Inequity in the Distribution of Non-Communicable Disease Multimorbidity in Adults in South Africa: An Analysis of Prevalence and Patterns

Abstract

Objectives: The present study examined the prevalence and patterns of non-communicable disease multimorbidity by wealth quintile among adults in South Africa.Methods: The South African National Income Dynamics Study Wave 5 was conducted in 2017 to examine the livelihoods of individuals and households. We analysed data in people aged 15 years and older (N = 27,042), including self-reported diagnosis of diabetes, stroke, heart disease and anthropometric measurements. Logistic regression and latent class analysis were used to analyse factors associated with multimorbidity and common disease patterns.Results: Multimorbidity was present in 2.7% of participants. Multimorbidity was associated with increasing age, belonging to the wealthiest quintile group, increasing body mass index and being a current smoker. Having secondary education was protective against multimorbidity. Three disease classes of multimorbidity were identified: Diabetes and Hypertension; Heart Disease and Hypertension; and Stroke and Hypertension.Conclusion: Urgent reforms are required to improve health systems responsiveness to mitigate inequity in multimorbidity patterns in the adult population of South Africa as a result of income inequality.

Multimorbidity in South Africa: Is the health system ready?

“…This was evident in the analysis of three South African national surveys which showed that multimorbidity increased with older age and peaked in the 60 years and older (60+ years) age group (Table 1). [22][23][24] These findings are also confirmed in recently published studies that looked at the prevalence of multimorbidity in South African national surveys. 17,18,20 The increased odds of multimorbidity in older age are consistent with what has been observed internationally.…”

“…In examining the different disease clusters (classes) in the multimorbid population, hypertension was prominent in the majority of clusters. 26 The combination of diabetes and hypertension was common across three surveys; [22][23][24] while heart disease and hypertension were common in two surveys. 23,24 Hypertension co-occurred with other NCDs and with an infectious disease such as HIVthus a mix of concordant and discordant multimorbidity classes exist in the population.…”

“…Concordant multimorbidity tends to be similar in its origin or aetiology, whereas discordant multimorbidity is when the co-existing disease conditions tend to be unrelated. 10 An important caveat when interpreting this data is that the surveys analysed [22][23][24] only collected information about selected disease conditions, hence these may not be the only prevalent disease clusters present in the population. For example, few national surveys collect information on mental health conditions and there are indications that the mental health burden is large in South Africa.…”

“…[16][17][18][19][20] Our project consisted of a systematic review of prevalence studies on multimorbidity, 21 which informed, and was followed up by the systematic analyses of the three most recent national health surveys. [22][23][24] The systematic review found a paucity of local studies and a lack of standardization of studies reporting multimorbidity estimates. 21 It was argued that the lack of funding and reporting mechanisms are impeding research on multimorbidity.…”

“…21 It was argued that the lack of funding and reporting mechanisms are impeding research on multimorbidity. 25 The systematic analyses 26 of multimorbidity in three nationally representative surveys in South Africa, [22][23][24] highlight the high levels of multimorbidity among three key groups, namely, older adults, women, and the wealthy. 26 Our results indicate eleven common disease clusters affecting the multimorbid population.…”