Determinants of multimorbidity in low‐ and middle‐income countries: A systematic review of longitudinal studies and discovery of evidence gaps

Author:

Tan Michelle M. C.1234ORCID,Barbosa Matheus G.5,Pinho Pedro J. M. R.5ORCID,Assefa Esubalew678,Keinert Ana Á. M.5,Hanlon Charlotte16910ORCID,Barrett Barbara1ORCID,Dregan Alexandru1,Su Tin Tin234ORCID,Mohan Devi2ORCID,Ferri Cleusa5,Muniz‐Terrera Graciela1112ORCID,Prina Matthew1ORCID,

Affiliation:

1. Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience King's College London London UK

2. Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences Monash University Malaysia Sunway City Selangor Malaysia

3. South East Asia Community Observatory (SEACO) Monash University Malaysia Sunway City Selangor Malaysia

4. Victorian Heart Institute Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton Campus Clayton Victoria Australia

5. Psychogeriatric Unit, Department of Psychiatry, Medical School Universidade Federal de São Paulo (UNIFESP) São Paulo Brazil

6. Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT‐Africa) Addis Ababa University Addis Ababa Ethiopia

7. Department of Economics, College of Business and Economics Jimma University Jimma Ethiopia

8. Department of Economics, Faculty of Arts and Social Sciences The Open University Milton Keynes UK

9. Global Mental Health, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neurosciences King's College London London UK

10. Department of Psychiatry, School of Medicine, College of Health Sciences Addis Ababa University Addis Ababa Ethiopia

11. Edinburgh Dementia Prevention University of Edinburgh and Western General Hospital Edinburgh UK

12. Department of Social Medicine, Heritage College of Osteopathic Medicine Ohio University Athens Ohio USA

Abstract

SummaryMultimorbidity—the coexistence of at least two chronic health conditions within the same individual—is an important global health challenge. In high‐income countries (HICs), multimorbidity is dominated by non‐communicable diseases (NCDs); whereas, the situation may be different in low‐ and middle‐income countries (LMICs), where chronic communicable diseases remain prominent. The aim of this systematic review was to identify determinants (including risk and protective factors) and potential mechanisms underlying multimorbidity from published longitudinal studies across diverse population‐based or community‐dwelling populations in LMICs. We systematically searched three electronic databases (Medline, Embase, and Global Health) using pre‐defined search terms and selection criteria, complemented by hand‐searching. All titles, abstracts, and full texts were independently screened by two reviewers from a pool of four researchers. Data extraction and reporting were according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Methodological quality and risk of bias assessment was performed using the Newcastle‐Ottawa Scale for cohort studies. Data were summarized using narrative synthesis. The search yielded 1782 records. Of the 52 full‐text articles included for review, 8 longitudinal population‐based studies were included for final data synthesis. Almost all studies were conducted in Asia, with only one from South America and none from Africa. All studies were published in the last decade, with half published in the year 2021. The definitions used for multimorbidity were heterogeneous, including 3–16 chronic conditions per study. The leading chronic conditions were heart disease, stroke, and diabetes, and there was a lack of consideration of mental health conditions (MHCs), infectious diseases, and undernutrition. Prospectively evaluated determinants included socio‐economic status, markers of social inequities, childhood adversity, lifestyle behaviors, obesity, dyslipidemia, and disability. This review revealed a paucity of evidence from LMICs and a geographical bias in the distribution of multimorbidity research. Longitudinal research into epidemiological aspects of multimorbidity is warranted to build up scientific evidence in regions beyond Asia. Such evidence can provide a detailed picture of disease development, with important implications for community, clinical, and interventions in LMICs. The heterogeneity in study designs, exposures, outcomes, and statistical methods observed in the present review calls for greater methodological standardisation while conducting epidemiological studies on multimorbidity. The limited evidence for MHCs, infectious diseases, and undernutrition as components of multimorbidity calls for a more comprehensive definition of multimorbidity globally.

Funder

Medical Research Council

Publisher

Wiley

Subject

Public Health, Environmental and Occupational Health,Endocrinology, Diabetes and Metabolism

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