Multimorbidity in Latin America and the Caribbean: a systematic review and meta-analysis

Huaquía-Díaz, Alessandra M; Chalán-Dávila, Tarick S; Carrillo‐Larco, Rodrigo M.; Bernabé‐Ortiz, Antonio

doi:10.1136/bmjopen-2021-050409

Cited by 18 publications

(18 citation statements)

References 42 publications

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“…The prevalences found alert to the extent of multimorbidity in Brazil, which may be close to high-income countries with longer life expectancies, such as Portugal [ 42 ], Finland, Spain, and Poland [ 8 ]. Meanwhile, our prevalence was higher than those reported in analyses of the overall population of Latin America and the Caribbean, regarding both combined prevalence (43%; CI: 35%-51%) and combined prevalence excluding Brazilian studies (35%; CI: 26%-43%) [ 43 ].…”

Section: Discussioncontrasting

confidence: 69%

Racial inequalities in multimorbidity: baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

et al. 2022

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Background Evidence of multimorbidity has come mainly from high-income regions, while disparities among racial groups have been less explored. This study examined racial differences in multimorbidity in the multiracial cohort of the Longitudinal Study of Adult Health (Estudo Longitudinal de Saúde do Adulto), ELSA-Brasil. Methods The study examined baseline (2008–2010) data for 14 099 ELSA-Brasil participants who self-reported being white, mixed-race, or black. A list of 16 morbidities was used to evaluate multimorbidity, operationalised by simple count into ≥ 2, ≥ 3, ≥ 4, ≥ 5 and ≥ 6 morbidities, in addition to evaluating the number of coexisting conditions. Prevalence ratios (PR) were estimated from logistic models and a quantile model was used to examine racial differences graphically in the distribution quantiles for the number of morbidities. Results Overall prevalence of multimorbidity (≥ 2 morbidities) was 70% and, after controlling for age and sex, was greater among mixed-race and black participants – by 6% (PR: 1.06; 95% CI: 1.03–1.08) and 9% (PR: 1.09; 95% CI: 1.06–1.12), respectively – than among white participants. As the cutoff value for defining multimorbidity was raised, so the strength of the association increased, especially among blacks: if set at ≥ 6 morbidities, the prevalence was 27% greater for those of mixed-race (PR: 1.27; 95% CI: 1.07–1.50) and 47% greater for blacks (PR: 1.47; 95% CI: 1.22–1.76) than for whites. The disparities were smaller in the lower morbidity distribution quantiles and larger in the upper quantiles, indicating a heavier burden of disease, particularly on blacks. Conclusions Multimorbidity was common among adults and older adults in a Brazilian cohort, but important racial inequalities were found. Raising the cutoff point for defining multimorbidity revealed stronger associations between race/skin colour and multimorbidity, indicating a higher prevalence of multimorbidity among mixed-race and black individuals than among whites and that the former groups coexisted more often with more complex health situations (with more coexisting morbidities). Interventions to prevent and manage the condition of multimorbidity that consider the social determinants of health and historically discriminated populations in low- and middle-income regions are necessary.

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Section: Discussioncontrasting

confidence: 69%

Racial inequalities in multimorbidity: baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

et al. 2022

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“…Globally, about one-third of adults 64 , including a substantial proportion in LMICs [65][66][67] , and more than half of all adults with any chronic condition 19 have multimorbidity 25 . Systematic reviews focusing on community-based studies in both high-income countries (HICs) and LMICs have found a prevalence of 15-43% 28,64,68,69 . A scoping review in LMICs found a prevalence of 3% to 68% in adults, with most of the evidence from Brazil, China, South Africa, India, Mexico and Iran 70 , and 43% in adults in Latin America and the Caribbean 68 .…”

Section: Prevalencementioning

confidence: 99%

“…Systematic reviews focusing on community-based studies in both high-income countries (HICs) and LMICs have found a prevalence of 15-43% 28,64,68,69 . A scoping review in LMICs found a prevalence of 3% to 68% in adults, with most of the evidence from Brazil, China, South Africa, India, Mexico and Iran 70 , and 43% in adults in Latin America and the Caribbean 68 . Prevalence estimates are generally lower in LMICs than in HICs (Fig.…”

Section: Prevalencementioning

confidence: 99%

Multimorbidity

Skou

Mair

Fortin

et al. 2022

Nat Rev Dis Primers

284

283

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Interest in multimorbidity -commonly defined as the co-occurrence of at least two chronic conditions in the same individual 1 -has increased in the past few years owing to its substantial effect on the individual and the individual's family, as well as on health systems and on society, particularly in resource-poor settings 2-4 . Multimorbidity is distinct from the related concept of comorbidity, which refers to the combined effects of additional conditions in relation to the index condition in an individual [5][6][7][8] . By contrast, care for multimorbidity is patient-centred and does not routinely give priority to any single condition, although in clinical care, patients and clinicians will usually focus on the most pressing problems that the patient is experiencing.People with multimorbidity are more likely to die prematurely, be admitted to hospital and have an increased length of stay than people with a single chronic condition 9,10 . Multimorbidity is also associated with poorer function and health-related quality of life (HRQOL), depression and intake of multiple drugs (polypharmacy) and greater socioeconomic costs [11][12][13][14][15][16][17][18] . Most health care is designed to treat individual conditions rather than providing comprehensive, person-centred care 2,19,20 , which often leads to fragmented and sometimes contradictory care for people with multimorbidity and increases their treatment burden 21 Moreover, treating one condition at a time is inefficient and unsatisfactory for both people with multimorbidity and their health-care providers [22][23][24] .Multimorbidity is increasingly common owing to changes in lifestyle risk factors, notably physical inactivity and obesity, and population ageing that in part reflects improvements in survival from acute and chronic conditions 2,19,25,26 . Multimorbidity is associated with socioeconomic status and age 3,19,25,27 . However, although age is the strongest driver of multimorbidity, in absolute numbers, more people <65 years of age have multimorbidity than people ≥65 years of age, partly because more people in the general population are in that age group. Moreover, this emphasizes that multimorbidity is not just a feature of ageing 19,26 .Multimorbidity is further complicated in low-income and middle-income countries (LMICs) by the overlap of compounding factors, including adverse environmental and early life stressors linked to poverty, limited social infrastructure and poorer family coping mechanisms, that translate into chronic diseases occurring at earlier ages [28][29][30][31] . LMICs also have a higher prevalence of multimorbidity-related financial burden 32,33 and have weaknesses in health systems including a greater focus Treatment burdenThe workload associated with managing treatments and health-care recommendations and the impact of this on an individual and their supporters.

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“…According to the reviews of Abebe et al the prevalence of multimorbidity in LMICs has increased from 3.2 to 67.8% among people over 18 years old (8). Metaanalyses have shown a 43% of prevalence of multimorbidity of chronic conditions in Latin America and the Caribbean (9,10). Yao et al have shown that multimorbidity occurred in 42.4% of the participants aged at least 50 years in China in 2011-2015 (11).…”

Section: Introductionmentioning

confidence: 99%

Effects of potential risk factors on the development of cardiometabolic multimorbidity and mortality among the elders in China

Zhang

Duan

Rong

et al. 2022

Front. Cardiovasc. Med.

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ObjectivesTo examine the impact of demographic, socioeconomic, and behavioral factors on the development of cardiometabolic multimorbidity and mortality in Chinese elders.MethodsData from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) 2002–2018 was used in the study. Cardiometabolic multimorbidity was defined as the presence of two or more cardiometabolic disorders, such as hypertension, diabetes, cardiovascular disease (CVD), heart disease, or stroke. Cox regression model and multi-state Markov model were developed to evaluate the association of the study factors with the progression of cardiometabolic conditions and mortality. The outcomes included three states (first cardiometabolic disease, cardiometabolic multimorbidity, and all-cause mortality) and five possible transitions among the three states.ResultsOf the 13,933 eligible individuals, 7,917 (56.8%) were female, and 9,540 (68.50%) were over 80 years old. 2,766 (19.9%) participants had their first cardiometabolic disease, 975 (7.0%) participants suffered from cardiometabolic multimorbidity, and 9,365 (67.2%) participants died. The progression to cardiometabolic multimorbidity was positively associated with being female (HR = 1.42; 95%CI, 1.10 − 1.85), living in the city (HR = 1.41; 95%CI, 1.04 − 1.93), overweight (HR = 1.43; 95%CI, 1.08 − 1.90), and obesity (HR = 1.75; 95% CI, 1.03 − 2.98). A higher risk for the first cardiometabolic disease was associated with being female (HR = 1.26; 95% CI, 1.15 − 1.39), higher socioeconomic status (SES, HR = 1.17; 95%CI, 1.07 − 1.28), lack of regular physical activity (HR = 1.13; 95%CI, 1.04 − 1.23), smoking (HR = 1.20; 95%CI, 1.08 − 1.33), ≤ 5 h sleep time (HR = 1.15; 95%CI, 1.02 − 1.30), overweight (HR = 1.48; 95% CI, 1.32 − 1.66), and obesity (HR = 1.34; 95%CI, 1.06 − 1.69). It also should be noted that not in marriage, lower SES and unhealthy behavioral patterns were risk factors for mortality.ConclusionThis study emphasized the importance of lifestyle and SES in tackling the development of cardiometabolic conditions among Chinese elders and provided a reference for policy-makers to develop a tailored stage-specific intervention strategy.

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Multimorbidity in Latin America and the Caribbean: a systematic review and meta-analysis

Cited by 18 publications

References 42 publications

Racial inequalities in multimorbidity: baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Racial inequalities in multimorbidity: baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Multimorbidity

Effects of potential risk factors on the development of cardiometabolic multimorbidity and mortality among the elders in China

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