Background

• Chronic diseases are a significant public health issue in low- and middle-income countries (LMICs), contributing greatly to disease burden.

• Multimorbidity refers to the co-occurrence of two or more chronic conditions, which is increasingly common among both older and younger adults.

• Socioeconomic status (SES) is strongly correlated with the prevalence of multimorbidity, with lower SES leading to higher prevalence of chronic diseases.

Study Objectives

1. To assess the prevalence and SES correlates of multimorbidity among adults in LMICs.

2. To explore associations between multimorbidity and health outcomes: self-rated health (SRH), activities of daily living (ADLs), depression, and quality of life.

Methods

• Data Source: WHO’s Study on global AGEing and adult health (SAGE), Wave 1 (2007-2010), a cross-sectional survey covering six LMICs: China, Ghana, India, Mexico, Russia, and South Africa.

• Sample Size: 42,236 adults aged 18 and older.

• Chronic Conditions Assessed: Angina pectoris, arthritis, asthma, chronic lung disease, diabetes mellitus, hypertension, stroke, and vision impairment.

• Statistical Analysis: Random-intercept multilevel regression models applied on pooled data from six countries to analyze associations with health outcomes.

Key Findings

• Prevalence of Conditions: 54.2% had at least one chronic disease, and 21.9% had multimorbidity. Highest prevalence of multimorbidity observed in Russia (34.7%), while China had the lowest (20.3%).

• Health Outcome Measures: 14% of participants had one or more ADL limitations, 5.7% reported depression, and 11.6% reported poor SRH. Mean WHOQoL score was 54.4.

• Age and SES Correlations: Older age groups had a higher likelihood of multimorbidity, with lower SES associated with higher prevalence.

Health Outcomes Related to Multimorbidity

• ADL Limitations: Increased with more chronic conditions; 58.7% of those with four or more conditions had ADL limitations compared to only 7.1% of those with no conditions.

• Depression: Prevalence increased significantly with chronic conditions, reaching 27% among those with four or more chronic diseases.

• Self-Rated Health (SRH): Poor SRH increased from 5.8% amongst those with no chronic conditions to 50% for those with four or more conditions.

• Quality of Life (WHOQoL): Declined with an increasing number of chronic diseases; scores ranged from 57.0 in those with no diseases to 43.3 for those with four or more.

Socioeconomic Status Associations

• Low education and household wealth were consistently associated with higher prevalence of multimorbidity and poorer health outcomes.

• For example, the prevalence of multimorbidity was 35.2% for those with no formal education compared to 16% among those with 10+ years of schooling.

Discussion

• The findings highlight the urgent need for LMICs to address the growing burden of multimorbidity among older adults, particularly focusing on lower SES populations.

• Health care systems must adapt, shifting resources towards chronic disease management and integrated healthcare models to effectively address the complications of multimorbidity.

• Further research is needed to explore paths for mitigating the health impacts of multimorbidity and improving service accessibility in LMICs.