of having a unique definition of chronic disease, the prevalence obtained was coherent with the estimates reported by other national surveillance systems such as Passi and Passi d'Argento. Underestimates were observed when international comparisons were done; however, when we used less stringent definitions of chronic diseases, similar results were obtained.

Leisure and Leisure Education as Resources for Rehabilitation Supports for Chronic Condition Self-Management in Rural and Remote Communities

The potential of leisure (enjoyable free time pursuits) to be a resource for chronic condition self-management (CCSM) is well-established. Because leisure pursuits are often self-determined, they have the potential to allow people to not only address self-management goals (e.g., managing symptoms through movements or stress-reducing activities) but meet important psychosocial needs (e.g., affiliation, sense of mastery) as well as support participation in a range of meaningful life situations. In this “Perspective” piece, we advocate for the ways leisure and leisure education can be resources for rehabilitation professionals to support CCSM, especially in rural and remote communities. In particular, we focus on aspects of the Taxonomy of Everyday Self-Management Strategies [TEDSS (1)] to highlight ways that embedding leisure and leisure education into supports for CCSM can strengthen rehabilitation services offered to rural and remote dwelling adults living with chronic conditions. Recognizing the breadth of leisure-related resources available in rural and remote communities, we recommend the following strategies to incorporate a focus on leisure-based self-management within rehabilitation services: (a) enhance the knowledge and capacity of rehabilitation practitioners to support leisure-based CCSM; (b) focus on coordinated leadership, patient navigation, and building multi-sectoral partnerships to better link individuals living with chronic conditions to community services and supports; and (c) educate individuals with chronic conditions and family/carers to develop knowledge, skills, awareness and confidence to use leisure as a self-management resource.

Theoretical explanations for socioeconomic inequalities in multimorbidity: a scoping review

OBJECTIVE

To document socioepidemiological theories used to explain the relationship between socioeconomic disadvantage and multimorbidity.

DESIGN

Scoping review.

METHODS

A search strategy was developed and then applied to multiple electronic databases including Medline, Embase, PsychInfo, Web of Science, Scielo, Applied Social Sciences, ERIC, Humanities Index and Sociological Abstracts. After the selection of studies, data were extracted using a data charting plan. The last search was performed on the 28 September 2021. Extracted data included: study design, country, population subgroups, measures of socioeconomic inequality, assessment of multimorbidity and conclusion on the association between socioeconomic variables and multimorbidity. Included studies were further assessed on their use of theory, type of theories used and context of application. Finally, we conducted a meta-narrative synthesis to summarise the results.

RESULTS

A total of 64 studies were included in the review. Of these, 33 papers included theories as explanations for the association between socioeconomic position and multimorbidity. Within this group, 16 explicitly stated those theories and five tested at least one theory. Behavioural theories (health behaviours) were the most frequently used, followed by materialist (access to health resources) and psychosocial (stress pathways) theories. Most studies used theories as post hoc explanations for their findings or for study rationale. Supportive evidence was found for the role of material, behavioural and life course theories in explaining the relationship between social inequalities and multimorbidity.

CONCLUSION

Given the widely reported social inequalities in multimorbidity and its increasing public health burden, there is a critical gap in evidence on pathways from socioeconomic disadvantage to multimorbidity. Generating evidence of these pathways will guide the development of intervention and public policies to prevent multimorbidity among people living in social disadvantage. Material, behavioural and life course pathways can be targeted to reduce the negative effect of low socioeconomic position on multimorbidity.

eHealth interventions targeting poor diet, alcohol use, tobacco smoking and vaping among disadvantaged youth: A systematic review protocol (Preprint)

Background

Chronic disease burden is higher among disadvantaged populations. Preventing lifestyle risk behaviors such as poor diet, alcohol use, tobacco smoking, and vaping in adolescence is critical for reducing the risk of chronic disease and related harms in adolescence and adulthood. Although eHealth interventions are a promising prevention approach among the general population, it is unclear whether they adequately serve adolescents from disadvantaged backgrounds such as those living in geographically remote or lower socioeconomic areas.

Objective

This is the first systematic review to identify, evaluate, and synthesize evidence for the effectiveness of eHealth interventions targeting adolescents living in geographically remote or lower socioeconomic areas in preventing poor diet, alcohol use, tobacco smoking, and vaping.

Methods

A systematic search will be conducted in 7 electronic databases: the Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PROSPERO, MEDLINE (Ovid), Embase (Ovid), Scopus, and PsycInfo (Ovid). The search will be limited to eHealth-based experimental studies (ie, randomized controlled trials and quasi-experimental studies) targeting diet, alcohol use, tobacco smoking, and vaping among adolescents (aged 10-19 years). Eligible studies will be those reporting on at least one marker of socioeconomic status (eg, social class, household income, parental occupation status, parental education, and family affluence) or geographical remoteness (eg, living in rural, regional, and remote areas, or living outside major metropolitan centers). One reviewer will screen all studies for eligibility, of which 25% will be double-screened. Data will be extracted and summarized in a narrative synthesis. Risk of bias will be assessed using the Cochrane Revised Risk of Bias Tool.

Results

As of December 2021, the title and abstract screening of 3216 articles was completed, and the full-text review was underway. The systematic review is expected to be completed in 2022.

Conclusions

This systematic review will provide an in-depth understanding of effective eHealth interventions targeting poor diet, alcohol use, tobacco smoking, and vaping among adolescents living in geographically remote or lower socioeconomic areas and the factors that contribute to their effectiveness. This in turn will provide critical knowledge to improve future interventions delivered to these populations.

Trial Registration

PROSPERO CRD42021294119; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=294119

International Registered Report Identifier (IRRID)

PRR1-10.2196/35408