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.

Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis

“… 2 , 3 , 4 Due to a lack of data from low-income countries and the use of different definitions of multimorbidity, a recent systematic review highlighted the need to estimate the prevalence of multimorbidity and patterns of multimorbidity. 5 …”

“… 14 , 16 , 17 , 18 , 19 Two systematic reviews on multimorbidity identified depression, hypertension, and diabetes as the most prevalent co-occurring chronic diseases. 5 , 20 Another study of multimorbidity identified cardiovascular and metabolic diseases as the most common diseases, followed by mental health disorders and musculoskeletal conditions. 21 In a multi-national cross-sectional study of non-institutionalized adults aged 50 and over in Finland, Poland, Spain, China, Ghana, India, Mexico, Russia, and South Africa, hypertension, cataract, and arthritis were the most prevalent comorbid conditions.…”

Correlations between comorbidities in trials and the community: An individual-level participant data meta-analysis

“…Thus, while comorbidity is more prevalent in the community than trials, among those with comorbidity, the pattern of correlations were mostly similar. Although a number of studies have examined patterns of comorbidity in the community, [4][5][6] or looked at excluded comorbid conditions in trials. 20 This is the first study of which we are aware to examine patterns of comorbidity in trials, or to compare comorbidity patterns between trials and the community.…”

Associations among socioeconomic status, multimorbidity of non-communicable diseases, and the risk of household catastrophic health expenditure in China: a population-based cohort study

“…With ageing of population, the prevalence of multimorbidity (defined as the coexistence of 2 or more NCDs in one person) is increasing among older adults. In a systematic review, the median prevalence of multimorbidity was 30.7% among all people in China, and it was about half of the prevalence among older adults [ 11 – 13 ]. Such a severe disease burden directly triggers a high amount of medical expenditure and CHE incidence.…”