Multimorbidity of cardiometabolic diseases: a cross-sectional study of patterns, clusters and associated risk factors in sub-Saharan Africa

Otieno, Peter; Asiki, Gershim; Wekesah, Frederick; Wilunda, Calistus; Sanya, Richard E.; Wami, Welcome; Agyemang, Charles

doi:10.1136/bmjopen-2022-064275

Cited by 9 publications

(7 citation statements)

References 74 publications

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“…Similarly, our previous study on the patterns of cardiometabolic multimorbidity in sub-Saharan Africa identified the clustering of physical inactivity and obesity as one of the leading risk factors for cardiometabolic multimorbidity. However, the study did not include the clustering of cardiometabolic diseases with unrelated conditions such as arthritis, cataract and chronic respiratory diseases [ 54 ]. Importantly, the discordant multimorbidity clusters without well-established pathogeneses such as cardiometabolic diseases and arthritis identified in the current study should be studied in the future to elucidate the causal pathways.…”

Section: Discussionmentioning

confidence: 99%

Cardiometabolic multimorbidity and associated patterns of healthcare utilization and quality of life: Results from the Study on Global AGEing and Adult Health (SAGE) Wave 2 in Ghana

Otieno

Asiki

Wilunda

et al. 2023

PLOS Glob Public Health

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Understanding the patterns of multimorbidity, defined as the co-occurrence of more than one chronic condition, is important for planning health system capacity and response. This study assessed the association of different cardiometabolic multimorbidity combinations with healthcare utilization and quality of life (QoL). Data were from the World Health Organization (WHO) study on global AGEing and adult health Wave 2 (2015) conducted in Ghana. We analysed the clustering of cardiometabolic diseases including angina, stroke, type 2 diabetes, and hypertension with unrelated conditions such as asthma, chronic lung disease, arthritis, cataract and depression. The clusters of adults with cardiometabolic multimorbidity were identified using latent class analysis and agglomerative hierarchical clustering algorithms. We used negative binomial regression to determine the association of multimorbidity combinations with outpatient visits. The association of multimorbidity clusters with hospitalization and QoL were assessed using multivariable logistic and linear regressions. Data from 3,128 adults aged over 50 years were analysed. We identified four distinct classes of multimorbidity: relatively “healthy class” with no multimorbidity (47.9%): abdominal obesity only (40.7%): cardiometabolic and arthritis class comprising participants with hypertension, type 2 diabetes, stroke, abdominal and general obesity, arthritis and cataract (5.7%); and cardiopulmonary and depression class including participants with angina, chronic lung disease, asthma, and depression (5.7%). Relative to the class with no multimorbidity, the cardiopulmonary and depression class was associated with a higher frequency of outpatient visits [β = 0.3; 95% CI 0.1 to 0.6] and higher odds of hospitalization [aOR = 1.9; 95% CI 1.0 to 3.7]. However, cardiometabolic and arthritis class was associated with a higher frequency of outpatient visits [β = 0.8; 95% CI 0.3 to 1.2] and not hospitalization [aOR = 1.1; 95% CI 0.5 to 2.9]. The mean QoL scores was lowest among participants in the cardiopulmonary and depression class [β = -4.8; 95% CI -7.3 to -2.3] followed by the cardiometabolic and arthritis class [β = -3.9; 95% CI -6.4 to -1.4]. Our findings show that cardiometabolic multimorbidity among older persons in Ghana cluster together in distinct patterns that differ in healthcare utilization. This evidence may be used in healthcare planning to optimize treatment and care.

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Section: Discussionmentioning

confidence: 99%

Cardiometabolic multimorbidity and associated patterns of healthcare utilization and quality of life: Results from the Study on Global AGEing and Adult Health (SAGE) Wave 2 in Ghana

Otieno

Asiki

Wilunda

et al. 2023

PLOS Glob Public Health

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“…In this cross-sectional study, we recruited chronic disease patients who had been diagnosed at Seoul National University Hospital between October 2016 and February 2017. The inclusion criteria were as follows: aged ≥ 19 years, diagnosed with ≥ 1 chronic disease (hypertension 4 , 66 , hyperlipidemia 66 , diabetes 4 , 66 , chronic pulmonary disease 67 , 68 , chronic renal disease 69 , 70 , chronic arthritis 67 , 71 , or osteoporosis 4 , 5 ), visited the outpatient clinic at Seoul National University Hospital between October 2016 and February 2017 for treatment of chronic diseases, fluent in Korean, and willing to participate in this study. A total of 535 adults regularly visited the outpatient clinic for treatment of chronic diseases and completed self-report questionnaires between October 5, 2016 and February 28, 2017.…”

Section: Methodsmentioning

confidence: 99%

Health-promoting behavior to enhance perceived meaning and control of life in chronic disease patients with role limitations and depressive symptoms: a network approach

Yun

2023

Sci Rep

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The association between health-related role limitations in the mental and physical subdomains and clinical status (i.e., chronic disease and comorbid depressive symptoms) is mediated by health-promoting behaviors. To enhance health-promoting behaviors in adults with chronic disease, it is necessary to identify item-level associations among targets of health-related monitoring and management. Therefore, the current study used a network approach to examine associations among health-related role limitations, depressive symptoms, existential well-being, socioeconomic position, and health-promoting behavior in adults with chronic disease. A total of 535 adults (mean ± SD age = 62.9 ± 11.9 years; males, n = 231, females, n = 304) who were regularly visiting an outpatient clinic for chronic disease treatment participated in this cross-sectional study. Data on participant demographics, chronic disease diagnoses, socioeconomic status, health-related role limitations (12-item short form survey scores), depressive symptoms (patient health questionnaire-9 scores), existential well-being (scores for four items of the McGill quality of life questionnaire-Revised), and health-promoting behavior (Healthy Habits Questionnaire scores) were acquired. “Undirected regularized partial correlations” and “directional joint probability distributions” among these variables were calculated using a mixed graphical model (MGM) and directed acyclic graph (DAG). In the MGM, the most influential nodes were emotional well-being, feelings of failure, and health-related limitations affecting usual role and physical activities. According to both the MGM and DAG, the relationship between emotional well-being and feelings of failure mediated the relationships of health-related role limitations with concentration difficulty and suicidal ideation. A positive mindset was dependent on the probability distributions of suicidal ideation, controllability of life, and positive self-image. Both the meaning of life and a positive mindset had direct associations with proactive living. Specifically, proactive living was associated with a balanced diet, regular exercise, volunteering in the community, and nurturing intimacy in social interactions. The meaning and controllability of life in individuals with chronic diseases could mediate the relationships of health-promoting behavior with health-related limitations related to usual role activities, physical activities, and depressive symptoms. Thus, interventions targeting health-promoting behaviors should aim to enhance the meaning and controllability of life (as it pertains to limitations in usual role and physical activities), as well as promote proactive screening and timely psychiatric treatment of depressive symptoms including feelings of failure, concentration difficulties, and suicidal ideation.

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“…A systematic review of randomised controlled trials (RCTs) of integrated care for multimorbidity in children and adults in primary care in LMICs identified five RCTs, with only low-certainty evidence found for improvement in systolic blood pressure 27. In sub-Saharan Africa, there was moderate-grade evidence for integrated care models in primary care settings for people with cardiometabolic morbidity 28. A Cochrane review of the interventions for multimorbidity published in 2021 could not make strong recommendations for the care of people with multimorbidity but suggested that organisational changes that target specific problems and align with outcomes of interest specific to the patient could be successful and that more research was needed.…”

Section: Introductionmentioning

confidence: 99%

Interventions in adult patients with multimorbidity in low-income and middle-income countries: protocol for a mixed-methods systematic review

George,

Manski-Nankervis,

Klaic

et al. 2024

BMJ Open

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IntroductionMultimorbidity, the coexistence of two or more chronic conditions in the same individual, is a major public health problem in low-income and middle-income countries (LMICs). The use of single-disease guidelines contributes to polypharmacy, fragmented care and increased treatment burden. Health systems in LMICs are very different from those in high-income countries, and adapting interventions from one to the other may not be feasible. This review aims to systematically present the current evidence for interventions for multimorbidity in the LMIC setting.Methods and analysisIn this mixed-methods systematic review, we will include all studies of interventions for the care of adults (>18 years of age) with multimorbidity (defined as the presence of two or more chronic illnesses in an individual) in any healthcare organisation (primary, secondary or tertiary care) in an LMIC (as defined by the World Bank), published between 2000 and March 2023. All primary study designs will be included. Studies reported in languages other than English and those describing interventions classified as ‘financial’ or ‘governance arrangement’ according to the Cochrane Effective Practice and Organisation of Care classification will be excluded. MEDLINE, PubMed, Cochrane Library, TRIP, SCOPUS and the 3ie databases will be searched. The titles will be screened by one author, and two authors will independently screen all included abstracts and full texts. A third author will resolve conflicts at every stage. Studies will be reviewed for quality of evidence using appropriate tools. Epidemiological, intervention and outcome data will be extracted and summarised. Outcomes of interest for LMICs defined by the Global Alliance for Chronic Diseases research group will be analysed. Subgroup analysis according to study types and study settings will be done.Ethics and disseminationNo ethics approval is required for this systematic review. Results will be disseminated through publication in an open-access journal and presentation at conferences.PROSPERO registration numberCRD42023391897.

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Multimorbidity of cardiometabolic diseases: a cross-sectional study of patterns, clusters and associated risk factors in sub-Saharan Africa

Cited by 9 publications

References 74 publications

Cardiometabolic multimorbidity and associated patterns of healthcare utilization and quality of life: Results from the Study on Global AGEing and Adult Health (SAGE) Wave 2 in Ghana

Cardiometabolic multimorbidity and associated patterns of healthcare utilization and quality of life: Results from the Study on Global AGEing and Adult Health (SAGE) Wave 2 in Ghana

Health-promoting behavior to enhance perceived meaning and control of life in chronic disease patients with role limitations and depressive symptoms: a network approach

Interventions in adult patients with multimorbidity in low-income and middle-income countries: protocol for a mixed-methods systematic review

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