Status of prevalence study on multimorbidity of chronic disease in China: Systematic review

Abstract

It is imperative to provide a more uniform method to improve the validity of prevalence studies on multimorbidity. However, the status of prevalence studies on multimorbidity of chronic disease is still yet to be confirmed in China. The objective of the present systematic review was to evaluate the variance across prevalence studies and to explore possible explanations for variations in China. Published literature was obtained from four databases. The studies that described the prevalence of multimorbidity on chronic disease based on the general population were considered. We assessed the risk of bias by a preplanned checklist referring to STROBE (Strengthening the Reporting of Observational Studies in Epidemiology). The heterogeneity among eligible studies was estimated by I(2) statistic and P-value using MetaAnalyst software. Nine studies were eligible for this systematic review. The prevalence of multimorbidity among the population aged 60 years or more ranged from 6.4% (95% CI 5.1-8.0) to 76.5% (95%CI 73.6-79.2). However, just two of nine studies could be judged as having a low risk of bias. It was shown that key items introducing the risk of bias included inconsistent sampling method, lacking of uniform measure indices and data source based on self-report. Heterogeneity test showed I(2) = 50% (P < 0.001), which showed there was substantial variation among individual studies. Therefore, only a narrative summary rather than meta-analysis was carried out. Marked methodology heterogeneity exists among prevalence studies on multimorbidity. Suggested methodological aspects that should be considered in future studies include sampling method, measure indices of multimorbidity and data source.

Multimorbidity associated with functional independence among community-dwelling older people: a cross-sectional study in Southern China

“…It fits well with the range of the overall prevalence of multimorbidity from a systematic review of 9 published studies in China (6.4%–76.5%) [27]. A study with a large sample conducted in Southern China showed that the prevalence of multimorbidity among the elderly people was 47.5% [18], consistent with our results.…”

Multimorbidity among middle‐aged and older persons in urban China: Prevalence, characteristics and health service utilization

“…10,16 These inconsistencies might arise from at least the following factors: residents in poorer countries lack access to health services and diagnoses, and therefore the prevalence of multimorbidity is underreported; 3,17 richer and poorer countries are at different stages of the health transition, and the conclusions obtained from richer countries do not apply to poorer countries; 18 or from differences in study design. 12,19,20 Further evidence could clarify the situation.…”

“…Pati et al found the prevalence of multimorbidity in South Asia varied widely, mostly lower than those reported in high‐income countries, but most studies were based on small samples . We searched both Chinese and English language databases for studies of multimorbidity prevalence in China and found extremely divergent reports; for example, the proportion of older people reported with more than one chronic disease ranged from 6.4% to 90.5% …”

“…11 We searched both Chinese and English language databases for studies of multimorbidity prevalence in China and found extremely divergent reports; for example, the proportion of older people reported with more than one chronic disease ranged from 6.4% to 90.5%. 8,[12][13][14][15] The prevalence of multimorbidity in LMIC seems lower than that in high-income countries; 2,4,10,11 however, in both LMIC and high-income countries, a negative relationship exists between socioeconomic status and the prevalence of multimorbidity. 10,16 These inconsistencies might arise from at least the following factors: residents in poorer countries lack access to health services and diagnoses, and therefore the prevalence of multimorbidity is underreported; 3,17 richer and poorer countries are at different stages of the health transition, and the conclusions obtained from richer countries do not apply to poorer countries; 18 or from differences in study design.…”

Multiple chronic conditions and healthcare costs among adults

“…Some studies have measured MCC as the presence of comorbid conditions in the context of a single disease. These studies have used pre-existing [13], co-existing [14], and newly developed conditions in the context of an index chronic condition [15]. Within the framework of an index disease, these combinations have been grouped using a conceptual framework based on clinical management of the index disease.…”