1
|
Kwaitana D, Chisoni F, van Breevoort D, Mildestvedt T, Meland E, Bates J, Umar E. Primary healthcare service delivery for older people with progressive multimorbidity in low- and middle-income countries: a systematic review. Trans R Soc Trop Med Hyg 2024; 118:137-147. [PMID: 37795606 DOI: 10.1093/trstmh/trad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/02/2023] [Accepted: 10/01/2023] [Indexed: 10/06/2023] Open
Abstract
Ensuring primary healthcare (PHC) accessibility to older people with multimorbidity is vital in preventing unnecessary health deterioration. However, older people ≥50 y of age in low- and middle-income countries (LMICs) face challenges in effectively accessing and utilizing PHC. A systematic review was conducted adopting the Andersen-Newman theoretical framework for health services utilization to assess evidence on factors that affect access to PHC by older people. This framework predicts that a series of factors (predisposing, enabling and need factors) influence the utilization of health services by people in general. Seven publications were identified and a narrative analytical method revealed limited research in this area. Facilitating factors included family support, closeness to the PHC facility, friendly service providers and improved functional status of the older people. Barriers included long distance and disjointed PHC services, fewer health professionals and a lack of person-centred care. The following needs were identified: increasing the number of health professionals, provision of PHC services under one roof and regular screening services. There is a need for more investment in infrastructure development, coordination of service delivery and capacity building of service providers in LMICs to improve access and utilization of PHC services for older people.
Collapse
Affiliation(s)
| | - Felix Chisoni
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | | | | | - Jane Bates
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Eric Umar
- Kamuzu University of Health Sciences, Blantyre, Malawi
| |
Collapse
|
2
|
Craig A, Mapanga W, Mtintsilana A, Dlamini S, Norris S. Exploring the national prevalence of mental health risk, multimorbidity and the associations thereof: a repeated cross-sectional panel study. Front Public Health 2023; 11:1217699. [PMID: 37920573 PMCID: PMC10619674 DOI: 10.3389/fpubh.2023.1217699] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/27/2023] [Indexed: 11/04/2023] Open
Abstract
Objective and methods South Africans were affected by the COVID-19 pandemic and resultant economic hardships. As a result, mental health within this region may have worsened. Therefore, using large scale nationally representative data, we repeated the cross-sectional panel study to investigate mental health risk post COVID-19 to explore mental health and multimorbidity and to examine the relationship between adverse childhood experiences (ACEs) and comorbid health conditions in South African adults (aged 18 years and older). Results Post-pandemic, 26.2, 17.0, and 14.8% of the South African respondents reported being probably depressed, anxious and had suffered high exposure to early life adversity, respectively. Nationally, the prevalence of mental health across the country remained alarmingly high when compared to Panel 1. The prevalence of multimorbidity (2 or more chronic morbidities) among the South African population was reported at 13.9%, and those with 2 or more morbidities were found to have increased odds of early adversity, irrespective of differing socio-demographics. Furthermore, early adversity was also associated with multimorbidity partly via mental health. Conclusion This repeated cross-sectional national study reiterated that the prevalence of mental health across South African adults aged 18 years and older is widespread. Mental health remains worryingly high post-pandemic where more than a quarter of respondents are probably depressed, nearly one in every five respondents are anxious, and 14.8% reported high exposure ACEs. Public health interventions need to be upscaled with efforts to reduce the incidence of early adversity that may have the ability to lower adverse health outcomes and mental ill-health in adulthood.
Collapse
Affiliation(s)
- Ashleigh Craig
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Witness Mapanga
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Asanda Mtintsilana
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- DSI-NRF Centre of Excellence in Human Development, University of Witwatersrand, Johannesburg, South Africa
| | - Siphiwe Dlamini
- School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Human Development and Health, University of Southampton, Southampton, United Kingdom
| |
Collapse
|
3
|
Zhong Y, Qin G, Xi H, Cai D, Wang Y, Wang T, Gao Y. Prevalence, patterns of multimorbidity and associations with health care utilization among middle-aged and older people in China. BMC Public Health 2023; 23:537. [PMID: 36944960 PMCID: PMC10031889 DOI: 10.1186/s12889-023-15412-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 03/09/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Multimorbidity has become one of the main challenges in health care system. The association between prevalence, patterns of multimorbidity and health care utilization is less often discussed in China. The purpose of this study is to examine this association among Chinese middle-aged and older adults and take into account different sociodemographic, behavioral and health characteristics. Based on this, implications of current evidence and effective intervention on multimorbidity and health care utilization can be identified and put into practice. METHODS The wave 4 in 2018 of the China Health and Retirement Longitudinal Study (CHARLS) was used in the study. Multimorbidity was defined as the co-occurrence of two or more chronic medical condition of a list of fourteen chronic diseases in one person. The presence of chronic diseases was assessed through self-report. Health care utilization include whether the respondents received outpatient service last month and inpatient service in the past year. Latent Class Analysis was conducted to identify the clustering pattern of chronic diseases. Logistic regressions were employed to explore the association between prevalence, patterns of multimorbidity and health care utilization. Analyses were weighted using individual sample weights, adjusted for non-response of individual and household. RESULTS Among 19,559 participants aged 45 and older, 23.10% were aged above 70 years and 52.42% were female. The prevalence of multimorbidity was 56.73%. Four patterns were identified: relatively healthy class, respiratory class, stomach-arthritis class and vascular class. Multimorbid individuals used more outpatient services (OR = 1.89, 95%CI = 1.65-2.17) and more inpatient services (OR = 2.52, 95%CI = 2.22-2.86) compared to their no-multimorbid counterparts. Compared to relatively healthy class, the respondents classified into respiratory class, stomach-arthritis class and vascular class used more outpatient services (OR = 1.90, 95%CI = 1.57-2.30; OR = 2.39, 95%CI = 2.06-2.78; OR = 1.53, 95%CI = 1.32-1.79 respectively) and more inpatient services (OR = 2.19, 95%CI = 1.83-2.62; OR = 2.93, 95%CI = 2.53-3.40; OR = 1.90, 95%CI = 1.65-2.19 respectively). CONCLUSION Our study provided evidence that multimorbidity is high among Chinese older adults and is associated substantially higher health care utilization in China. Four multimorbidity patters were identified. Policy should prioritize improving the management of individuals with multimorbidity to increase healthcare efficiency. Further research is necessary with special emphasis on the trajectory of multimorbidity and the role of health system in satisfying needs of multimorbid individuals.
Collapse
Affiliation(s)
- Yaqin Zhong
- School of Public Health, Nantong University, 9 Se-yuan Road, Nantong, Jiangsu, 210029, China
| | - Gang Qin
- Clinical Trial Center, Affiliated Hospital of Nantong University, 20 Xi-Si Road, Nantong, Jiangsu, 226001, China
| | - Hanqing Xi
- School of Medicine, Nantong University, 9 Qixiu Road, Nantong, Jiangsu, 226019, China
| | - Duanying Cai
- School of Nursing, Jiujiang University, 551 Qianjin Dong Road, Jiujiang, Jiangxi Province, 332005, China
| | - Yanan Wang
- School of Public Health, Nantong University, 9 Se-yuan Road, Nantong, Jiangsu, 210029, China
| | - Tiantian Wang
- School of Public Health, Nantong University, 9 Se-yuan Road, Nantong, Jiangsu, 210029, China
| | - Yuexia Gao
- School of Public Health, Nantong University, 9 Se-yuan Road, Nantong, Jiangsu, 210029, China.
| |
Collapse
|
4
|
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: 120] [Impact Index Per Article: 120.0] [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.
Collapse
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.
| |
Collapse
|
5
|
The Health-Seeking Behavior of the Elderly with Non-Communicable Diseases in Coastal Areas of Vietnam. Healthcare (Basel) 2023; 11:healthcare11040465. [PMID: 36832999 PMCID: PMC9957095 DOI: 10.3390/healthcare11040465] [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: 12/18/2022] [Revised: 01/16/2023] [Accepted: 01/28/2023] [Indexed: 02/08/2023] Open
Abstract
This study aimed to analyze the utilization of health care facilities and the health-seeking behavior of elderly people with non-communicable diseases and find the factors that affect them. A cross-sectional study was conducted in seven coastal areas of the Thua Thien Hue province, Vietnam, using a sample of 370 elderly people aged over 60 years. Chi-square and multiple logistic regression analyses were used to examine the factors associated with the utilization of health care services. The participants' average age was 69.70 (SD), and 18% of them reported having ≥ two non-communicable diseases (NCDs). The results of the study showed that 69.8% of the total participants exhibited health-seeking behaviors. The findings also revealed that elderly people living alone, and those with an average or above-average income, had higher utilization of health care services. Participants with multiple NCDs exhibited more health-seeking behaviors than those with only one (OR: 9.24, 95% CI: 2.66-32.15, p = <0.001). The presence of health insurance and the need for health care counseling were also relevant ([OR: 4.16, 95% CI: 1.30-13.31, p = 0.016], [OR: 3.91, 95% CI: 2.04-7.49, p < 0.001], respectively). Health-seeking behavior is one of the most important positive implications for the aged population, as it encompasses one's physical, mental, and psychological wellbeing. Future studies can aim at gaining an in-depth understanding of the same results, helping improve the health-seeking behavior of elderly people, and enhancing their quality of life.
Collapse
|
6
|
Aihemaitijiang S, Zhang L, Ye C, Halimulati M, Huang X, Wang R, Zhang Z. Long-Term High Dietary Diversity Maintains Good Physical Function in Chinese Elderly: A Cohort Study Based on CLHLS from 2011 to 2018. Nutrients 2022; 14:1730. [PMID: 35565697 PMCID: PMC9105097 DOI: 10.3390/nu14091730] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Objective: This study aimed to explore the correlation between dietary factors and physical function in Chinese elderly. (2) Methods: A cohort study was conducted on the association of long-term dietary intake status with physical function in older people based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2011 to 2018. The physical function of the subjects was judged according to the scores of basic activities of daily living (BADL) and instrumental activities of daily living (IADL). The dietary diversity score was established according to the intake frequency of the food groups, and the dietary pattern score was obtained by factor analysis. The associations between dietary factors and functional impairment was investigated by logistic regressions. (3) Results: A total of 2282 subjects were included in our cohort study, 458 and 1439 of whom had BADL limitation and IADL limitation, respectively. The risk of functional impairment decreased in the consistent high dietary diversity groups compared with the consistent low dietary diversity group (p < 0.05). The fruit-egg-milk pattern, vegetable-meat-fish pattern, and condiment and tea pattern reduced the risk of functional impairment (p < 0.05). (4) Conclusions: Long-term maintenance of high dietary diversity and increasing total dietary intake can help maintain good physical function of Chinese elderly.
Collapse
Affiliation(s)
- Sumiya Aihemaitijiang
- Department of Nutrition & Food Hygiene, School of Public Health, Peking University Health Science Center, Haidian District, Beijing 100191, China; (S.A.); (C.Y.); (M.H.); (X.H.); (R.W.)
| | - Li Zhang
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, King’s College London, London SE1 1UL, UK;
| | - Chen Ye
- Department of Nutrition & Food Hygiene, School of Public Health, Peking University Health Science Center, Haidian District, Beijing 100191, China; (S.A.); (C.Y.); (M.H.); (X.H.); (R.W.)
| | - Mairepaiti Halimulati
- Department of Nutrition & Food Hygiene, School of Public Health, Peking University Health Science Center, Haidian District, Beijing 100191, China; (S.A.); (C.Y.); (M.H.); (X.H.); (R.W.)
| | - Xiaojie Huang
- Department of Nutrition & Food Hygiene, School of Public Health, Peking University Health Science Center, Haidian District, Beijing 100191, China; (S.A.); (C.Y.); (M.H.); (X.H.); (R.W.)
| | - Ruoyu Wang
- Department of Nutrition & Food Hygiene, School of Public Health, Peking University Health Science Center, Haidian District, Beijing 100191, China; (S.A.); (C.Y.); (M.H.); (X.H.); (R.W.)
| | - Zhaofeng Zhang
- Department of Nutrition & Food Hygiene, School of Public Health, Peking University Health Science Center, Haidian District, Beijing 100191, China; (S.A.); (C.Y.); (M.H.); (X.H.); (R.W.)
| |
Collapse
|
7
|
Khan MR, Malik MA, Akhtar SN, Yadav S, Patel R. Multimorbidity and its associated risk factors among older adults in India. BMC Public Health 2022; 22:746. [PMID: 35422020 PMCID: PMC9008964 DOI: 10.1186/s12889-022-13181-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/07/2022] [Indexed: 02/08/2023] Open
Abstract
Abstract
Background
Health at older ages is a key public health challenge especially among the developing countries. Older adults are at greater risk of vulnerability due to their physical and functional health risks. With rapidly rising ageing population and increasing burden of non-communicable diseases older adults in India are at a greater risk for multimorbidities. Therefore, to understand this multimorbidity transition and its determinants we used a sample of older Indian adults to examine multimorbidity and its associated risk factors among the Indian older-adults aged 45 and above.
Methods
Using the sample of 72,250 older adults, this study employed the multiple regression analysis to study the risk factors of multimorbidity. Multimorbidity was computed based on the assumption of older-adults having one or more than one disease risks.
Results
Our results confirm the emerging diseases burden among the older adults in India. One of the significant findings of the study was the contrasting prevalence of multimorbidity among the wealthiest groups (AOR = 1.932; 95% CI = 1.824- 2.032). Similarly women were more likely to have a multimorbidity (AOR = 1.34; 95% CI = 1.282—1.401) as compared to men among the older adults in India.
Conclusion
Our results confirm an immediate need for proper policy measures and health system strengthening to ensure the better health of older adults in India.
Collapse
|
8
|
Mohd Hassan NZA, Mohd Nor Sham Kunusagaran MSJ, Zaimi NA, Aminuddin F, Ab Rahim FI, Jawahir S, Abdul Karim Z. The inequalities and determinants of Households' Distress Financing on Out-off-Pocket Health expenditure in Malaysia. BMC Public Health 2022; 22:449. [PMID: 35255884 PMCID: PMC8900333 DOI: 10.1186/s12889-022-12834-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/22/2022] [Indexed: 01/02/2023] Open
Abstract
Background Out-of-pocket (OOP) payments for healthcare services potentially have severe consequences on households, especially among the poor. Under certain circumstances, healthcare payments are financed through selling household assets, or borrowings. This certainly could influence households’ decision, which likely resorts to forgoing healthcare services. Thus, the focal point of this study is aimed to identify the inequalities and determinants of distress financing among households in Malaysia. Methods This study used secondary data from the National Health and Morbidity Survey (NHMS) 2019, a national cross-sectional household survey that used a two-stage stratified random sampling design involving 5,146 households. The concentration curve and concentration index were used to determine the economic inequalities in distress financing. Whereas, the determinants of distress financing were identified using the modified Poisson regression model. Results The prevalence of borrowing without interest was the highest (13.86%), followed by borrowing with interest (1.03%) while selling off assets was the lowest (0.87%). Borrowing without interest was highest among rural (16.21%) and poor economic status (23.34%). The distribution of distress financing was higher among the poor, with a concentration index of -0.245. The modified Poisson regression analysis revealed that the poor, middle, rich, and richest had 0.57, 0.58, 0.40 and 0.36 times the risk to develop distress financing than the poorest socio-economic group. Whereas, the presence of one and two or more elderly were associated with a 1.94 and 1.59 times risk of experiencing distress financing than households with no elderly members. The risk of developing distress financing was also 1.28 and 1.58 times higher among households with one and two members receiving inpatient care in the past 12 months compared to none. Conclusions The findings implied that the improvement of health coverage should be emphasized to curtail the prevalence of distress financing, especially among those caring for the elderly, requiring admission to hospitals, and poor socio-economic groups. This study could be of interest to policymakers to help achieve and sustain health coverage for all.
Collapse
Affiliation(s)
- Nor Zam Azihan Mohd Hassan
- Centre of Health Economics Research (CHEeR), Institute for Health Systems Research (IHSR), Ministry of Health Malaysia, Kompleks Institut Kesihatan Negara (NIH), Blok B2, No.1, Jalan Setia Murni U13/52, Seksyen 13 Setia Alam, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia.
| | - Mohd Shaiful Jefri Mohd Nor Sham Kunusagaran
- Centre of Health Economics Research (CHEeR), Institute for Health Systems Research (IHSR), Ministry of Health Malaysia, Kompleks Institut Kesihatan Negara (NIH), Blok B2, No.1, Jalan Setia Murni U13/52, Seksyen 13 Setia Alam, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Nur Amalina Zaimi
- Centre of Health Economics Research (CHEeR), Institute for Health Systems Research (IHSR), Ministry of Health Malaysia, Kompleks Institut Kesihatan Negara (NIH), Blok B2, No.1, Jalan Setia Murni U13/52, Seksyen 13 Setia Alam, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Farhana Aminuddin
- Centre of Health Economics Research (CHEeR), Institute for Health Systems Research (IHSR), Ministry of Health Malaysia, Kompleks Institut Kesihatan Negara (NIH), Blok B2, No.1, Jalan Setia Murni U13/52, Seksyen 13 Setia Alam, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Fathullah Iqbal Ab Rahim
- Centre of Health Economics Research (CHEeR), Institute for Health Systems Research (IHSR), Ministry of Health Malaysia, Kompleks Institut Kesihatan Negara (NIH), Blok B2, No.1, Jalan Setia Murni U13/52, Seksyen 13 Setia Alam, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Suhana Jawahir
- Centre of Health Economics Research (CHEeR), Institute for Health Systems Research (IHSR), Ministry of Health Malaysia, Kompleks Institut Kesihatan Negara (NIH), Blok B2, No.1, Jalan Setia Murni U13/52, Seksyen 13 Setia Alam, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Zulkefly Abdul Karim
- Faculty of Economics and Management, Center for Sustainable and Inclusive Development (SID), Universiti Kebangsaan Malaysia (UKM), Bangi, Malaysia
| |
Collapse
|
9
|
Dewiasty E, Agustina R, Saldi SRF, Pramudita A, Hinssen F, Kumaheri M, de Groot LCPGM, Setiati S. Malnutrition Prevalence and Nutrient Intakes of Indonesian Community-Dwelling Older Adults: A Systematic Review of Observational Studies. Front Nutr 2022; 9:780003. [PMID: 35284453 PMCID: PMC8912970 DOI: 10.3389/fnut.2022.780003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/31/2022] [Indexed: 11/15/2022] Open
Abstract
Background Malnutrition and inadequate nutrient intake are associated with functional decline, frailty, and bad clinical outcomes among community-dwelling older adults. Despite the growing proportion of the elderly population in Indonesia, data on the prevalence of malnutrition and adequacy of macronutrient and micronutrient intakes among Indonesian older adults are scattered and vary between studies. Therefore, our study aims to obtain data on malnutrition prevalence, level and distribution of nutrient intakes, and prevalence of macronutrient and micronutrient inadequacies in Indonesian community-dwelling older adults. Methods We carried out a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and registered in PROSPERO. A systematic electronic database search of MEDLINE, CENTRAL, EMBASE, ProQuest, HINARI, IMSEAR, GARUDA, and Indonesian Publication Index was undertaken. Additional searches were conducted in gray literature sources, hand-searching, retrospective searching, and personal communication with authors of the relevant publication. Observational studies presenting the malnutrition prevalence of habitual dietary intakes of older adults (60 years or older) were included. The risk of bias of studies was assessed using the Joanna Briggs Institute critical appraisal form. Sex-specific mean (and standard deviation) habitual macronutrient and a selection of micronutrients (calcium, vitamin D, and vitamin B12) intakes were extracted from each article to calculate the percentage of older people who were at risk for inadequate micronutrient intakes using a proxy of estimated average requirement (EAR) cut-point method, which is calculated from the national guideline of recommended dietary allowance (RDA). Prevalence of malnutrition, based on body mass index (BMI) categories and mini-nutritional assessment (MNA) criteria. and the population at risk of malnutrition were presented descriptively. Results Nine studies retrieved from electronic databases and gray literature were included in the pooled systematic analysis. According to BMI criteria, the underweight prevalence ranged from 8.0 to 26.6%. According to the MNA, the prevalence of malnutrition ranged from 2.1 to 14.6%, whereby the prevalence of at risk of malnutrition amounted to 18–78%. Our systematic review identified a high prevalence of nutrient inadequacies, most markedly for protein, calcium, vitamin D, and vitamin B12. Conclusion We signal a high risk of malnutrition along with poor macronutrients and micronutrients intakes among Indonesian community-dwelling older adults. These findings provide important and robust evidence on the magnitude of malnutrition and nutrient inadequacy concerns that call for appropriate nutrition, as well as public health policies and prompt intervention. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018102268.
Collapse
Affiliation(s)
- Esthika Dewiasty
- Department of Internal Medicine, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
- *Correspondence: Esthika Dewiasty ; ;
| | - Rina Agustina
- Department of Nutrition, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Human Nutrition Research Center, Indonesian Medical Education and Research Center, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Siti Rizny F. Saldi
- Department of Internal Medicine, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Arvin Pramudita
- Department of Internal Medicine, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Fenna Hinssen
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Meutia Kumaheri
- Department of Internal Medicine, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | | | - Siti Setiati
- Department of Internal Medicine, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Center of Clinical Epidemiology and Evidence-Based Medicine, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| |
Collapse
|
10
|
The Sustainable Care Model for an Ageing Population in Vietnam: Evidence from a Systematic Review. SUSTAINABILITY 2022. [DOI: 10.3390/su14052518] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Social demographic studies in Vietnam have shown a growing trend of an ageing population. Demographic trends project that one third of the Vietnamese population will be aged 65 years and older by 2050. Vietnam is a country where the majority of the elderly live with their children, with little savings and pension. The purpose of this review was to explore existing literature on models of care for an ageing population and provide evidence to develop a care model that is suitable for the ageing community in Vietnam. A systematic review utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework was carried out. An extensive literature search was performed, with a focus on articles and other materials with relevance to elderly care in Vietnam in terms of socio-economic, demographic, and associated factors based on comprehensive data sources. The review found that there is a lack of evidence of professional practice for caring for the aged in Vietnam. There also is a lack of evidence of government support for the limited community initiatives to support the ageing. There exist no community models of care for the ageing population in Vietnam. From a global perspective, there exist alternative models of care options to support the elderly through various care models, such as living in assisted-care facilities, home care, and other assistance. Inter-professional practice care models and health services were found to be essential for an ageing population. There is limited literature specifically for the care of an ageing population in Vietnam. Most of the available literature on care models for the aged is drawn from developed countries. The review offers insights into the development of care models for the elderly in Vietnam, with the need for inter-professional efforts in practice settings to support the ageing Vietnamese population. The reviewed literature agrees on the developing global challenges due to ageing. Despite the existing literature on care models for the ageing, there is a lack evidence-based care models concerning the current and future needs of elderly care in middle- and lower-income economies like Vietnam. More evidence is required to establish evidence for best care models for the elderly in developing economies.
Collapse
|
11
|
Cândido LM, Wagner KJP, Costa MED, Pavesi E, Avelar NCPD, Danielewicz AL. Comportamento sedentário e associação com multimorbidade e padrões de multimorbidade em idosos brasileiros: dados da Pesquisa Nacional de Saúde de 2019. CAD SAUDE PUBLICA 2022; 38:e00128221. [DOI: 10.1590/0102-311x00128221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/09/2021] [Indexed: 11/21/2022] Open
Abstract
Resumo: O comportamento sedentário emerge como um importante determinante da saúde da pessoa idosa, no entanto, sua relação com a multimorbidade e seus padrões de acometimento em estudos epidemiológicos têm sido pouco explorados na população brasileira. Tais associações poderão auxiliar na elaboração de políticas públicas visando à modificação desse comportamento. Assim, o objetivo deste estudo foi avaliar a associação entre comportamento sedentário com multimorbidade e seus padrões em idosos brasileiros. Estudo transversal, com 43.554 idosos da Pesquisa Nacional de Saúde de 2019. O comportamento sedentário autorreferido foi categorizado em < 3; 3-6; e > 6 horas por dia. A presença de multimorbidade e seus padrões foram analisados pelo autorrelato da coexistência de duas ou mais doenças crônicas, sendo que os três padrões estabelecidos consideraram as doenças com características clínicas similares: (1) cardiopulmonar; (2) vascular-metabólico; e (3) mental-musculoesquelético. As associações foram realizadas pela regressão logística binária. Os idosos que despendiam 3-6 horas/dia em comportamento sedentário tiveram maiores chances (OR = 1,39; IC95%: 1,29; 1,50) de apresentar multimorbidade, padrão vascular-metabólico (OR = 1,39; IC95%: 1,29; 1,50) e mental-musculoesquelético (OR = 1,11; IC95%: 1,00; 1,24). Quando o comportamento sedentário foi > 6 horas/dia, houve maiores chances de multimorbidade (OR = 1,58; IC95%: 1,43; 1,74) e dos padrões cardiopulmonar (OR = 1,73; IC95%: 1,33; 2,27), vascular-metabólico (OR = 1,49; IC95%: 1,35; 1,64) e mental-musculoesquelético (OR = 1,15; IC95%: 1,01; 1,31), quando comparados àqueles que ficavam até 3 horas/dia. Dessa forma, evidenciou-se que tempos elevados em comportamento sedentário são fatores de risco relevantes para a ocorrência de multimorbidade e seus padrões em idosos.
Collapse
|
12
|
Feng X, Kelly M, Sarma H. The association between educational level and multimorbidity among adults in Southeast Asia: A systematic review. PLoS One 2021; 16:e0261584. [PMID: 34929020 PMCID: PMC8687566 DOI: 10.1371/journal.pone.0261584] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/03/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In Southeast Asia, the prevalence of multimorbidity is gradually increasing. This paper aimed to investigate the association between educational level and multimorbidity among over 15-years old adults in Southeast Asia. METHODS We conducted a systematic review of published observational studies. Studies were selected according to eligibility criteria of addressing definition and prevalence of multimorbidity and associations between level of education and multimorbidity in Southeast Asia. The Newcastle-Ottawa Scale (NOS) was used to measure the quality and risk of bias. The methodology has been published in PROSPERO with registered number ID: CRD42021259311. RESULTS Eighteen studies were included in the data synthesis. The results are presented using narrative synthesis due to the heterogeneity of differences in exposures, outcomes, and methodology. The prevalence of multimorbidity ranged from 1.7% to 72.6% among over 18 years-old adults and from 1.5% to 51.5% among older people (≥ 60 years). There were three association patterns linking between multimorbidity and education in these studies: (1) higher education reducing odds of multimorbidity, (2) higher education increasing odds of multimorbidity and (3) education having no association with multimorbidity. The association between educational attainment and multimorbidity also varies widely across countries. In Singapore, three cross-sectional studies showed that education had no association with multimorbidity among adults. However, in Indonesia, four cross-sectional studies found higher educated persons to have higher odds of multimorbidity among over 40-years-old persons. CONCLUSIONS Published studies have shown inconsistent associations between education and multimorbidity because of different national contexts and the lack of relevant research in the region concerned. Enhancing objective data collection such as physical examinations would be necessary for studies of the connection between multimorbidity and education. It can be hypothesised that more empirical research would reveal that a sound educational system can help people prevent multimorbidity.
Collapse
Affiliation(s)
- Xiyu Feng
- Department of Global Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Matthew Kelly
- Department of Global Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Haribondhu Sarma
- Department of Global Health, Research School of Population Health, The Australian National University, Canberra, Australia
| |
Collapse
|
13
|
Shariff Ghazali S, Seman Z, Zainuddin NH, Omar MA, Sooryanarayana R, Ariaratnam S, Mohd Tohit N, Ho BK, Krishnapillai AD, Zainal Abidin SI. Prevalence and factors associated with multimorbidity among older adults in Malaysia: a population-based cross-sectional study. BMJ Open 2021; 11:e052126. [PMID: 34670764 PMCID: PMC8529977 DOI: 10.1136/bmjopen-2021-052126] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To determine the prevalence and factors associated with multimorbidity among community-dwelling older adults in Malaysia. DESIGN A population-based cross-sectional study. SETTING 13 states and 3 Federal Territories in Malaysia. PARTICIPANTS A total of 3966 adults aged 60 years and above were extracted from the nationwide National Health and Morbidity Survey (NHMS) 2018 data set. PRIMARY OUTCOME MEASURES Multimorbidity was defined as co-occurrence of at least two known chronic non-communicable diseases in the same individual. The chronic diseases included hypertension, type 2 diabetes mellitus, dyslipidaemia and cancer. RESULTS The prevalence of multimorbidity among Malaysian older adults was 40.6% (95% CI: 37.9 to 43.3). The factors associated with multimorbidity were those aged 70-79 years (adjusted OR (AOR)=1.30; 95% CI=1.04 to 1.63; p=0.019), of Indian (AOR=1.69; 95% CI=1.14 to 2.52; p=0.010) and Bumiputera Sarawak ethnicities (AOR=1.81; 95% CI=1.14 to 2.89; p=0.013), unemployed (AOR=1.53; 95% CI=1.20 to 1.95; p=0.001), with functional limitation from activities of daily livings (AOR=1.66; 95% CI=1.17 to 2.37; p=0.005), physically inactive (AOR=1.28; 95% CI=1.03 to 1.60; p=0.026), being overweight (AOR=1.62; 95% CI=1.11 to 2.36; p=0.014), obese (AOR=1.88; 95% CI=1.27 to 2.77; p=0.002) and with abdominal obesity (AOR=1.52; 95% CI=1.11 to 2.07; p=0.009). CONCLUSION This study highlighted that multimorbidity was prevalent among older adults in the community. Thus, there is a need for future studies to evaluate preventive strategies to prevent or delay multimorbidity among older adults in order to promote healthy and productive ageing.
Collapse
Affiliation(s)
- Sazlina Shariff Ghazali
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Laboratory of Medical Gerontology, Malaysian Research Institute on Ageing (MyAgeing), Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Zamtira Seman
- Sector for Biostatistics and Data Repository, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Nabilah Hanis Zainuddin
- Sector for Biostatistics and Data Repository, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Mohd Azahadi Omar
- Sector for Biostatistics and Data Repository, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Rajini Sooryanarayana
- Elderly Health Sector, Family Health Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Suthahar Ariaratnam
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Cawangan Selangor, Kampus Selayang, Batu Caves, Malaysia
| | - Noorlaili Mohd Tohit
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bandar Tun Razak, Cheras, Malaysia
| | - Bee Kiau Ho
- Klinik Kesihatan Bandar Botanik, Ministry of Health Malaysia, Bandar Botanic, Klang, Malaysia
| | - Ambigga Devi Krishnapillai
- Department of Family Medicine, Faculty of Medicine and Health, National Defense University of Malaysia, Kem Sg. Besi, Malaysia
| | | |
Collapse
|
14
|
Melo LAD, Lima KCD. Prevalence and factors associated with multimorbidities in Brazilian older adults. CIENCIA & SAUDE COLETIVA 2020; 25:3869-3877. [PMID: 32997019 DOI: 10.1590/1413-812320202510.34492018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/17/2018] [Indexed: 11/22/2022] Open
Abstract
This study aimed to identify the prevalence of multimorbidity in Brazilian older adults and factors associated with socioeconomic and lifestyle variables. This is a cross-sectional, population-based study carried out with data from the National Health Survey database. Seniors with multimorbidity where the ones with a diagnosis of two or more chronic diseases. The chi-square test was used in data analysis, and then prevalence ratios were estimated through Poisson multiple regression, both with 95% confidence level. In total, 11,697 older adults were evaluated and the multimorbidity prevalence was 53.1%. As a result of the multivariate analysis, female seniors (p < 0.001), the oldest elderly (p = 0.002), those who were not single, more strongly associated with widowers (p = 0.001) and those with a health plan at the interview (p < 0.001) were associated with multimorbidity. Also, in comparison with older adults with two chronic diseases, women are associated with three (p = 0.003) and four or more chronic diseases (p < 0.001). We can conclude that multimorbidity in Brazilian older adults is a widespread condition and that it has been influenced by socioeconomic factors and is poorly related to lifestyle.
Collapse
Affiliation(s)
- Laércio Almeida de Melo
- Departamento de Odontologia, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte. Av. Salgado Filho 1787, Lagoa Nova. 59056-000 Natal RN Brasil.
| | - Kenio Costa de Lima
- Departamento de Odontologia, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte. Av. Salgado Filho 1787, Lagoa Nova. 59056-000 Natal RN Brasil.
| |
Collapse
|
15
|
Melo LAD, Lima KCD. Factors associated with the most frequent multimorbidities in Brazilian older adults. CIENCIA & SAUDE COLETIVA 2020; 25:3879-3888. [PMID: 32997020 DOI: 10.1590/1413-812320202510.35632018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/04/2019] [Indexed: 12/16/2022] Open
Abstract
This study aimed to identify an association between the most frequent multimorbidities in Brazilian older adults and socioeconomic and lifestyle variables. National Health Survey's data were used. The Chi-square test and the Poisson multiple regression were used to analyze data. A total of 5,575 older adults with multimorbidity and mean age of 70.3 years participated in the study. Most of them are female (66.3%), white (56.1%), are sedentary (75.3%), with low schooling (40%), no health plan (65.3%), did not consume alcohol (78.7%) and did not smoke (90.1%). The most prevalent multimorbidities were hypertension and high cholesterol (31.3%), hypertension and stroke (30.9%) and hypertension and diabetes (23.3%). There was an association of the first condition with females, younger adults and no tobacco use. On the other hand, the second condition was associated with females and low level of schooling. The third group was associated with low schooling, sedentary lifestyle and no tobacco use. We can conclude that multimorbidity in Brazilian older adults is a frequent condition in women, younger seniors and those socioeconomically disadvantaged. Also, socioeconomic conditions and lifestyle influenced the prevalence of primary multimorbidities.
Collapse
Affiliation(s)
- Laércio Almeida de Melo
- Departamento de Odontologia, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte. Av. Salgado Filho 1787, Lagoa Nova. 59056-000 Natal RN Brasil.
| | - Kenio Costa de Lima
- Departamento de Odontologia, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte. Av. Salgado Filho 1787, Lagoa Nova. 59056-000 Natal RN Brasil.
| |
Collapse
|
16
|
Nguyen TN, Nguyen TN, Nguyen AT, Nguyen TX, Nguyen HTT, Nguyen TTH, Pham T, Vu HTT. Prevalence of sarcopenia and its associated factors in patients attending geriatric clinics in Vietnam: a cross-sectional study. BMJ Open 2020; 10:e037630. [PMID: 32948562 PMCID: PMC7500289 DOI: 10.1136/bmjopen-2020-037630] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES This study aims to investigate the prevalence of sarcopenia and its associated factors in patients attending geriatric clinics in Vietnam. DESIGN AND SETTING A cross-sectional study was conducted in consecutive patients aged ≥60 visiting outpatient clinics of the National Geriatric Hospital in Hanoi, Vietnam, from January 2018 to October 2018. Handgrip strength was measured with a hand dynamometer. Whole-body dual-energy X-ray absorptiometry was applied to measure the appendicular skeletal muscle mass. Sarcopenia was defined by the criteria proposed by the Asian Working Group for Sarcopenia (AWGS 2019) and by the Foundation for the National Institutes of Health (FNIH) Sarcopenia Project. RESULTS There were 600 participants, mean age 70.0±8.0, 60.8% female. The prevalence of sarcopenia was 54.7% according to AWGS 2019 criteria and 40.5% according to FNIH. In multivariate logistic regression, age (adjusted OR 1.08, 95% CI 1.05 to 1.11), male (adjusted OR 2.03, 95% CI 1.29 to 3.21), underweight (adjusted OR 2.32, 95% CI 1.22 to 4.41), being malnourished (adjusted OR 3.77, 95% CI 1.19 to 11.91), chronic lung diseases (adjusted OR 3.48, 95% CI 2.10 to 5.77) and lower physical activity were significantly associated with sarcopenia defined by AWGS 2019 criteria. With FNIH definition, the significantly associated factors were age (adjusted OR 1.07, 95% CI 1.04 to 1.11), male (adjusted OR 6.78, 95% CI 4.12 to 11.17), low education (adjusted OR 2.15, 95% CI 1.27 to 3.63), being malnourished (adjusted OR 3.35, 95% CI 1.28 to 8.76), chronic lung diseases (adjusted OR 2.58, 95% CI 1.56 to 4.28) and lower physical activity level. CONCLUSION The prevalence of sarcopenia in patients attending geriatric clinics was high. Further studies are needed to examine the impact of sarcopenia on adverse outcomes in this population.
Collapse
Affiliation(s)
- Tam Ngoc Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, Viet Nam
- Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam
| | - Tu Ngoc Nguyen
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Anh Trung Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, Viet Nam
- Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam
| | - Thanh Xuan Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, Viet Nam
- Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam
| | - Huong Thu Thi Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, Viet Nam
- Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam
| | - Thu Thi Hoai Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, Viet Nam
- Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam
- Dinh Tien Hoang Institute of Medicine, Hanoi, Viet Nam
| | - Thang Pham
- Department of Geriatrics, Hanoi Medical University, Hanoi, Viet Nam
- Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam
| | - Huyen Thanh Thi Vu
- Department of Geriatrics, Hanoi Medical University, Hanoi, Viet Nam
- Hanoi Medical University Hospital, Ha Noi, Viet Nam
| |
Collapse
|
17
|
The socio-economic determinants of multimorbidity among the elderly population in Trinidad and Tobago. PLoS One 2020; 15:e0237307. [PMID: 32915825 PMCID: PMC7485802 DOI: 10.1371/journal.pone.0237307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 07/24/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of multimorbidity and investigate the socioeconomic factors that are associated with multimorbidity among persons 70 years and older in Trinidad and Tobago. DESIGN AND METHODS The data were obtained from a nationally representative comprehensive cross-sectional survey conducted in 2014 among elderly persons in the targeted age group. The prevalence of multimorbidity among the elderly population was estimated. A logit model was utilized to determine the socioeconomic characteristics that are associated with multimorbidity in the elderly. RESULTS The results of the study show that multimorbidity in the elderly population is strongly associated with age, ethnicity, lower education, smoking history, no physical activity and being female. An interesting finding is that elderly persons in the richest quintile are in general, more prone to multimorbidity. CONCLUSION The findings suggest that interventions to reduce multimorbidity among the elderly population must encourage greater levels of physical activity, provide education on the risk factors of multimorbidity, and discourage smoking.
Collapse
|
18
|
Socio-economic-related health inequality in non-communicable diseases among older people in Viet Nam. AGEING & SOCIETY 2020. [DOI: 10.1017/s0144686x19001843] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThis study contributes to a growing literature body of studies aimed at explaining socio-economic-related health inequality in non-communicable diseases (NCDs), with a focus on older people who are commonly affected by socio-economic gradient in later life. It identifies factors associated with self-reported NCDs and examines socio-economic-related health inequality in self-reported NCDs between rural and urban Vietnamese older people. This cross-sectional study utilised data from the Viet Nam Ageing Survey. A sample of 2,682 older people aged 60 and over (urban = 703, rural = 1,979) was analysed. Concentration indices were computed to measure socio-economic inequalities in self-reported NCDs. Concentration index decomposition analysis was performed to determine the relative contributions of the determinants to explaining those inequalities. Significant socio-economic inequalities in self-reported NCDs favouring the rich were found, in which the degree of inequality was more pronounced in urban areas than in their rural counterparts. Household wealth and social health insurance were the main drivers contributing to increased socio-economic inequalities in self-reported NCDs in urban and rural areas, respectively. Among disadvantaged groups, older people living alone, with lowest wealth and with social health insurance had highest probability of reporting at least one NCD for both areas. Public policies aimed at narrowing wealth gaps and expanding and improving principle roles of social health insurance should prioritise the most disadvantaged groups in order to achieve health equality.
Collapse
|
19
|
Oliveira DVD, Moreira CR, Freire GLM, Melo RSD, Franco MF, Nascimento Júnior JRAD. Does multimorbitdity interfere with the fundtionality of the physically active elderly? FISIOTERAPIA EM MOVIMENTO 2020. [DOI: 10.1590/1980-5918.033.ao52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Multimorbidity is currently considered as a relevant clinical condition due to its severity and the high prevalence among the elderly. Objective: Assessing whether multimorbidity is an intervening factor in the functionality of the physically active elderly. Method: This is a cross-sectional study carried out with 70 older people of both sexes who practice exercises at the Fitness zones (FZ) in the municipality of Maringá, state of Paraná. A sociodemographic questionnaire, and the World Health Organization Disability Assessment Scale (WHO-DAS 2.0) were used as instruments. Data analysis was performed by using the Kolmogorov-Smirnov test, Kruskal-Wallis test, Mann-Whitney test and Spearman’s rank correlation, in addition to the Path Analysis (p <0.05). Results: the elderly who have more than two diseases showed worse functionality than the ones with none or from 1 to 2 diseases (p <0.05). The number of diseases showed a significant association (p <0.05) with a reduction in functional domain scores, which explains from 15% to 31% of the variable’s variability. Specifically, the number of diseases was positively associated with the strong effect on the domains referred to as self-care (β = 0.56) and cognition (β = 0.55), besides a moderate effect on interpersonal relationships (β = 0.39) and social participation domains (β = 0.39). Conclusion: it was concluded that multimorbidity can be considered as an intervening factor in the functionality of elderly people who practice physical activity.
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
Ir P, Jacobs B, Asante AD, Liverani M, Jan S, Chhim S, Wiseman V. Exploring the determinants of distress health financing in Cambodia. Health Policy Plan 2019; 34:i26-i37. [PMID: 31644799 PMCID: PMC6807511 DOI: 10.1093/heapol/czz006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2019] [Indexed: 11/14/2022] Open
Abstract
Borrowing is a common coping strategy for households to meet healthcare costs in countries where social health protection is limited or non-existent. Borrowing with interest, hereinafter termed distress health financing or distress financing, can push households into heavy indebtedness and exacerbate the financial consequences of healthcare costs. We investigated distress health financing practices and associated factors among Cambodian households, using primary data from a nationally representative household survey of 5000 households. Multivariate logistic regression was used to determine factors associated with distress health financing. Results showed that 28.1% of households consuming healthcare borrowed to pay for that healthcare with 55% of these subjected to distress financing. The median loan was US$125 (US$200 for loans with interest and US$75 for loans without interest). Approximately 50.6% of healthcare-related loans were to pay for the costs of outpatient care in the past month, 45.8% for inpatient care and 3.6% for preventive care in the past 12 months. While the average period to pay off the loan was 8 months, 78% of households were still indebted from loans taken over 12 months before the survey. Distress financing is strongly associated with household poverty-the poorer the household the more likely it is to borrow, fall into debt and unable to pay off the debt-even for members of the health equity funds, a national scheme designed to improve financial access to health services for the poor. Other determinants of distress financing were household size, use of inpatient care and outpatient consultations with private providers or with both private and public providers. In order to ensure effective financial risk protection, Cambodia should establish a more comprehensive and effective social health protection scheme that provides maximum population coverage and prioritizes services for populations at risk of distress financing, especially poorer and larger households.
Collapse
Affiliation(s)
- Por Ir
- National Institute of Public Health, Lot No. 80, Street 289, Phnom Penh, Cambodia
| | - Bart Jacobs
- Social Health Protection Programme, Deutsche Gesellschaft für Internationale Zusammenarbeit (GiZ), Lot No. 80, Street 289, Phnom Penh, Cambodia
| | - Augustine D Asante
- School of Public Health & Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Marco Liverani
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Pl, Kings Cross, London, UK
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, 1 King St Newtown, New South Wales, Australia
| | - Srean Chhim
- National Institute of Public Health, Lot No. 80, Street 289, Phnom Penh, Cambodia
| | - Virginia Wiseman
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Pl, Kings Cross, London, UK
- Kirby Institute, University of New South Wales, Wallace Wurth Building, High St, Kensington NSW, Australia
| |
Collapse
|
22
|
Ba NV, Minh HV, Quang LB, Chuyen NV, Ha BTT, Dai TQ, Duc DM, Quynh NT, Khanh PG. Prevalence and correlates of multimorbidity among adults in border areas of the Central Highland Region of Vietnam, 2017. JOURNAL OF COMORBIDITY 2019; 9:2235042X19853382. [PMID: 31192142 PMCID: PMC6542113 DOI: 10.1177/2235042x19853382] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 04/26/2019] [Indexed: 12/12/2022]
Abstract
Introduction: The objectives of this study are to estimate the prevalence of multimorbidity (MM) among adults in the Central Highland Region (a poor region) of Vietnam in 2017 and to identify the sociodemographic correlates of these conditions. Methods: We used data from a cross-sectional study conducted in 2018 on health status among people in four provinces in the Central Highlands Region (Tay Nguyen) of Vietnam. A sample of 1680 adults (aged 15 years and older) were randomly selected for this study. Respondents were asked whether they had been told by a health worker that they had cancer, heart and circulatory conditions, chronic joint problems, chronic pulmonary diseases, chronic kidney problems, chronic digestive problems, psychological illness, diabetes, and/or other chronic conditions. Results: The prevalence of MM among the study participants was 16.4% (95% confidence interval (CI): 14.6%–18.2%). By looking at the 95% CIs, the differences in MM prevalence between the groups classified by gender, age, education, and occupation were not statistically significant. Only the difference in MM prevalence between farmers and government staff was statistically significant. Multivariate logistic analyses show education and occupations were shown to be significant correlates of MM. Conclusion: MMs were quite common among the adult populations in the study area, especially among people with lower socioeconomic status. Given the evidence, actions to reduce levels of MM in the setting are clearly urgent. The interventions should address all people in society, with focus on disadvantaged groups, like those with lower education and farmers.
Collapse
Affiliation(s)
- Nguyen Van Ba
- Department of Science and Technology Management, Vietnam Military Medical University, Hanoi, Vietnam
| | - Hoang Van Minh
- Department of Science and Technology Management, Hanoi University of Public Health, Hanoi, Vietnam
| | - Le Bach Quang
- Department of Science and Technology Management, Vietnam Military Medical University, Hanoi, Vietnam
| | - Nguyen Van Chuyen
- Department of Science and Technology Management, Vietnam Military Medical University, Hanoi, Vietnam
| | - Bui Thi Thu Ha
- Department of Science and Technology Management, Hanoi University of Public Health, Hanoi, Vietnam
| | - Tran Quoc Dai
- Department of Science and Technology Management, Hanoi University of Public Health, Hanoi, Vietnam
| | - Duong Minh Duc
- Department of Science and Technology Management, Hanoi University of Public Health, Hanoi, Vietnam
| | - Nguyen Thuy Quynh
- Department of Science and Technology Management, Hanoi University of Public Health, Hanoi, Vietnam
| | - Pham Gia Khanh
- Department of Science and Technology Management, Vietnam Military Medical University, Hanoi, Vietnam
| |
Collapse
|
23
|
Nguyen H, Manolova G, Daskalopoulou C, Vitoratou S, Prince M, Prina AM. Prevalence of multimorbidity in community settings: A systematic review and meta-analysis of observational studies. JOURNAL OF COMORBIDITY 2019; 9:2235042X19870934. [PMID: 31489279 PMCID: PMC6710708 DOI: 10.1177/2235042x19870934] [Citation(s) in RCA: 272] [Impact Index Per Article: 54.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/30/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND With ageing world populations, multimorbidity (presence of two or more chronic diseases in the same individual) becomes a major concern in public health. Although multimorbidity is associated with age, its prevalence varies. This systematic review aimed to summarise and meta-analyse the prevalence of multimorbidity in high, low- and middle-income countries (HICs and LMICs). METHODS Studies were identified by searching electronic databases (Medline, Embase, PsycINFO, Global Health, Web of Science and Cochrane Library). The term 'multimorbidity' and its various spellings were used, alongside 'prevalence' or 'epidemiology'. Quality assessment employed the Newcastle-Ottawa scale. Overall and stratified analyses according to multimorbidity operational definitions, HICs/LMICs status, gender and age were performed. A random-effects model for meta-analysis was used. RESULTS Seventy community-based studies (conducted in 18 HICs and 31 LMICs) were included in the final sample. Sample sizes ranged from 264 to 162,464. The overall pooled prevalence of multimorbidity was 33.1% (95% confidence interval (CI): 30.0-36.3%). There was a considerable difference in the pooled estimates between HICs and LMICs, with prevalence being 37.9% (95% CI: 32.5-43.4%) and 29.7% (26.4-33.0%), respectively. Heterogeneity across studies was high for both overall and stratified analyses (I 2 > 99%). A sensitivity analysis showed that none of the reviewed studies skewed the overall pooled estimates. CONCLUSION A large proportion of the global population, especially those aged 65+, is affected by multimorbidity. To allow accurate estimations of disease burden, and effective disease management and resources distribution, a standardised operationalisation of multimorbidity is needed.
Collapse
Affiliation(s)
- Hai Nguyen
- Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, King’s College London, London, UK
| | - Gergana Manolova
- Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, King’s College London, London, UK
| | - Christina Daskalopoulou
- Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, King’s College London, London, UK
| | - Silia Vitoratou
- Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, King’s College London, London, UK
| | - Martin Prince
- Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, King’s College London, London, UK
| | - A Matthew Prina
- Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, King’s College London, London, UK
| |
Collapse
|
24
|
de Carvalho JN, de Camargo Cancela M, de Souza DLB. Lifestyle factors and high body mass index are associated with different multimorbidity clusters in the Brazilian population. PLoS One 2018; 13:e0207649. [PMID: 30458026 PMCID: PMC6245742 DOI: 10.1371/journal.pone.0207649] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 11/05/2018] [Indexed: 01/06/2023] Open
Abstract
Multimorbidity patterns of a population can be influenced by socioeconomic and lifestyle-related factors. Some of these factors are preventable when healthy habits are promoted to the population. This study analyzed the main grouping patterns of chronic diseases and the relationship with socioeconomic and lifestyle-related factors of the Brazilian population (over the age of 18), based on a population-based survey (2013 National Health Survey). A total of 60,202 participants were included. Cluster analysis was carried out to identify the combinations of chronic diseases. Bivariate and multivariate analyses were carried out to verify the relationship between disease clusters and independent variables, utilizing Poisson's regression with robust variance, considering a 95% confidence interval. Cluster analysis revealed four disease clusters:cardiometabolic diseases/cancer, mental/occupational diseases, musculoskeletal diseases and respiratory diseases, all significantly associated with the female gender, current/past smoking habits and overweight/obesity in multivariate analyses. These aspects must be considered when planning health services and developing strategies and guidelines for the prevention and treatment of multiple chronic conditions.
Collapse
Affiliation(s)
- Januse Nogueira de Carvalho
- Graduate Program in Collective Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | | | - Dyego Leandro Bezerra de Souza
- Graduate Program in Collective Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- * E-mail:
| |
Collapse
|
25
|
The association of multimorbidity with healthcare expenditure among the elderly patients in Beijing, China. Arch Gerontol Geriatr 2018; 79:32-38. [PMID: 30086414 DOI: 10.1016/j.archger.2018.07.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 06/10/2018] [Accepted: 07/11/2018] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To add evidence to the relationship between multimorbidity and healthcare expenditure. METHODS The study population comprised patients aged ≥60 in Beijing, covered by the Urban Employee Basic Medical Insurance (UEBMI) (N = 30,774). Multimorbidity was measured with 33 chronic conditions confirmed by doctors. Multivariate linear regression was performed. RESULTS The prevalence of multimorbidity was 82% among elderly patients in Beijing and was higher in older and female patients. About 95% of the healthcare expenditure on the 33 conditions was spent on multimorbid patients. In the multivariate analysis, after inclusion of demographic characteristics, disease severity, and health facility level, the expenditure increased significantly with the number of chronic conditions. After further including condition types, the coefficients of the number of conditions were much lower than those in previous models. The expenditure on patients with two and three conditions was 3.4 times (95% CI: 3.2-3.7) and 5.3 times (95% CI: 4.7-6.0) higher than that on patients with a single condition, respectively; however, the expenditure did not significantly increase after three conditions. CONCLUSIONS Multimorbidity is common among elderly patients in Beijing and consumes the majority of the healthcare resources. The health delivery system in China and other low- and middle-income countries needs to pay more attention to multimorbidity.
Collapse
|
26
|
Liang Y, Xu X, Yin M, Li Y, Zhang Y, Huang L, Ni J. A more comprehensive investigation of disability and associated factors among older adults receiving home-based care in rural Dongguan, China. BMC Geriatr 2018; 18:158. [PMID: 29976138 PMCID: PMC6034336 DOI: 10.1186/s12877-018-0852-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 06/27/2018] [Indexed: 12/19/2022] Open
Abstract
Background No previous study has evaluated disability in older persons according to the International Classification of Functioning, Disability and Health Framework guidelines. We conducted a more comprehensive investigation of disability and associated factors among older adults receiving home-based care in rural Dongguan, a city in the central Guangdong Province of Southern China. Methods A total of 819 individuals aged ≥60 years were recruited from Dongguan home-based care system of via a two-stage selection process. We interviewed participants and assessed their ability level using the Ability Assessment for Older Adults, which defined by a combination of activity of daily living, sensory perception, mental status and social involvement. Conditional probability and Logistic regression approaches were used to assess the strength of association between each pair of conditions. Factors significantly associated with disability were identified via χ2 tests and multinomial ordinal logistic regression. Results Of the 819 included participants (mean age 87 ±4.7 years), 75.5% were female, 76.7% had any disability, and 62.3% had a mild disability. The occurrence of any deficits significantly increased the likelihood of the co-occurrence of other deficits (odds ratio [OR] > 1, P < 0.05), with the lowest prevalence odds ratio observed among individuals with sensory and communication deficiency (OR: 2.99; 95% confidence interval [CI]: 2.21–4.05). Multivariable ordinal logistic regression analysis indicated that physical activity (OR: 0.96; 95% CI: 0.93–0.99), sedentary behavior (OR: 1.25; 95% CI: 1.13–1.38), not watching television (OR: 1.7; 95% CI: 1.07–2.72) and age (OR: 1.09; 95% CI: 1.02–1.17) were significantly associated with disability. Conclusions Impairment of ADL, sensory perception, mental status or social involvement increased the likelihood of risk of the co-occurrence of other deficits. Comprehensive disability among older adults receiving home-based care is associated with age, sedentariness, physical activity and TV viewing. Electronic supplementary material The online version of this article (10.1186/s12877-018-0852-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Yaping Liang
- Department of Epidemiology and Biostatistics, Dongguan Key Laboratory of Environmental Medicine, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Xiaojia Xu
- Department of Epidemiology and Biostatistics, Dongguan Key Laboratory of Environmental Medicine, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Mingjuan Yin
- Department of Epidemiology and Biostatistics, Dongguan Key Laboratory of Environmental Medicine, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Yulian Li
- Da Lang Community Health Service Center, Dongguan, China
| | - Yan Zhang
- Department of Epidemiology and Biostatistics, Dongguan Key Laboratory of Environmental Medicine, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Lingfeng Huang
- Department of Epidemiology and Biostatistics, Dongguan Key Laboratory of Environmental Medicine, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Jindong Ni
- Department of Epidemiology and Biostatistics, Dongguan Key Laboratory of Environmental Medicine, School of Public Health, Guangdong Medical University, Dongguan, China.
| |
Collapse
|
27
|
Canevelli M, Remiddi F, Mjekaj S, Vanacore N, Bruno G, Cesari M. Agreement between diseases-centered and multidimensional models of care in disadvantaged settings. Eur J Intern Med 2018; 52:e32-e34. [PMID: 29625776 DOI: 10.1016/j.ejim.2018.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 03/26/2018] [Indexed: 11/22/2022]
Affiliation(s)
- Marco Canevelli
- Department of Human Neuroscience, "Sapienza" University of Rome, Roma, Italy.
| | - Francesca Remiddi
- Department of Human Neuroscience, "Sapienza" University of Rome, Roma, Italy
| | - Sebastjan Mjekaj
- Departamenti Infermieri, Universiteti i Shkodrës "Luigj Gurakuqi", Shkodër, Albania
| | - Nicola Vanacore
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Giuseppe Bruno
- Department of Human Neuroscience, "Sapienza" University of Rome, Roma, Italy
| | - Matteo Cesari
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy; Geriatric Unit, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
| |
Collapse
|
28
|
Jantsch AG, Alves RFS, Faerstein E. Educational inequality in Rio de Janeiro and its impact on multimorbidity: evidence from the Pró-Saúde study. A cross-sectional analysis. SAO PAULO MED J 2018; 136:51-58. [PMID: 29513787 PMCID: PMC9924166 DOI: 10.1590/1516-3180.2017.0209100917] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 09/10/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Information about multimorbidity is scarce in developing countries. This study aimed to estimate the association of educational attainment with occurrences of multimorbidity in a population of public employees on university campuses in Rio de Janeiro. DESIGN AND SETTING We conducted cross-sectional analyses on baseline data (1999-2001) from 3,253 participants in the Pró-Saúde study, conducted in Brazil. METHODS The prevalence of multimorbidity, defined as a self-reported history of medical diagnoses of two or more chronic conditions, was estimated according to sex, age, smoking, obesity and educational level. The association between education and multimorbidity was estimated using odds ratios (OR) and the relative and slope indices of inequality, in order to quantify the degree of educational inequality among individuals with multimorbidity in this population. RESULTS Greater age, female sex, smoking and obesity had direct associations with multimorbidity; and tobacco exposure and obesity also showed direct relationships with poorer educational level. There was a monotonic inverse linear trend between educational level and the presence of multimorbidity among women, with twice the odds (OR 2.47; 95% confidence interval, CI: 1.42-4.40) between extremities of schooling categories. There was excess multimorbidity of 22% at the lowest extremity of schooling, thus showing that women with worse educational status were more affected by the outcome. No trend and no excess multimorbidity was seen among men. CONCLUSIONS Educational inequality is an important determinant for development of multimorbidity. Men and women experience its effect differently. Researchers need to consider that sex may be an effect modifier in multimorbidity studies.
Collapse
Affiliation(s)
- Adelson Guaraci Jantsch
- MD, MSc. Doctoral Student, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro (UERJ), and Coordinator, Residency Program in Family and Community Medicine, Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro (RJ), Brazil.
| | - Ronaldo Fernandes Santos Alves
- MSc. Doctoral Student, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro (RJ), Brazil.
| | - Eduardo Faerstein
- MSc, PhD. Associate Professor, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro (RJ), Brazil.
| |
Collapse
|
29
|
Islam MA, Khan MFH, Quee PJ, Snieder H, van den Heuvel ER, Bruggeman R, Alizadeh BZ. Familial liability to psychosis is a risk factor for multimorbidity in people with psychotic disorders and their unaffected siblings. Eur Psychiatry 2017; 45:81-89. [PMID: 28750277 DOI: 10.1016/j.eurpsy.2017.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 05/01/2017] [Accepted: 05/03/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Multimorbidity may impose an overwhelming burden on patients with psychosis and is affected by gender and age. Our aim is to study the independent role of familial liability to psychosis as a risk factor for multimorbidity. METHODS We performed the study within the framework of the Genetic Risk and Outcome of Psychosis (GROUP) project. Overall, we compared 1024 psychotic patients, 994 unaffected siblings and 566 controls on the prevalence of 125 lifetime diseases, and 19 self-reported somatic complaints. Multimorbidity was defined as the presence of two or more complaints/diseases in the same individual. Generalized linear mixed model (GLMM) were used to investigate the effects of gender, age (adolescent, young, older) and familial liability (patients, siblings, controls) and their interactions on multimorbidity. RESULTS Familial liability had a significant effect on multimorbidity of either complaints or diseases. Patients had a higher prevalence of multimorbidity of complaints compared to siblings (OR 2.20, 95% CI 1.79-2.69, P<0.001) and to controls (3.05, 2.35-3.96, P<0.001). In physical health multimorbidity, patients (OR 1.36, 95% CI 1.05-1.75, P=0.018), but not siblings, had significantly higher prevalence than controls. Similar finding were observed for multimorbidity of lifetime diseases, including psychiatric diseases. Significant results were observed for complaints and disease multimorbidity across gender and age groups. CONCLUSION Multimorbidity is a common burden, significantly more prevalent in patients and their unaffected siblings. Familial liability to psychosis showed an independent effect on multimorbidity; gender and age are also important factors determining multimorbidity.
Collapse
Affiliation(s)
- M A Islam
- University Center for Psychiatry, Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Statistics, Shahjalal University of Science and Technology, Sylhet 3114, Bangladesh.
| | - M F H Khan
- University Center for Psychiatry, Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - P J Quee
- University Psychiatric Centre (UPC), KU Leuven, campus Kortenberg, Leuven, Belgium
| | - H Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - E R van den Heuvel
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - R Bruggeman
- University Center for Psychiatry, Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - B Z Alizadeh
- University Center for Psychiatry, Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | |
Collapse
|
30
|
Jacobs B, de Groot R, Fernandes Antunes A. Financial access to health care for older people in Cambodia: 10-year trends (2004-14) and determinants of catastrophic health expenses. Int J Equity Health 2016; 15:94. [PMID: 27316716 PMCID: PMC4912821 DOI: 10.1186/s12939-016-0383-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 06/13/2016] [Indexed: 01/10/2023] Open
Abstract
Background Older people make up an increasing proportion of the population in low- and middle-income countries. This brings a number of challenges, as their health needs are greater than, and different from, those of younger people. In general, these health systems are not geared to address their needs, and traditional support systems tend to erode, potentially causing financial hardship when accessing health care. This paper provides an overview of older Cambodians’ financial access to health care over time, using nationally representative data to enable the formulation of appropriate responses. Methods Using data from three nationally representative household surveys from 2004, 2009 and 2014, we assess key indicators of financial access to health care for households with older people (aged 60 years or older), and compare these with households without older members. For 2014 data, the determinants of catastrophic health expenses at the 10 and 40 % threshold were determined for older people. Data was stratified by age and place of residence (urban/rural), and analysed using Stata statistical software. Sample weights were calibrated to reflect accurate population composition at the time of the survey. Monetary values for 2004 and 2009 were transformed into 2014 values using annual inflation rate figures. Results Care-seeking when sick among older people increased considerably from 2004 to 2014, irrespective of gender or place of residence. There were positive trends in the incidence of catastrophic and impoverishing healthcare expenses over the studied time periods. This was also the case for indebtedness. Rural households with older people were considerable more likely to suffer financial hardship due to health-related expenses than their urban equivalents. In 2014, older people spent 50 % more per month on health care than younger people. Determinants of catastrophic health expenditures among households with older people were residing in a rural area, and having a household member with an illness, especially a non-communicable disease. Conclusion In order to make health care more equitable for older people, efforts should be directed to rural areas. Interventions should include improving management of non-communicable diseases at the primary care level, together with a reconfiguration of social health protection schemes to increase the inclusion of older people.
Collapse
Affiliation(s)
- Bart Jacobs
- Social Health Protection Programme, Deutsche Gesellschaft für Internationale Zusammenarbeit (GiZ), c/o NIPH, No.2, Street 289, Khan Toul Kork, P.O. Box 1238, Phnom Penh, Cambodia.
| | | | | |
Collapse
|