Community prevalence and dyad disease pattern of multimorbidity in China and India: a systematic review

Abstract

Background: Driven by the increasing life expectancy, China and India, the two most populous countries in the world are experiencing a rising burden of multimorbidity. This study aims to explore community prevalence and dyad patterns of multimorbidity in China and India.

Methods: We conducted a systematic review of five English and Chinese electronic databases. Studies involving adults 18 years or older at a community level, which reported multimorbidity prevalence and/or patterns were included. A modified Newcastle-Ottawa Scale was used for quality assessment. Despite large heterogeneity among reported studies, a systematic synthesis of the results was conducted to report the findings.

Results: From 13 996 studies retrieved, 59 studies met the inclusion criteria (46 in China, 9 in India and 4 in both). The median prevalence of multimorbidity was 30.7% (IQR 17.1, 49.4), ranging from 1.5% to 90.5%. There was a large difference in multimorbidity prevalence between China and India, with median prevalence being 36.1% (IQR 19.6, 48.8) and 28.3% (IQR 8.9, 56.8), respectively. Among 27 studies that reported age-specific prevalence, 19 studies found multimorbidity prevalence increased with age, while 8 studies observed a paradoxical reduction in the oldest age group. Of the 34 studies that reported sex-specific prevalence, 86% (n=32) observed a higher prevalence in females. The most common multimorbidity patterns from 14 studies included hypertensive diseases combined with diabetes mellitus, arthropathies, heart diseases and metabolic disorders. All included studies were rated as fair or poor quality.

Conclusion: Multimorbidity is highly prevalent in China and India with hypertensive diseases and other comorbidities being the most observed patterns. The overall quality of the studies was low and there was a lack of representative samples in most studies. Large epidemiology studies, using a common definition of multimorbidity and national representative samples, with sex disaggregation are needed in both countries.

Prospero registration number: CRD42020176774.

Keywords: arthritis; epidemiology; hypertension; public health; systematic review.

Figure 1

Study flow chart. CNKI, China National Knowledge Infrastructure.

Figure 2

Multimorbidity prevalence between female and male. *The 2010 dataset of Fu, 2014. †The 2005 dataset of Fu, 2014. ‡The 2000 dataset of Fu, 2014. Panel A: forest plot showing multimorbidity prevalence difference between female and male in studies with youngest age of enrolled participants between 18 and 34 years. Panel B: forest plot showing multimorbidity prevalence difference between female and male in studies with youngest age of enrolled participants between 35 and 59 years. Panel C: forest plot showing multimorbidity prevalence difference between female and male in studies with youngest age of enrolled participants >60 years.

Figure 3

Age-specific prevalence of multimorbidity. ♦: Sample size <1000; ▲: Sample size between 1000 and 10 000; ●: Sample size >10 000. Panel A: prevalence of multimorbidity by age group in China. Panel B: prevalence of multimorbidity by age group in India.

Figure 4

The prevalence of different dyads patterns of multimorbidity in included studies. The numbers in brackets represent the frequency of pattern in the studies. Colours in green: studies with youngest age of enrolled participants between 18 and 34 years; colours in blue: studies with youngest age of enrolled participants between 35 and 59 years; colours in red: studies with youngest age of enrolled participants >60 years. Digestive Dis, Oother diseases of the digestive system; DM, Diabetes mellitus; Eye Dis, Diseases of the eye and adnexa; General symptoms, General symptoms and signs; HTN, hypertensive Diseases; Liver Dis, Diseases of liver; Respiratory Dis, Other diseases of the respiratory system; Sexual infections, Iinfections with a predominantly sexual mode of transmission; Stomach Dis, Diseases of esophagus, stomach and duodenum.