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The impact of multimorbidity on adult physical and mental health in low-and middle-income countries: what does the study on global ageing and adult health (SAGE) reveal?

The impact of multimorbidity on adult physical and mental health in low-and middle-income countries: what does the study on global ageing and adult health (SAGE) reveal?
The impact of multimorbidity on adult physical and mental health in low-and middle-income countries: what does the study on global ageing and adult health (SAGE) reveal?
BACKGROUND: Chronic diseases contribute a large share of disease burden in low- and middle-income countries (LMICs). Chronic diseases have a tendency to occur simultaneously and where there are two or more such conditions, this is termed as 'multimorbidity'. Multimorbidity is associated with adverse health outcomes, but limited research has been undertaken in LMICs. Therefore, this study examines the prevalence and correlates of multimorbidity as well as the associations between multimorbidity and self-rated health, activities of daily living (ADLs), quality of life, and depression across six LMICs.

METHODS: Data was obtained from the WHO's Study on global AGEing and adult health (SAGE) Wave-1 (2007/10). This was a cross-sectional population based survey performed in LMICs, namely China, Ghana, India, Mexico, Russia, and South Africa, including 42,236 adults aged 18 years and older. Multimorbidity was measured as the simultaneous presence of two or more of eight chronic conditions including angina pectoris, arthritis, asthma, chronic lung disease, diabetes mellitus, hypertension, stroke, and vision impairment. Associations with four health outcomes were examined, namely ADL limitation, self-rated health, depression, and a quality of life index. Random-intercept multilevel regression models were used on pooled data from the six countries.

RESULTS: The prevalence of morbidity and multimorbidity was 54.2 % and 21.9 %, respectively, in the pooled sample of six countries. Russia had the highest prevalence of multimorbidity (34.7 %) whereas China had the lowest (20.3 %). The likelihood of multimorbidity was higher in older age groups and was lower in those with higher socioeconomic status. In the pooled sample, the prevalence of 1+ ADL limitation was 14 %, depression 5.7 %, self-rated poor health 11.6 %, and mean quality of life score was 54.4. Substantial cross-country variations were seen in the four health outcome measures. The prevalence of 1+ ADL limitation, poor self-rated health, and depression increased whereas quality of life declined markedly with an increase in number of diseases.

CONCLUSIONS: Findings highlight the challenge of multimorbidity in LMICs, particularly among the lower socioeconomic groups, and the pressing need for reorientation of health care resources considering the distribution of multimorbidity and its adverse effect on health outcomes.
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Arokiasamy, Perianayagam
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Uttamacharya, Uttamacharya
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Jain, Kshipra
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Biritwum, Richard Berko
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Yawson, Alfred Edwin
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Wu, Fan
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Guo, Yanfei
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Maximova, Tamara
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Espinoza, Betty Manrique
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Salinas Rodríguez, Aarón
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Afshar, Sara
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Pati, Sanghamitra
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Ice, Gillian
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Banerjee, Sube
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Liebert, Melissa A.
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Snodgrass, James Josh
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Naidoo, Nirmala
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Chatterji, Somnath
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Kowal, Paul
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Arokiasamy, Perianayagam
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Uttamacharya, Uttamacharya
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Jain, Kshipra
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Biritwum, Richard Berko
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Yawson, Alfred Edwin
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Wu, Fan
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Guo, Yanfei
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Maximova, Tamara
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Espinoza, Betty Manrique
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Salinas Rodríguez, Aarón
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Afshar, Sara
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Pati, Sanghamitra
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Ice, Gillian
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Banerjee, Sube
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Liebert, Melissa A.
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Snodgrass, James Josh
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Naidoo, Nirmala
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Chatterji, Somnath
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Kowal, Paul
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Arokiasamy, Perianayagam, Uttamacharya, Uttamacharya, Jain, Kshipra, Biritwum, Richard Berko, Yawson, Alfred Edwin, Wu, Fan, Guo, Yanfei, Maximova, Tamara, Espinoza, Betty Manrique, Salinas Rodríguez, Aarón, Afshar, Sara, Pati, Sanghamitra, Ice, Gillian, Banerjee, Sube, Liebert, Melissa A., Snodgrass, James Josh, Naidoo, Nirmala, Chatterji, Somnath and Kowal, Paul (2015) The impact of multimorbidity on adult physical and mental health in low-and middle-income countries: what does the study on global ageing and adult health (SAGE) reveal? BMC Medicine, 13, 1-16, [178]. (doi:10.1186/s12916-015-0402-8). (PMID:26239481)

Record type: Article

Abstract

BACKGROUND: Chronic diseases contribute a large share of disease burden in low- and middle-income countries (LMICs). Chronic diseases have a tendency to occur simultaneously and where there are two or more such conditions, this is termed as 'multimorbidity'. Multimorbidity is associated with adverse health outcomes, but limited research has been undertaken in LMICs. Therefore, this study examines the prevalence and correlates of multimorbidity as well as the associations between multimorbidity and self-rated health, activities of daily living (ADLs), quality of life, and depression across six LMICs.

METHODS: Data was obtained from the WHO's Study on global AGEing and adult health (SAGE) Wave-1 (2007/10). This was a cross-sectional population based survey performed in LMICs, namely China, Ghana, India, Mexico, Russia, and South Africa, including 42,236 adults aged 18 years and older. Multimorbidity was measured as the simultaneous presence of two or more of eight chronic conditions including angina pectoris, arthritis, asthma, chronic lung disease, diabetes mellitus, hypertension, stroke, and vision impairment. Associations with four health outcomes were examined, namely ADL limitation, self-rated health, depression, and a quality of life index. Random-intercept multilevel regression models were used on pooled data from the six countries.

RESULTS: The prevalence of morbidity and multimorbidity was 54.2 % and 21.9 %, respectively, in the pooled sample of six countries. Russia had the highest prevalence of multimorbidity (34.7 %) whereas China had the lowest (20.3 %). The likelihood of multimorbidity was higher in older age groups and was lower in those with higher socioeconomic status. In the pooled sample, the prevalence of 1+ ADL limitation was 14 %, depression 5.7 %, self-rated poor health 11.6 %, and mean quality of life score was 54.4. Substantial cross-country variations were seen in the four health outcome measures. The prevalence of 1+ ADL limitation, poor self-rated health, and depression increased whereas quality of life declined markedly with an increase in number of diseases.

CONCLUSIONS: Findings highlight the challenge of multimorbidity in LMICs, particularly among the lower socioeconomic groups, and the pressing need for reorientation of health care resources considering the distribution of multimorbidity and its adverse effect on health outcomes.

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Accepted/In Press date: 17 June 2015
e-pub ahead of print date: 3 August 2015
Published date: 3 August 2015
Organisations: Primary Care & Population Sciences

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Local EPrints ID: 390173
URI: http://eprints.soton.ac.uk/id/eprint/390173
PURE UUID: 41e57720-8679-492d-8d20-dbb1bcd48a4b

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Date deposited: 21 Mar 2016 15:41
Last modified: 14 Jul 2020 16:38

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Contributors

Author: Perianayagam Arokiasamy
Author: Uttamacharya Uttamacharya
Author: Kshipra Jain
Author: Richard Berko Biritwum
Author: Alfred Edwin Yawson
Author: Fan Wu
Author: Yanfei Guo
Author: Tamara Maximova
Author: Betty Manrique Espinoza
Author: Aarón Salinas Rodríguez
Author: Sara Afshar
Author: Sanghamitra Pati
Author: Gillian Ice
Author: Sube Banerjee
Author: Melissa A. Liebert
Author: James Josh Snodgrass
Author: Nirmala Naidoo
Author: Somnath Chatterji
Author: Paul Kowal

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