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Tazzeo C, Zucchelli A, Vetrano DL, Demurtas J, Smith L, Schoene D, Sanchez-Rodriguez D, Onder G, Balci C, Bonetti S, Grande G, Torbahn G, Veronese N, Marengoni A. Risk factors for multimorbidity in adulthood: A systematic review. Ageing Res Rev 2023; 91:102039. [PMID: 37647994 DOI: 10.1016/j.arr.2023.102039] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/25/2023] [Accepted: 08/18/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Multimorbidity, the coexistence of multiple chronic diseases in an individual, is highly prevalent and challenging for healthcare systems. However, its risk factors remain poorly understood. OBJECTIVE To systematically review studies reporting multimorbidity risk factors. METHODS A PRISMA-compliant systematic review was conducted, searching electronic databases (MEDLINE, EMBASE, Web of Science, Scopus). Inclusion criteria were studies addressing multimorbidity transitions, trajectories, continuous disease counts, and specific patterns. Non-human studies and participants under 18 were excluded. Associations between risk factors and multimorbidity onset were reported. RESULTS Of 20,806 identified studies, 68 were included, with participants aged 18-105 from 23 countries. Nine risk factor categories were identified, including demographic, socioeconomic, and behavioral factors. Older age, low education, obesity, hypertension, depression, low pysical function were generally positively associated with multimorbidity. Results for factors like smoking, alcohol consumption, and dietary patterns were inconsistent. Study quality was moderate, with 16.2% having low risk of bias. CONCLUSIONS Several risk factors seem to be consistently associated with an increased risk of accumulating chronic diseases over time. However, heterogeneity in settings, exposure and outcome, and baseline health of participants hampers robust conclusions.
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Affiliation(s)
- Clare Tazzeo
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Alberto Zucchelli
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Jacopo Demurtas
- Primary Care Department USL Toscana Sud Est, AFT Orbetello, Italy
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Daniel Schoene
- Friedrich-Alexander University Erlangen-Nürnberg, Institute of Medical Physics, Erlangen, Germany; Leipzig University, Institute of Exercise and Public Health, Leipzig, Germany; Robert-Bosch-Hospital, Department of Clinical Gerontology, Stuttgart, Germany
| | - Dolores Sanchez-Rodriguez
- Geriatrics Department, Brugmann university hospital, Université Libre de Bruxelles, Brussels, Belgium; WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium; Geriatrics Department, Parc Salut Mar, Rehabilitation Research Group, Hospital Del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Graziano Onder
- Department of Geriatric and Orthopedic sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Cafer Balci
- Hacettepe University Faculty of Medicine Division of Geriatric Medicine, Turkey
| | - Silvia Bonetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giulia Grande
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Gabriel Torbahn
- Department of Pediatrics, Paracelsus Medical University, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität Nürnberg, Nuremberg, Germany; Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria; Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Nicola Veronese
- Department of Internal Medicine, Geriatrics Section, University of Palermo, Palermo, Italy
| | - Alessandra Marengoni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Tan MMC, Prina AM, Muniz-Terrera G, Mohan D, Ismail R, Assefa E, Keinert AÁM, Kassim Z, Allotey P, Reidpath D, Su TT. Prevalence of and factors associated with multimorbidity among 18 101 adults in the South East Asia Community Observatory Health and Demographic Surveillance System in Malaysia: a population-based, cross-sectional study of the MUTUAL consortium. BMJ Open 2022; 12:e068172. [PMID: 36564121 PMCID: PMC9791377 DOI: 10.1136/bmjopen-2022-068172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To assess the prevalence and factors associated with multimorbidity in a community-dwelling general adult population on a large Health and Demographic Surveillance System (HDSS) scale. DESIGN Population-based cross-sectional study. SETTING South East Asia Community Observatory HDSS site in Malaysia. PARTICIPANTS Of 45 246 participants recruited from 13 431 households, 18 101 eligible adults aged 18-97 years (mean age 47 years, 55.6% female) were included. MAIN OUTCOME MEASURES The main outcome was prevalence of multimorbidity. Multimorbidity was defined as the coexistence of two or more chronic conditions per individual. A total of 13 chronic diseases were selected and were further classified into 11 medical conditions to account for multimorbidity. The conditions were heart disease, stroke, diabetes mellitus, hypertension, chronic kidney disease, musculoskeletal disorder, obesity, asthma, vision problem, hearing problem and physical mobility problem. Risk factors for multimorbidity were also analysed. RESULTS Of the study cohort, 28.5% people lived with multimorbidity. The individual prevalence of the chronic conditions ranged from 1.0% to 24.7%, with musculoskeletal disorder (24.7%), obesity (20.7%) and hypertension (18.4%) as the most prevalent chronic conditions. The number of chronic conditions increased linearly with age (p<0.001). In the logistic regression model, multimorbidity is associated with female sex (adjusted OR 1.28, 95% CI 1.17 to 1.40, p<0.001), education levels (primary education compared with no education: adjusted OR 0.63, 95% CI 0.53 to 0.74; secondary education: adjusted OR 0.60, 95% CI 0.51 to 0.70; tertiary education: adjusted OR 0.65, 95% CI 0.54 to 0.80; p<0.001) and employment status (working adults compared with retirees: adjusted OR 0.70, 95% CI 0.60 to 0.82, p<0.001), in addition to age (adjusted OR 1.05, 95% CI 1.05 to 1.05, p<0.001). CONCLUSIONS The current single-disease services in primary and secondary care should be accompanied by strategies to address complexities associated with multimorbidity, taking into account the factors associated with multimorbidity identified. Future research is needed to identify the most commonly occurring clusters of chronic diseases and their risk factors to develop more efficient and effective multimorbidity prevention and treatment strategies.
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Affiliation(s)
- Michelle M C Tan
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Victorian Heart Institute, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - A Matthew Prina
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Graciela Muniz-Terrera
- Edinburgh Dementia Prevention, University of Edinburgh and Western General Hospital, Scotland, UK
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, USA
| | - Devi Mohan
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Sunway City, Selangor, Malaysia
| | - Roshidi Ismail
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Sunway City, Selangor, Malaysia
| | - Esubalew Assefa
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Economics, College of Business and Economics, Jimma University, Jimma, Ethiopia
| | - Ana Á M Keinert
- Departamento de Psiquiatria e Psicologia Médica, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Zaid Kassim
- District Health Office Segamat, Ministry of Health Malaysia, Segamat, Johor, Malaysia
| | - Pascale Allotey
- Department of Sexual and Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland
- International Institute for Global Health, United Nations University, Cheras, Kuala Lumpur, Malaysia
| | - Daniel Reidpath
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Sunway City, Selangor, Malaysia
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Tin Tin Su
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Sunway City, Selangor, Malaysia
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Sunway City, Selangor, Malaysia
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Seiler N, Ng M, Dawud M, Das S, Ooi SH, Waterdrinker A. Demographic and clinical factors associated with psychiatric inpatient admissions during the COVID-19 pandemic. Australas Psychiatry 2022; 30:229-234. [PMID: 34866418 PMCID: PMC8990577 DOI: 10.1177/10398562211052903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The COVID-19 pandemic may cause a major mental health impact. We aimed to identify demographic or clinical factors associated with psychiatric admissions where COVID-19 was attributed to contribute to mental state, compared to admissions which did not. METHODS A retrospective cohort study was undertaken of inpatients admitted to Northern Psychiatric Unit 1, Northern Hospital in Melbourne, Victoria, Australia during 27/02/2020 to 08/07/2020. Data were extracted for participants who identified COVID-19 as a stressor compared to participants who did not. Fisher's exact test and Mann-Whitley rank sum test were used. RESULTS Thirty six of 242 inpatients reported the COVID-19 pandemic contributed to mental ill health and subsequent admission. Reasons given included social isolation, generalized distress about the pandemic, barriers to support services, disruption to daily routine, impact on employment, media coverage, re-traumatization, cancelled ECT sessions, loss of loved ones, and increased drug use during the lockdown. Chronic medical conditions or psychiatric multimorbidity were positively associated and smoking status was negatively associated with reporting the COVID-19 pandemic as a contributor to mental ill health. CONCLUSION Screening and identifying vulnerable populations during and after the global disaster is vital for timely and appropriate interventions to reduce the impact of the pandemic worldwide.
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Affiliation(s)
- Natalie Seiler
- Northern Hospital, Northern Health, Melbourne, Victoria, Australia
| | - Matthew Ng
- Northern Hospital, Northern Health, Melbourne, Victoria, Australia
| | - Midya Dawud
- Northern Hospital, Northern Health, Melbourne, Victoria, Australia
| | - Subhash Das
- Northern Area Mental Health Service, Melbourne Health, Melbourne, Victoria, Australia
| | - Shu-Haur Ooi
- Northern Hospital, Northern Health, Melbourne, Victoria, Australia
| | - Astrid Waterdrinker
- Northern Area Mental Health Service, Melbourne Health, Melbourne, Victoria, Australia
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Fleitas Alfonzo L, King T, You E, Contreras-Suarez D, Zulkelfi S, Singh A. Theoretical explanations for socioeconomic inequalities in multimorbidity: a scoping review. BMJ Open 2022; 12:e055264. [PMID: 35197348 PMCID: PMC8882654 DOI: 10.1136/bmjopen-2021-055264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 01/27/2022] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Ludmila Fleitas Alfonzo
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tania King
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Emily You
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | - Diana Contreras-Suarez
- Melbourne Institute: Applied Economic and Social Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Syafiqah Zulkelfi
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ankur Singh
- Centre of Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Nascimento-Souza MA, Firmo JOA, Souza Júnior PRBD, Peixoto SV. Fatores sociodemográficos e de área de residência associados à multimorbidade: resultados do Projeto Saúde Brumadinho. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2022. [DOI: 10.1590/1980-549720220006.supl.2.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
RESUMO Objetivo: Avaliar a prevalência de multimorbidade e os fatores sociodemográficos e de área de residência associados a essa condição entre adultos residentes em Brumadinho, Minas Gerais. Métodos: Estudo transversal realizado a partir dos dados da linha de base do Projeto Saúde Brumadinho, que foi conduzida no ano de 2021 e incluiu 2.777 indivíduos com 18 anos ou mais. A variável desfecho foi a multimorbidade, definida pela existência de duas ou mais entre 20 doenças crônicas. As variáveis exploratórias foram sexo, faixa etária, escolaridade, cor da pele e área de residência. A associação entre as variáveis exploratórias e a multimorbidade foi avaliada pela regressão logística. Resultados: A prevalência de multimorbidade foi de 53,8% (IC95% 50,6–56,9). Maior chance de multimorbidade foi encontrada entre as mulheres (ORajustado=2,5; IC95% 1,9–3,2), nos participantes com idade entre 40 e 59 (ORajustado= 2,8; IC95% 1,8–4,3) ou com 60 anos ou mais (ORajustado= 7,9; IC95% 4,7–13,4) e nos residentes em áreas que foram diretamente atingidas pelo rompimento da barragem (ORajustado=1,6; IC95% 1,3–2,0). Conclusão: A elevada carga de multimorbidade sobre a população de Brumadinho requer medidas preventivas eficazes e ações no âmbito populacional, mas principalmente entre aqueles grupos mais vulneráveis, ou seja, mulheres, indivíduos de meia-idade e idosos bem como aqueles diretamente atingidos pelo rompimento da barragem, além de oferta oportuna de cuidados de saúde, de modo a reverter esse quadro apresentado.
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Nascimento-Souza MA, Firmo JOA, Souza Júnior PRBD, Peixoto SV. Sociodemographic and residential factors associated with multimorbity: results of Brumadinho Health Project. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2022; 25:e220006. [DOI: 10.1590/1980-549720220006.supl.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/18/2022] [Indexed: 11/06/2022] Open
Abstract
ABSTRACT Objective: To evaluate the prevalence of multimorbidity and sociodemographic and residential factors associated with this condition among adults living in Brumadinho, Minas Gerais. Methods: Cross-sectional study with baseline data from the Brumadinho Health Project, conducted in 2021 and comprising 2,777 individuals aged 18 years and over. The outcome variable was multimorbidity, defined by the existence of two or more of 20 chronic diseases. The exploratory variables were sex, age group, educational level, skin color and area of residence according to the dam failure. The association between exploratory variables and multimorbidity was assessed by logistic regression. Results: The prevalence of multimorbidity was 53.8% (95%CI 50.6–56.9). A greater chance of multimorbidity was found among women (adjusted OR=2.5; 95%CI 1.9–3.2), in participants aged between 40 and 59 (adjusted OR=2.8; 95%CI 1.8–4.3) or 60 years and older (adjusted OR=7.9; 95%CI 4.7–13.4) and in residents of the areas that were directly affected by the dam failure (adjusted OR=1.6; 95%CI 1.3–2.0). Conclusion: The burden of multimorbidity on the population of Brumadinho requires effective preventive measures and actions to the whole population, but mainly to the most vulnerable groups, that is, women, middle-aged and older individuals, and those directly affected by the dam failure, in addition to a timely provision of health care to reverse this situation.
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Kudesia P, Salimarouny B, Stanley M, Fortin M, Stewart M, Terry A, Ryan BL. The incidence of multimorbidity and patterns in accumulation of chronic conditions: A systematic review. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2021; 11:26335565211032880. [PMID: 34350127 PMCID: PMC8287424 DOI: 10.1177/26335565211032880] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/24/2021] [Indexed: 12/17/2022]
Abstract
Multimorbidity, the presence of 1+ chronic condition in an individual, remains one of the greatest challenges to health on a global scale. Although the prevalence of multimorbidity has been well-established, its incidence is not fully understood. This systematic review determined the incidence of multimorbidity across the lifespan; the order in which chronic conditions accumulate to result in multimorbidity; and cataloged methods used to determine and report accumulation of chronic conditions resulting in multimorbidity. Studies were identified by searching MEDLINE, Embase, CINAHL, and Cochrane electronic databases. Two independent reviewers evaluated studies for inclusion and performed quality assessments. Of 36 included studies, there was high heterogeneity in study design and operational definitions of multimorbidity. Studies reporting incidence (n = 32) reported a median incidence rate of 30.7 per 1,000 person-years (IQR 39.5 per 1,000 person-years) and a median cumulative incidence of 2.8% (IQR 28.7%). Incidence was notably higher for persons with older age and 1+ chronic conditions at baseline. Studies reporting patterns in accumulation of chronic conditions (n = 5) reported hypertensive and heart diseases, and diabetes, as among the common starting conditions resulting in later multimorbidity. Methods used to discern patterns were highly heterogenous, ranging from the use of latent growth trajectories to divisive cluster analyses, and presentation using alluvial plots to cluster trajectories. Studies reporting the incidence of multimorbidity and patterns in accumulation of chronic conditions vary greatly in study designs and definitions used. To allow for more accurate estimations and comparison, studies must be transparent and consistent in operational definitions of multimorbidity applied.
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Affiliation(s)
- Prtha Kudesia
- Schulich Interfaculty Program in Public Health, University of Western
Ontario, London, Ontario, Canada
| | - Banafsheh Salimarouny
- Schulich Interfaculty Program in Public Health, University of Western
Ontario, London, Ontario, Canada
| | - Meagan Stanley
- Allyn & Betty Taylor Library, University of Western
Ontario, London, Ontario, Canada
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Moira Stewart
- Centre for Studies in Family Medicine & Department of Family
Medicine, Schulich School of Medicine & Dentistry, University of Western
Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of
Medicine & Dentistry, University of Western Ontario, London, Ontario,
Canada
| | - Amanda Terry
- Schulich Interfaculty Program in Public Health, University of Western
Ontario, London, Ontario, Canada
- Centre for Studies in Family Medicine & Department of Family
Medicine, Schulich School of Medicine & Dentistry, University of Western
Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of
Medicine & Dentistry, University of Western Ontario, London, Ontario,
Canada
| | - Bridget L Ryan
- Centre for Studies in Family Medicine & Department of Family
Medicine, Schulich School of Medicine & Dentistry, University of Western
Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of
Medicine & Dentistry, University of Western Ontario, London, Ontario,
Canada
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Abebe F, Schneider M, Asrat B, Ambaw F. Multimorbidity of chronic non-communicable diseases in low- and middle-income countries: A scoping review. JOURNAL OF COMORBIDITY 2020; 10:2235042X20961919. [PMID: 33117722 PMCID: PMC7573723 DOI: 10.1177/2235042x20961919] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/07/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Multimorbidity is rising in low- and middle-income countries (LMICs). However, the evidence on its epidemiology from LMICs settings is limited and the available literature has not been synthesized as yet. OBJECTIVES To review the available evidence on the epidemiology of multimorbidity in LMICs. METHODS PubMed, Scopus, PsycINFO and Grey literature databases were searched. We followed the PRISMA-ScR reporting guideline. RESULTS Of 33, 110 articles retrieved, 76 studies were eligible for the epidemiology of multimorbidity. Of these 76 studies, 66 (86.8%) were individual country studies. Fifty-two (78.8%) of which were confined to only six middle-income countries: Brazil, China, South Africa, India, Mexico and Iran. The majority (n = 68, 89.5%) of the studies were crosssectional in nature. The sample size varied from 103 to 242, 952. The largest proportion (n = 33, 43.4%) of the studies enrolled adults. Marked variations existed in defining and measuring multimorbidity. The prevalence of multimorbidity in LMICs ranged from 3.2% to 90.5%. CONCLUSION AND RECOMMENDATIONS Studies on the epidemiology of multimorbidity in LMICs are limited and the available ones are concentrated in few countries. Despite variations in measurement and definition, studies consistently reported high prevalence of multimorbidity. Further research is urgently required to better understand the epidemiology of multimorbidity and define the best possible interventions to improve outcomes of patients with multimorbidity in LMICs.
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Affiliation(s)
- Fantu Abebe
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Jhpiego Corporation, Ethiopia Country Office, Bahir Dar, Ethiopia
| | - Marguerite Schneider
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Biksegn Asrat
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Fentie Ambaw
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Physical multimorbidity and subjective cognitive complaints among adults in the United Kingdom: a cross-sectional community-based study. Sci Rep 2019; 9:12417. [PMID: 31455875 PMCID: PMC6711967 DOI: 10.1038/s41598-019-48894-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 08/14/2019] [Indexed: 02/06/2023] Open
Abstract
Our goal was to examine the association between physical multimorbidity and subjective cognitive complaints (SCC) using UK nationally representative cross-sectional community-based data, and to quantify the extent to which a broad range of mainly psychological and behavioral factors explain this relationship. Data from the 2007 Adult Psychiatric Morbidity Survey were analyzed [N = 7399 adults, mean (SD) age 46.3 (18.6) years, 48.6% men]. Multimorbidity was defined as ≥2 physical diseases. SCC included two different cognitive constructs: subjective concentration and memory complaints. Multivariable logistic regression and mediation analyses were conducted. Multimorbidity was associated with higher prevalence of subjective concentration (30.7% vs. 17.3%) and memory complaints (42.8% vs. 22.9%) compared to no multimorbidity. In the regression model adjusted for sociodemographics, multimorbidity was associated with subjective concentration (OR = 2.58; 95% CI = 2.25–2.96) and memory complaints (OR = 2.34; 95% CI = 2.08–2.62). Sleep problems, stressful life events and any anxiety disorder explained 21–23%, 20–22% and 14–15% of the multimorbidity-SCC association, respectively. Multimorbidity and SCC are highly co-morbid. The utility of SCC screening in identifying individuals at high risk for future cognitive decline among individuals with multimorbidity should be assessed.
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Johnston MC, Black C, Mercer SW, Prescott GJ, Crilly MA. Impact of educational attainment on the association between social class at birth and multimorbidity in middle age in the Aberdeen Children of the 1950s cohort study. BMJ Open 2019; 9:e024048. [PMID: 30696675 PMCID: PMC6352766 DOI: 10.1136/bmjopen-2018-024048] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Multimorbidity (the coexistence of two or more health conditions) is increasingly prevalent. No long-term cohort study has examined the impact of contemporaneously measured birth social class along with educational attainment on adult self-reported multimorbidity. We investigated the impact of educational attainment on the relationship between social class at birth and adult self-reported multimorbidity in the Aberdeen Children of the 1950s (ACONF) cohort. METHODS A prospective cohort study using the ACONF cohort. ACONF included 12 150 individuals born in Aberdeen, Scotland 1950-1956. In 2001, 7184 (64%) responded to a questionnaire providing information including self-reported morbidity and educational attainment. The exposure was father's social class at birth from birth records and the outcome was self-reported multimorbidity.Logistic regression assessed the association between social class and multimorbidity with adjustment for gender, then by educational attainment and finally by childhood cognition and secondary school type. ORs and 95% CIs were presented. RESULTS Of 7184 individuals (mean age 48, 52% female), 5.4% reported multimorbidity. Birth social class was associated with adult multimorbidity. For example, the OR of multimorbidity adjusted by gender was 0.62 (95% CI 0.39 to 1.00) in the highest social class group (I/II) in relation to the reference group (III (manual)) and was 1.85 (95% CI 1.19 to 2.88) in the lowest social class group. This was partially attenuated in all social class categories by educational attainment, for example, the OR was 0.74 (95% CI 0.45 to 1.21) in group I/II following adjustment. CONCLUSION Lower social class at birth was associated with developing multimorbidity in middle age. This was partially mediated by educational attainment and future research should consider identifying the other explanatory variables. The results are relevant to researchers and to those aiming to reduce the impact of multimorbidity.
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Affiliation(s)
- Marjorie C Johnston
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, UK
| | - Corrinda Black
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, UK
- Public Health Directorate, NHS Grampian, Aberdeen, UK
| | - Stewart W Mercer
- The Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Gordon J Prescott
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Michael A Crilly
- Public Health Directorate, NHS Grampian, Aberdeen, UK
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Melo LAD, Braga LDC, Leite FPP, Bittar BF, Oséas JMDF, Lima KCD. Factors associated with multimorbidity in the elderly: an integrative literature review. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2019. [DOI: 10.1590/1981-22562019022.180154] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Abstract Objective: The objective of the present study was to identify factors associated with multimorbidity in the elderly through an integrative literature review. Method: The “Cochrane Library”, “MEDLINE”, “Web of Science”, “Scopus” and “LILACS” databases were used, as well as the “SciELO” virtual library and the electronic search engine “Google Academic”. The following search terms were applied: “multimorbidity”; “multi-morbidity”; “comorbidity; “multiple diseases”; “elderly”; “major adults”, “older people”, “older persons”, “aged”, “associated factors”, “correlated factors”, “socioeconomic factors” and “demographic factors.” The inclusion criterion was that the object of the study was the elderly population with multimorbidity. Studies in which multimorbidity was not the dependent variable were excluded. Results: a total of seven articles were included in this review. A prevalence of multimorbidity in the elderly ranging from 30.7% to 57% was found. The associated factors were smoking, alcohol consumption, lived in rural areas, low levels of schooling, the female gender, older elderly persons and not living with children. In the majority of articles a low level of family income was also associated with multimorbidity. Conclusion: The results suggest that multimorbidity in the elderly is a common condition and that it is influenced by socioeconomic and demographic factors, lifestyle and family structure.
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Xu X, Mishra GD, Jones M. Mapping the global research landscape and knowledge gaps on multimorbidity: a bibliometric study. J Glob Health 2018; 7:010414. [PMID: 28685036 PMCID: PMC5475311 DOI: 10.7189/jogh.07.010414] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background To summarize global research trends and activities on multimorbidity; then to assess the knowledge gaps and to identify implications for knowledge exchange between high income countries (HICs) and low– and middle– income countries (LMICs). Methods A comprehensive search was conducted to identify research publications on multimorbidity in the Web of ScienceTM, as well as diabetes, depression, hypertension, and Chronic Obstructive Pulmonary Disease (COPD). The time frame for the search was from 1900 to June, 2016. Information (such as publication date, subject category, author, country of origin, title, abstract, and keywords) were extracted and the full texts were obtained for the co–citation analysis. Data were linked with the life expectancy at birth (years) and Gross National Income (GNI). Co–citation and hierarchal clustering analysis was used to map the trends and research networks with CiteSpace II (JAVA freeware, copyright Chaomei Chen, http://cluster.cis.drexel.edu/~cchen/citespace/). Findings We identified 2864 relevant publications as at June 2016, with the first paper on this topic indexed in 1974 from Germany, but 80% were published after 2010. Further analysis yielded two knowledge gaps: (1) compared with single conditions (diabetes, hypertension, depression, and COPD), there is a mismatch between the high prevalence of multimorbidity and its research outputs (ratio of articles on multimorbidity vs other four single conditions is 1:13–150); (2) although a total of 76 countries have contributed to this research area, only 5% of research originated from LMICs where 73% of non–communicable disease (NCD) related deaths had occurred. Additional analysis showed the median year of first publication occurred 15 years later in the LMICs compared with HICs (2010 vs 1995); and longer life expectancy was associated with exponentially higher publication outputs (Pearson correlation coefficient r = 0.95) at the global level. The life expectancy at the median year (1994) of first publication was 66.1, with the gap between LMICs and HICs 7.9 (68.4 vs 76.3). Conclusions This study confirms substantial knowledge gaps in the research agenda on multimorbidity, with input urgently needed to move us forward worldwide, especially for and in LMICs. There is the possibility that LMICs can learn from and collaborate with HICs in this area.
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Affiliation(s)
- Xiaolin Xu
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland, Brisbane, Australia
| | - Gita D Mishra
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland, Brisbane, Australia
| | - Mark Jones
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland, Brisbane, Australia
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Turabián JL, Pérez Franco B. [A way of helping "Mr. Minotaur" and "Ms. Ariadne" to exit from the multiple morbidity labyrinth: the "master problems"]. Semergen 2015; 42:38-48. [PMID: 25817854 DOI: 10.1016/j.semerg.2015.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 02/07/2015] [Accepted: 02/09/2015] [Indexed: 11/24/2022]
Abstract
Multiple morbidity seems to be "infinite" and so is not easy to make useful decisions. A new concept is introduced: the "master problems", as a qualitative method to facilitate the exit from this maze of multiple morbidity. Metaphors from the art world have been used to teach this concept. These "master problems" generally remain hidden and can only "unravel" between the interstices of multiple morbidity, when the details of the system that defines the problem are explained. A problem with "energy" or a "master problem" is complex, multiple and dramatic or theatrical--everything in the clinical history history make us look into that particular question. It is what gives us a blow to the stomach, which causes our hearts to beat faster, that moves us on many levels, which has a high "density of emotions", human elements, social symbols, and opens solutions in a patient.
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Affiliation(s)
- J L Turabián
- Medicina de Familia y Comunitaria, Centro de Salud Polígono Industrial, Toledo, España.
| | - B Pérez Franco
- Medicina de Familia y Comunitaria, Centro de Salud La Estación, Talavera de la Reina, Toledo, España
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Disparities in multiple chronic conditions within populations. JOURNAL OF COMORBIDITY 2013; 3:45-50. [PMID: 29090147 PMCID: PMC5636025 DOI: 10.15256/joc.2013.3.24] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 11/26/2013] [Indexed: 11/12/2022]
Abstract
Disadvantaged populations are disproportionately affected by multiple chronic conditions (MCCs), yet few studies examine the prevalence, outcomes, or effectiveness of MCC interventions in minority and socioeconomically deprived individuals and populations. An important first step in understanding MCCs, not only in such diverse population groups, but also in the general population as a whole, is to broaden the definition and scope of MCC measurement, to encompass more than the simple additive effect of clinical conditions, and to include a wide range of health and health-related aspects that interact and make up the full spectrum of multimorbidity. Only with the use of a comprehensive MCC measurement can some of the differences between the disadvantaged populations be adequately detected. Better understanding of the disparities in access to high quality health and healthcare for persons with MCCs can help guide policy and practice aimed at the prevention and amelioration of the effects of MCCs among disadvantaged groups. Indeed, disparity in MCC populations has been identified as a key goal of the U.S. Department of Health and Human Services’ Strategic Framework on MCCs. The aim of the present paper is to describe current knowledge on disparities in the population of persons with MCCs and to guide efforts for the prevention and management of MCCs in disadvantaged populations. Journal of Comorbidity 2013;3:45–50
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Shadmi E. Multimorbidity and equity in health. Int J Equity Health 2013; 12:59. [PMID: 23961952 PMCID: PMC3846622 DOI: 10.1186/1475-9276-12-59] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 08/11/2013] [Indexed: 11/21/2022] Open
Affiliation(s)
- Efrat Shadmi
- Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Haifa 31905, Israel.
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