Global Multimorbidity Patterns: A Cross-Sectional, Population-Based, Multi-Country Study

Abstract

Background: Population ageing challenges health care systems due to the high prevalence and impact of multimorbidity in older adults. However, little is known about how chronic conditions present in certain multimorbidity patterns, which could have great impact on public health at several levels. The aim of our study was to identify and describe multimorbidity patterns in low-, middle-, and high-income countries.

Methods: We analyzed data from the Collaborative Research on Ageing in Europe project (Finland, Poland, and Spain) and the World Health Organization's Study on Global Ageing and Adult Health (China, Ghana, India, Mexico, Russia, and South Africa). These cross-sectional studies obtained data from 41,909 noninstitutionalized adults older than 50 years. Exploratory factor analysis was performed to detect multimorbidity patterns. Additional adjusted binary logistic regressions were performed to identify associations between sociodemographic factors and multimorbidity.

Results: Overall multimorbidity prevalence was high across countries. Hypertension, cataract, and arthritis were the most prevalent comorbid conditions. Two or three multimorbidity patterns were found per country. Several patterns were identified across several countries: "cardio-respiratory" (angina, asthma, and chronic obstructive pulmonary disease), "metabolic" (diabetes, obesity, and hypertension), and "mental-articular" (arthritis and depression).

Conclusions: A high prevalence of multimorbidity occurs in older adults across countries, with low- and middle-income countries gradually approaching the figures of richer countries. Certain multimorbidity patterns are present in several countries, which suggest that common underlying etiopathogenic factors may play a role. Deeper understanding of these patterns may lead to the development of preventive actions to diminish their prevalence and also give rise to new, comprehensive approaches for the management of these co-occurring conditions.

Keywords: Epidemiology; Health disparities; Morbidity; Multimorbidities; Public health; Socioeconomic issues.

Figure 1.

Multimorbidity prevalence across age groups. Prevalence calculation was based on weighted sample. Multimorbidity defined as having at least two of the following conditions: angina, arthritis, asthma, cataract, COPD, depression, diabetes, edentulism, hypertension, cognitive impairment, obesity, and stroke.

Figure 2.

Comorbidity prevalence using overall pooled data. For country-wise information see Supplementary Appendix . To interpret the graph, choose one condition in the left column and then from the total patients with this condition check the percentage of those who have one of the co-occurring conditions from the list below.