Patients with more comorbidities have better detection of chronic conditions, but poorer management and control: findings from six middle-income countries

Abstract

Background: The burden of non-communicable diseases (NCDs) is rising rapidly in middle-income countries (MICs), where NCDs are often undiagnosed, untreated and uncontrolled. How comorbidity impacts diagnosis, treatment, and control of NCDs is an emerging area of research inquiry and have important clinical implications as highlighted in the recent National Institute for Health and Care Excellence guidelines for treating patients suffering from multiple NCDs. This is the first study to examine the association between increasing numbers of comorbidities with being undiagnosed, untreated, and uncontrolled for NCDs, in 6 large MICs. Methods: Cross-sectional analysis of the World Health Organisation Study of Global Ageing and Adult Health (WHO SAGE) Wave 1 (2007-10), which consisted of adults aged ≥18 years from 6 populous MICs, including China, Ghana, India, Mexico, Russia and South Africa (overall n = 41, 557). Results: A higher number of comorbidities was associated with better odds of diagnosis for hypertension, angina, and arthritis, and higher odds of having treatment for hypertension and angina. However, more comorbidities were associated with increased odds of uncontrolled hypertension, angina, arthritis, and asthma. Comorbidity with concordant conditions was associated with improved diagnosis and treatment of hypertension and angina. Conclusion: Patients with more comorbidities have better diagnosis of chronic conditions, but this does not translate into better management and control of these conditions. Patients with multiple NCDs are high users of health services and are at an increased risk of adverse health outcomes. Hence, improving their access to care is a priority for healthcare systems.

The Associations Between Mental Disorders and Cascade of Care in Managing Hypertension, Diabetes, Dyslipidemia, Chronic Kidney Disease in China: A Pooled Cross-Sectional Analysis

“…The nding on the positive effect of having mental health conditions on better diagnosis of previously undiagnosed dyslipidemia and kidney disease is consistent with the small number of existing articles. Subjects with more comorbidities likely resulted in having more frequent visits to and interactions with multiple health providers, 5,17,[27][28][29] such as dyslipidemia, and kidney disease in this particular study.…”

“…Studies examined the relationship between comorbid health condition and NCD treatment have shown con icting results which may re ect complexity of the issue 5,17,[32][33][34][35] It is worth noting that our study considered only whether subjects were taking treatment or not, and did not if treatment was adequate, in terms of adherence to medication. 5,17,36 While our study showed that subjects with mental disorder have higher odds of taking treatment, but in reality, with more co-occurring physical conditions, the odds of treatment adherence and having adequate treatment would decline. 5,17 The nding on having mental health conditions not associated with increased or decreased odds of being controlled for hypertension, diabetes, dyslipidemia and kidney disease is not consistent with the little amount of existing literature.…”

“…9,11,15 There has been debate in the recent literature on how co-occurring conditions in uence the management and control of NCDs. 5,17 Magnan et al (2014) analysed electronic health data records of 24,430 adults aged 18 to 75 years from the United States, and revealed that even though having more concordant NCDs were correlated with a higher likelihood of achieving diabetes control goals, this relationship was not present for the outcome on achieving blood pressure control. 16 Ricci-Cabello et al (2015) investigated the prevalence of concordant and discordant NCDs of diabetes, and their impact on diabetes care in England.…”

“…15 Our recent paper which also analysed WHO SAGE found that having more NCDs was associated with better odds of diagnosis but not better management and control of co-occurring NCDs. 18 Importantly, generating more research from MICs is crucial as the ndings from HICs may not able applicable, due to different health systems and access to healthcare for diagnostic testing and treatment. 6,10,14,19 In addition, impact of a broader range of NCDs needs to be investigated.…”

“…6,10,14,19 In addition, impact of a broader range of NCDs needs to be investigated. 5,11,12,14,16,17 This study examines individuals in China with multimorbidity that consists of both physical and mental health chronic conditions. Speci cally, we investigate how having mental health conditions is associated with cascade of care in managing four common physical NCDs (e.g.…”