Chronic Noncommunicable Diseases in 6 Low- and Middle-Income Countries: Findings From Wave 1 of the World Health Organization's Study on Global Ageing and Adult Health (SAGE)

Perianayagam Arokiasamy¹, Uttamacharya¹, Paul Kowal^{2

3}, Benjamin D Capistrant⁴, Theresa E Gildner⁵, Elizabeth Thiele⁶, Richard B Biritwum⁷, Alfred E Yawson⁷, George Mensah⁸, Tamara Maximova⁹, Fan Wu¹⁰, Yanfei Guo¹¹, Yang Zheng¹², Sebastiana Zimba Kalula¹³, Aarón Salinas Rodríguez¹⁴, Betty Manrique Espinoza¹⁴, Melissa A Liebert⁵, Geeta Eick⁵, Kirstin N Sterner¹⁵, Tyler M Barrett⁵, Kwabena Duedu¹⁶, Ernest Gonzales¹⁷, Nawi Ng^{18

19}, Joel Negin²⁰, Yong Jiang²¹, Julie Byles²², Savathree Lorna Madurai²³, Nadia Minicuci²⁴, J Josh Snodgrass²⁵, Nirmala Naidoo², Somnath Chatterji²⁶

Affiliations

¹ International Institute for Population Sciences, Mumbai, India.
² Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland.
³ Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, Australia.
⁴ Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Twin Cities, MN, USA.
⁵ Department of Anthropology, University of Oregon, Eugene, Oregon, USA.
⁶ Department of Biology , Vassar College , Poughkeepsie , New York , USA.
⁷ Department of Community Health , University of Ghana , Accra , Ghana.
⁸ Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
⁹ Sechenov First Moscow State Medical University, Moscow, Russia.
¹⁰ Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
¹¹ Department of Neurology, 2nd Clinical Medical College of Jinan University, Shenzhen, Guangdong, China.
¹² Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
¹³ Division of Geriatric Medicine, The Albertina and Walter Sisulu Institute of Ageing in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa.
¹⁴ Center for Evaluation Research and Surveys, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
¹⁵ Department of Anthropology, University of Oregon, Eugene, USA.
¹⁶ Institute of Quantitative Biology, Biochemistry and Biotechnology, School of Biological Sciences, University of Edinburgh, Edinburgh, UK.
¹⁷ Department of Physics, University of Notre Dame, 225 Nieuwland Science Hall, Notre Dame, Indiana, USA.
¹⁸ Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
¹⁹ Centre for Demographic and Ageing Research, Umeå University, Umeå, Sweden.
²⁰ Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
²¹ Department of Pharmaceutical Analysis, School of Pharmacy, Hebei Medical University, Shijiazhuang, Hebei Province, China.
²² Research Centre for Gender, Health and Ageing, University of Newcastle, Newcastle, Australia.
²³ Polymer Science and Technology, CSIR - Central Leather Research Institute, Chennai, India.
²⁴ National Research Council, Neuroscience Institute, Padova, Italy.
²⁵ Department of Anthropology , University of Oregon , Eugene , Oregon , USA.
²⁶ Division of Information, Evidence and Research, World Health Organization, Avenue Appia, Geneva, Switzerland.

PMID: 28399566
PMCID: PMC6075549
DOI: 10.1093/aje/kww125

Chronic Noncommunicable Diseases in 6 Low- and Middle-Income Countries: Findings From Wave 1 of the World Health Organization's Study on Global Ageing and Adult Health (SAGE)

Perianayagam Arokiasamy et al. Am J Epidemiol. 2017.

. 2017 Mar 15;185(6):414-428.

doi: 10.1093/aje/kww125.

Authors

Affiliations

¹ International Institute for Population Sciences, Mumbai, India.
² Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland.
³ Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, Australia.
⁴ Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Twin Cities, MN, USA.
⁵ Department of Anthropology, University of Oregon, Eugene, Oregon, USA.
⁶ Department of Biology , Vassar College , Poughkeepsie , New York , USA.
⁷ Department of Community Health , University of Ghana , Accra , Ghana.
⁸ Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
⁹ Sechenov First Moscow State Medical University, Moscow, Russia.
¹⁰ Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
¹¹ Department of Neurology, 2nd Clinical Medical College of Jinan University, Shenzhen, Guangdong, China.
¹² Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
¹³ Division of Geriatric Medicine, The Albertina and Walter Sisulu Institute of Ageing in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa.
¹⁴ Center for Evaluation Research and Surveys, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
¹⁵ Department of Anthropology, University of Oregon, Eugene, USA.
¹⁶ Institute of Quantitative Biology, Biochemistry and Biotechnology, School of Biological Sciences, University of Edinburgh, Edinburgh, UK.
¹⁷ Department of Physics, University of Notre Dame, 225 Nieuwland Science Hall, Notre Dame, Indiana, USA.
¹⁸ Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
¹⁹ Centre for Demographic and Ageing Research, Umeå University, Umeå, Sweden.
²⁰ Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
²¹ Department of Pharmaceutical Analysis, School of Pharmacy, Hebei Medical University, Shijiazhuang, Hebei Province, China.
²² Research Centre for Gender, Health and Ageing, University of Newcastle, Newcastle, Australia.
²³ Polymer Science and Technology, CSIR - Central Leather Research Institute, Chennai, India.
²⁴ National Research Council, Neuroscience Institute, Padova, Italy.
²⁵ Department of Anthropology , University of Oregon , Eugene , Oregon , USA.
²⁶ Division of Information, Evidence and Research, World Health Organization, Avenue Appia, Geneva, Switzerland.

PMID: 28399566
PMCID: PMC6075549
DOI: 10.1093/aje/kww125

Abstract

In this paper, we examine patterns of self-reported diagnosis of noncommunicable diseases (NCDs) and prevalences of algorithm/measured test-based, undiagnosed, and untreated NCDs in China, Ghana, India, Mexico, Russia, and South Africa. Nationally representative samples of older adults aged ≥50 years were analyzed from wave 1 of the World Health Organization's Study on Global Ageing and Adult Health (2007-2010; n = 34,149). Analyses focused on 6 conditions: angina, arthritis, asthma, chronic lung disease, depression, and hypertension. Outcomes for these NCDs were: 1) self-reported disease, 2) algorithm/measured test-based disease, 3) undiagnosed disease, and 4) untreated disease. Algorithm/measured test-based prevalence of NCDs was much higher than self-reported prevalence in all 6 countries, indicating underestimation of NCD prevalence in low- and middle-income countries. Undiagnosed prevalence of NCDs was highest for hypertension, ranging from 19.7% (95% confidence interval (CI): 18.1, 21.3) in India to 49.6% (95% CI: 46.2, 53.0) in South Africa. The proportion untreated among all diseases was highest for depression, ranging from 69.5% (95% CI: 57.1, 81.9) in South Africa to 93.2% (95% CI: 90.1, 95.7) in India. Higher levels of education and wealth significantly reduced the odds of an undiagnosed condition and untreated morbidity. A high prevalence of undiagnosed NCDs and an even higher proportion of untreated NCDs highlights the inadequacies in diagnosis and management of NCDs in local health-care systems.

Keywords: chronic disease; diagnosis; low- and middle-income countries; noncommunicable diseases; untreated diseases.

© The Author 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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Figures

**Figure 1.**
Adjusted (for sociodemographic characteristics) self-reported and algorithm/measured test-based prevalences of noncommunicable diseases in 6 low- and middle-income countries, Study on Global Ageing and Adult Health (wave 1), 2007–2010. Black bars, self-reported prevalence; white bars, algorithm/measured test-based prevalence. A) Angina; B) arthritis; C) asthma; D) chronic lung disease; E) depression; F) hypertension.

**Figure 2.**
Adjusted (for sociodemographic characteristics) prevalences of undiagnosed chronic diseases in 6 low- and middle-income countries, Study on Global Ageing and Adult Health (wave 1), 2007–2010.

**Figure 3.**
Adjusted (for sociodemographic characteristics) proportions of untreated chronic diseases in 6 low- and middle-income countries, Study on Global Ageing and Adult Health (wave 1), 2007–2010.

See this image and copyright information in PMC

References

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Chronic Noncommunicable Diseases in 6 Low- and Middle-Income Countries: Findings From Wave 1 of the World Health Organization's Study on Global Ageing and Adult Health (SAGE)

Affiliations

Chronic Noncommunicable Diseases in 6 Low- and Middle-Income Countries: Findings From Wave 1 of the World Health Organization's Study on Global Ageing and Adult Health (SAGE)

Authors

Affiliations

Abstract

Figures

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical