Review

. 2020 Sep 6;10(9):e037079.

doi: 10.1136/bmjopen-2020-037079.

Critical review of multimorbidity outcome measures suitable for low-income and middle-income country settings: perspectives from the Global Alliance for Chronic Diseases (GACD) researchers

John R Hurst¹, Gina Agarwal², Job F M van Boven³, Meena Daivadanam^{4

5

6

7

8}, Gillian Sandra Gould^{9

10}, Erick Wan-Chun Huang^{11

12}, Pallab K Maulik^{13

14

15}, J Jaime Miranda¹⁶, M O Owolabi¹⁷, Shahirose Sadrudin Premji¹⁸, Joan B Soriano^{19

20

21}, Rajesh Vedanthan²², Lijing Yan²³, Naomi Levitt²⁴; GACD Multi-Morbidity Working Group

Collaborators, Affiliations

Collaborators

GACD Multi-Morbidity Working Group:
Ricardo Araya, Kirsten Bobrow, Niels H Chavannes, F Xavier Gómez-Olivé, Shabbar Jaffar, Bruce J Kirenga, Rianne M J J van der Kleij, Muralidhar M Kulkarni, Laura Loli-Dano, Patricio Lopez-Jaramillo, Shane Norris, Josefien van Olmen, Gary Parker, Trishul Siddharthan, Kamran Siddiqi, Najma Siddiqi, Antigona C Trofor

Affiliations

¹ UCL Respiratory, University College London, London, UK j.hurst@ucl.ac.uk.
² Family Medicine, McMaster University, Hamilton, Ontario, Canada.
³ Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, Groningen, The Netherlands.
⁴ Deptartment of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
⁵ Department of Food, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.
⁶ Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.
⁷ Deptartment of Global Public Health, Karolinska Institutet, Solna, Sweden.
⁸ International Maternal and Child Health Division, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
⁹ School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.
¹⁰ Hunter Medical Research Institute, New Lambton, New South Wales, Australia.
¹¹ Respiratory and Environmental Epidemiology, Woolcock Institute of Medical Research, Sydney, New South Wales, Australia.
¹² Division of Thoracic Medicine, Department of Internal Medicine, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan.
¹³ Research, The George Institute for Global Health, New Delhi, India.
¹⁴ Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
¹⁵ Prasanna School of Public Health, Manipal, India.
¹⁶ CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
¹⁷ Medicine, University of Ibadan College of Medicine, Ibadan, Nigeria.
¹⁸ School of Nursing, Faculty of Health, York University, Toronto, Ontario, Canada.
¹⁹ Universidad Autónoma de Madrid, Madrid, Spain.
²⁰ Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain.
²¹ Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
²² Department of Population Health and Department of Medicine, NYU Langone Health, New York, New York, USA.
²³ Global Health Research Center, Duke Kunshan University, Jiangsu, China.
²⁴ Medicine, University of Cape Town, Cape town, South Africa.

PMID: 32895277
PMCID: PMC7478040
DOI: 10.1136/bmjopen-2020-037079

Review

Critical review of multimorbidity outcome measures suitable for low-income and middle-income country settings: perspectives from the Global Alliance for Chronic Diseases (GACD) researchers

John R Hurst et al. BMJ Open. 2020.

. 2020 Sep 6;10(9):e037079.

doi: 10.1136/bmjopen-2020-037079.

Authors

Collaborators

GACD Multi-Morbidity Working Group:
Ricardo Araya, Kirsten Bobrow, Niels H Chavannes, F Xavier Gómez-Olivé, Shabbar Jaffar, Bruce J Kirenga, Rianne M J J van der Kleij, Muralidhar M Kulkarni, Laura Loli-Dano, Patricio Lopez-Jaramillo, Shane Norris, Josefien van Olmen, Gary Parker, Trishul Siddharthan, Kamran Siddiqi, Najma Siddiqi, Antigona C Trofor

Affiliations

¹ UCL Respiratory, University College London, London, UK j.hurst@ucl.ac.uk.
² Family Medicine, McMaster University, Hamilton, Ontario, Canada.
³ Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, Groningen, The Netherlands.
⁴ Deptartment of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
⁵ Department of Food, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.
⁶ Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.
⁷ Deptartment of Global Public Health, Karolinska Institutet, Solna, Sweden.
⁸ International Maternal and Child Health Division, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
⁹ School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.
¹⁰ Hunter Medical Research Institute, New Lambton, New South Wales, Australia.
¹¹ Respiratory and Environmental Epidemiology, Woolcock Institute of Medical Research, Sydney, New South Wales, Australia.
¹² Division of Thoracic Medicine, Department of Internal Medicine, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan.
¹³ Research, The George Institute for Global Health, New Delhi, India.
¹⁴ Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
¹⁵ Prasanna School of Public Health, Manipal, India.
¹⁶ CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
¹⁷ Medicine, University of Ibadan College of Medicine, Ibadan, Nigeria.
¹⁸ School of Nursing, Faculty of Health, York University, Toronto, Ontario, Canada.
¹⁹ Universidad Autónoma de Madrid, Madrid, Spain.
²⁰ Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain.
²¹ Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
²² Department of Population Health and Department of Medicine, NYU Langone Health, New York, New York, USA.
²³ Global Health Research Center, Duke Kunshan University, Jiangsu, China.
²⁴ Medicine, University of Cape Town, Cape town, South Africa.

PMID: 32895277
PMCID: PMC7478040
DOI: 10.1136/bmjopen-2020-037079

Abstract

Objectives: There is growing recognition around the importance of multimorbidity in low-income and middle-income country (LMIC) settings, and specifically the need for pragmatic intervention studies to reduce the risk of developing multimorbidity, and of mitigating the complications and progression of multimorbidity in LMICs. One of many challenges in completing such research has been the selection of appropriate outcomes measures. A 2018 Delphi exercise to develop a core-outcome set for multimorbidity research did not specifically address the challenges of multimorbidity in LMICs where the global burden is greatest, patterns of disease often differ and health systems are frequently fragmented. We, therefore, aimed to summarise and critically review outcome measures suitable for studies investigating mitigation of multimorbidity in LMIC settings.

Setting: LMIC.

Participants: People with multimorbidity.

Outcome measures: Identification of all outcome measures.

Results: We present a critical review of outcome measures across eight domains: mortality, quality of life, function, health economics, healthcare access and utilisation, treatment burden, measures of 'Healthy Living' and self-efficacy and social functioning.

Conclusions: Studies in multimorbidity are necessarily diverse and thus different outcome measures will be appropriate for different study designs. Presenting the diversity of outcome measures across domains should provide a useful summary for researchers, encourage the use of multiple domains in multimorbidity research, and provoke debate and progress in the field.

Keywords: clinical trials; primary care; public health; statistics & research methods.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

**Figure 1**
Eight domains of outcome measures for multimorbidity interventions in LMIC. LMIC, low-income and middle-income country.

See this image and copyright information in PMC

References

1. Academy of Medical Sciences Multimorbidity: a priority for global health research: full report. Available: https://acmedsci.ac.uk/policy/policy-projects/multimorbidity [Accessed 26 Apr 2020].
1. Academy of Medical Sciences Advancing research to tackle multimorbidity: the UK and LMIC perspectives workshop report. Available: https://acmedsci.ac.uk/policy/policy-projects/multimorbidity [Accessed 26 Apr 2020].
1. Smith SM, Wallace E, Salisbury C, et al. A core outcome set for multimorbidity research (COSmm). Ann Fam Med 2018;16:132–8. 10.1370/afm.2178 - DOI - PMC - PubMed
1. Hurst JR, Dickhaus J, Maulik PK, et al. Global alliance for chronic disease researchers’ statement on multimorbidity. Lancet Glob Health 2018;6:e1270–1. 10.1016/S2214-109X(18)30391-7 - DOI - PubMed
1. Vaanholt MCW, Kok MM, von Birgelen C, et al. Are component endpoints equal? A preference study into the practice of composite endpoints in clinical trials. Health Expect 2018;21:1046–55. 10.1111/hex.12798 - DOI - PMC - PubMed

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Critical review of multimorbidity outcome measures suitable for low-income and middle-income country settings: perspectives from the Global Alliance for Chronic Diseases (GACD) researchers

Collaborators

Affiliations

Critical review of multimorbidity outcome measures suitable for low-income and middle-income country settings: perspectives from the Global Alliance for Chronic Diseases (GACD) researchers

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources