Multimorbidity matters in low and middle-income countries

Basto-Abreu, Ana; Barrientos‐Gutiérrez, Tonatiuh; Wade, Alisha N.; Melo, Daniela Oliveira de; Souza, Ana Sara Semeão de; Nunes, Bruno Pereira; Arokiasamy, Perianayagam; Tian, Maoyi; Yan, Lijing L.; Ghosh, Arpita; Miranda, J. Jaime

doi:10.1177/26335565221106074

Cited by 43 publications

(45 citation statements)

References 87 publications

(121 reference statements)

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“…A process through which clinicians can refer patients for community support from local, non-clinical services. Research priorities on multimorbidity sensitive to LMIC contexts 45,312 Research priority 1: what are the trends and patterns in multimorbidity?…”

Section: Social Prescribingmentioning

confidence: 99%

Multimorbidity

Skou

Mair

Fortin

et al. 2022

Nat Rev Dis Primers

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363

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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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Section: Social Prescribingmentioning

confidence: 99%

Multimorbidity

Skou

Mair

Fortin

et al. 2022

Nat Rev Dis Primers

Self Cite

363

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“…Multimorbidity is more common in high income countries as well as low and middle-income nations (LMIC) (38% vs. 30%, respectively) [ 14 , 15 ] and has been studied in many large reviews [ 16 , 17 ]. However, the majority of Middle Eastern research to date has focused on a single, specific condition or the coexistence of a relatively small number of diseases, such as cancer, diabetes, obesity, and cardiovascular disorders.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Multimorbidity in the Middle East: A Systematic Review of Observational Studies

Singh

Alomari

Lenjawi

2022

IJERPH

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Background: There has not been a review that evaluated the prevalence of multimorbidity in the Middle East. This review aims to measure the prevalence, demographic factors, and consequences of multimorbidity in the Middle East region. Study Design: A quantitative systematic review includes cross-sectional and longitudinal cohort studies. Methods: The prevalence systematic review approach from the Joanna Briggs Institute was applied. We searched PsychINFO, MEDLINE, EMCARE, CINAHL, Scopus, Science Direct, and the Cochrane Central Register of Controlled Trials. Data were extracted methodically in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Studies written in English and released between 2012 and March 2022 were included. For the meta-analysis, a random-effects model was applied. PROSPERO registration number: CRD42022335534. Results: The final sample consisted of eight cohort and observational studies. The number of participants varied from 354 to 796,427. Multimorbidity was present in all populations with a prevalence of 21.8% (95% confidence interval (CI): 21.7–21.8%). Conclusion: Multimorbidity affects a significant section of the world’s population. A uniform operationalization of multimorbidity is required in the Middle East in order to enable reliable estimates of illness burden, effective disease management, and resource distribution.

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“…obesity, physical inactivity) continue to rise globally, the burden of multimorbidity is expected to increase (Academy of Medical Sciences 2018). This has implications for individuals and health systems worldwide, but particularly in low-and middle-income countries (LMICs), which already face a large burden of NCD-related deaths (Basto-Abreu et al 2022). Existing research on multimorbidity has been highly concentrated in high-income countries (HICs), but the literature on multimorbidity in LMICs is expanding, with several studies recently published (Abebe et al 2020;Chang et al 2019;Kamkuemah et al 2022;Keetile et al 2020;Khorrami et al 2020;Roomaney et al 2021;Sharman and Bachmann 2019).…”

Section: Introductionmentioning

confidence: 99%

“…Abreu et al 2022). There is a need to redesign health systems to properly care for patients with multimorbidity, and to overcome the structural inequalities that discourage and prevent certain groups of people from accessing health services.…”

mentioning

confidence: 99%