Multimorbidity and care for hypertension, diabetes and HIV among older adults in rural South Africa

Abstract

ObjectiveTo examine how multimorbidity might affect progression along the continuum of care among older adults with hypertension, diabetes and human immunodeficiency virus (HIV) infection in rural South Africa.MethodsWe analysed data from 4447 people aged 40 years or older who were enrolled in a longitudinal study in Agincourt sub-district. Household-based interviews were completed between November 2014 and November 2015. For hypertension and diabetes (2813 and 512 people, respectively), we defined concordant conditions as other cardiometabolic conditions, and discordant conditions as mental disorders or HIV infection. For HIV infection (1027 people) we defined any other conditions as discordant. Regression models were fitted to assess the relationship between the type of multimorbidity and progression along the care continuum and the likelihood of patients being in each stage of care for the index condition (four stages from testing to treatment).FindingsPeople with hypertension or diabetes plus other cardiometabolic conditions were more like to progress through the care continuum for the index condition than those without cardiometabolic conditions (relative risk, RR: 1.14, 95% confidence interval, CI: 1.09–1.20, and RR: 2.18, 95% CI: 1.52–3.26, respectively). Having discordant comorbidity was associated with greater progression in care for those with hypertension but not diabetes. Those with HIV infection plus cardiometabolic conditions had less progress in the stages of care compared with those without such conditions (RR: 0.86, 95% CI: 0.80–0.92).ConclusionPatients with concordant conditions were more likely to progress further along the care continuum, while those with discordant multimorbidity tended not to progress beyond diagnosis.

Epidemiology of multimorbidity in conditions of extreme poverty: a population-based study of older adults in rural Burkina Faso

“…However, these findings also indicate that discordant multimorbidity is no different to concordant multimorbidity in its association with poor individual outcomes, when controlling for number of conditions. This is in contrast with what has been found previously with patients with discordant multimorbidities typically having poorer health-related quality of life and worse clinical outcomes 6 13 58. Interestingly, we found that people who have multimorbidity with only MH conditions or multimorbidity with MH conditions and NCDs have worse outcomes than those with only NCDs.…”

“…A reason for this could be that people with NCDs have greater access to healthcare and have their needs addressed more thoroughly than people with MH conditions 59. A previous paper from South Africa found that patterns of multimorbidity affect healthcare utilisation, potentially supporting our hypothesis;13 however, this finding needs to be explored in further studies.…”

“…Although there have been studies on multimorbidity in lower-middle income countries most of them have been done in upper-middle income countries. In sub-Saharan Africa, these have mainly been conducted in South Africa,12 13 which is an upper-middle-income country with a relatively well-developed health system 14. There is very little information about who is affected by multimorbidity in other countries in sub-Saharan Africa, where many of the least developed countries with the world’s poorest populations and most under-resourced health systems are found.…”

“…The WHO defines multimorbidity as the coexistence of two or more chronic conditions 29. However, it has also been described as the count of conditions, two or more conditions in the disease domains of communicable, non-communicable or MH, and has been further subdivided into discordant (more than two conditions in different domains) or concordant (more than two conditions in the same domain) multimorbidity 6 13. Showing the relationships between multimorbidity using these definitions and functional outcomes in one of the poorest countries in the world is useful to policy makers, funders and researchers.…”

The patterns of Non-communicable disease Multimorbidity in Iran: A Multilevel Analysis

“…The mean prevalence of multimorbidity was 7.8% in 28 developing open Scientific RepoRtS | (2020) 10:3034 | https://doi.org/10.1038/s41598-020-59668-y www.nature.com/scientificreports www.nature.com/scientificreports/ countries in 2015 7 . NCD multimorbidity may occur 10-15 years earlier in individuals living in developing countries 8 and as mean population age increases, the growing prevalence of NCD multimorbidity has led to decreased quality of life among these patients [9][10][11] . Multimorbidity is already, and will be in the future, a great challenge for both developed and developing countries 12 .On the basis of WHO estimates, by 2050, Iran, as a developing country will have a high proportion of old citizens 13 .…”