Multimorbidity in South Asian adults: prevalence, risk factors and mortality

Singh, Kalpana; Patel, Shivani A.; Biswas, Subhrajit; Shivashankar, Roopa; Kondal, Dimple; Ajay, Vamadevan S.; Anjana, Ranjit Mohan; Fatmi, Zafar; Ali, Mohammed K.; Kadir, Muhammad Masood; Mohan, Viswanathan; Tandon, Nikhil; Narayan, K.M. Venkat; Prabhakaran, Dorairaj

doi:10.1093/pubmed/fdy017

Cited by 83 publications

(81 citation statements)

References 25 publications

(37 reference statements)

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“…There are very few reports on CMM from South Asia, and the types of conditions vary. In a study from urban areas of Delhi, Chennai and Karachi, 9.4% of adults aged ≥20 years had two or more of hypertension, diabetes, heart disease, stroke and CKD 25. Our study in hypertensive community dwellers from rural areas in three South Asian countries indicated a higher prevalence with one in four individuals having two additional cardiometabolic comorbid conditions.…”

Section: Discussionmentioning

confidence: 52%

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Prevalence and correlates of cardiometabolic multimorbidity among hypertensive individuals: a cross-sectional study in rural South Asia—Bangladesh, Pakistan and Sri Lanka

et al. 2019

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ObjectiveTo determinate the prevalence and correlates of cardiometabolic multimorbidity (CMM), and their cross-country variation among individuals with hypertension residing in rural communities in South Asia.DesignA cross-sectional study.SettingRural communities in Bangladesh, Pakistan and Sri Lanka.ParticipantsA total of 2288 individuals with hypertension aged ≥40 years from the ongoing Control of Blood Pressure and Risk Attenuation- Bangladesh, Pakistan and Sri Lanka clinical trial.Main outcome measuresCMM was defined as the presence of ≥2 of the conditions: diabetes, chronic kidney disease, heart disease and stroke. Logistic regression was done to evaluate the correlates of CMM.ResultsAbout 25.4% (95% CI 23.6% to 27.2%) of the hypertensive individuals had CMM. Factors positively associated with CMM included residing in Bangladesh (OR 3.42, 95% CI 2.52 to 4.65) or Sri Lankan (3.73, 95% CI 2.48 to 5.61) versus in Pakistan, advancing age (2.33, 95% CI 1.59 to 3.40 for 70 years and over vs 40–49 years), higher waist circumference (2.15, 95% CI 1.42 to 3.25) for Q2–Q3 and 2.14, 95% CI 1.50 to 3.06 for Q3 and above), statin use (2.43, 95% CI 1.84 to 3.22), and higher levels of triglyceride (1.01, 95% CI 1.01 to 1.02 per 5 mg/dL increase). A lower odds of CMM was associated with being physically active (0.75, 95% CI 0.57 to 0.97). A weak inverted J-shaped association between International Wealth Index and CMM was found (p for non-linear=0.058), suggesting higher risk in the middle than higher or lower socioeconomic strata.ConclusionsCMM is highly prevalent in rural South Asians affecting one in four individuals with hypertension. There is an urgent need for strategies to concomitantly manage hypertension, cardiometabolic comorbid conditions and associated determinants in South Asia.

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Section: Discussionmentioning

confidence: 52%

“…Data on multimorbidity are limited from South Asian countries 20–25. This study is the first to evaluate the prevalence and correlates of CMM in a representative sample aged ≥40 years with hypertension from rural communities in Bangladesh, Pakistan and Sri Lanka.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and correlates of cardiometabolic multimorbidity among hypertensive individuals: a cross-sectional study in rural South Asia—Bangladesh, Pakistan and Sri Lanka

et al. 2019

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“…This is comparable to studies with a cross-sectional design and similar definition of multimorbidity carried out in Scotland [ 4 ], Australia [ 23 ], Serbia [ 25 ], and Brazil [ 10 ]. The prevalence in Cyprus seems to be lower than Canada [ 26 ], Switzerland [ 27 ], and Indonesia [ 28 ], but higher than South Asia [ 29 ], China [ 16 ], and Iran [ 30 ]. About half of the study participants did not report suffering from any of the chronic diseases considered, something that is similar to results reported for Finland [ 29 ] and Italy [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence in Cyprus seems to be lower than Canada [ 26 ], Switzerland [ 27 ], and Indonesia [ 28 ], but higher than South Asia [ 29 ], China [ 16 ], and Iran [ 30 ]. About half of the study participants did not report suffering from any of the chronic diseases considered, something that is similar to results reported for Finland [ 29 ] and Italy [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of multimorbidity in the Cypriot population; A cross-sectional study (2018–2019)

et al. 2020

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Background Multimorbidity is defined as the co-existence of two or more chronic conditions. As life expectancy is increasing so does the prevalence of multimorbidity. Our aim was to estimate the prevalence of multimorbidity in Cyprus and identify the most prevalent diseases. Methods A representative sample of n = 1140 individuals over 18 years old was surveyed during 2018–2019. Demographic characteristics as well as the presence of chronic conditions, including mental disorders, were collected through a standardized questionnaire. Diseases were classified according to the International Classification of Diseases, 10 th Revision (ICD-10). Results The age and gender standardized prevalence of multimorbidity was 28.6%. Multimorbidity was associated with age (p<0.001), with the highest rate observed among people aged 65+ years old (68.9%). Multimorbidity was higher in women than men (28.2% vs. 22.5%, p < .001) but similar in urban and rural regions (26.4% vs. 23.8%, p = 0.395). The most prevalent chronic diseases among people with multimorbidity were hyperlipidemia (44.7%), followed by hypertension (37.5%), gastric reflux (23.9%), and thyroid diseases (22.2%), while the most common combinations of diseases were in the circulatory and endocrine systems. The profile of the multimorbid individual indicated this to be a person at an older age with a higher BMI, a current smoker with a higher salary. Conclusions More than one quarter of the general population of Cyprus has multimorbidity, and this rate is almost 70% among the elderly. Multimorbidity is relatively common even in younger ages too. This underlines the need for prevention strategies and health awareness programs for the entire population.

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“…The survey results established that multi-morbidity is common in the middle and old age population; which has been reported elsewhere. 2,18 This could easily be ascertained through a community survey. As multimorbidity is associated with higher mortality and poorer quality of life, 19 it requires the focus on health action.…”

Section: Multi-morbiditymentioning

confidence: 99%

Health Concerns of Older Adults: Observations from a Survey and Public Education Programme in Bhubaneswar, India

Kar¹,

Das²,

Mohapatra³

et al. 2019

Journal of the Indian Academy of Geriatrics

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Background: While it is apparent that old age is associated with multiple health concerns, the extent of its multiplicity and burden is often not clear. It was intended to find out self-reported health concerns for one month and cardiovascular risk factors in middle and older adults. Methods: In the cross-sectional survey, attendees of a Healthy Ageing Conference were approached with a semi-structured questionnaire about their health concerns and cardiovascular risks. Risk of a cardiovascular event in 10 years based on QRISK3 was calculated. Results: A considerable proportion of older adults had a range of physical symptoms, depressive mood state and memory problems. Mean number of health problems reported were 4.8±3.3 (male 4.4±3.1 and female 5.0±4.3). Cardiovascular risk was high, mean QRISK3 score for males were 22.2% (±14.4), and for females 10.3% (±6.6) (p<0.05). On average, the heart age was increased by 7.9±6.2 years (8.6±6.6 years for males and 5.0±3.3 for females). The relative risk of participants was 2.1 for males and 1.5 for females for heart attack or stroke within the ten years, compared to healthy persons. The symptoms and risk factors were elicited easily, and the process probably facilitated improving the awareness about the health concerns holistically. The survey also identified issues related to the engagement of older adults in the existing health care systems. Conclusions: The results suggested that questionnaire-based health screening in a community can identify a range of health concerns and identify multi-morbidity in general and cardiovascular risks in particular. This process may help to focus on the appropriate public health awareness and intervention programmes required in the community.

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Multimorbidity in South Asian adults: prevalence, risk factors and mortality

Abstract: Multimorbidity affects nearly 1 in 10 urban South Asians, and each additional morbidity carries a progressively higher risk of death. Identifying locally appropriate strategies for prevention and coordinated management of multimorbidity will benefit population health in the region.

Cited by 83 publications

References 25 publications

Prevalence and correlates of cardiometabolic multimorbidity among hypertensive individuals: a cross-sectional study in rural South Asia—Bangladesh, Pakistan and Sri Lanka

Prevalence and correlates of cardiometabolic multimorbidity among hypertensive individuals: a cross-sectional study in rural South Asia—Bangladesh, Pakistan and Sri Lanka

Prevalence of multimorbidity in the Cypriot population; A cross-sectional study (2018–2019)

Health Concerns of Older Adults: Observations from a Survey and Public Education Programme in Bhubaneswar, India

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