The impact of multimorbidity on adult physical and mental health in low- and middle-income countries: what does the study on global ageing and adult health (SAGE) reveal?
The impact of multimorbidity on adult physical and mental health in low- and middle-income countries: what does the study on global ageing and adult health (SAGE) reveal?
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DOI：
10.1186/s12916-015-0402-8
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发表时间：
2015-08-03
期刊：
影响因子：
9.3
通讯作者：
Kowal P
中科院分区：
文献类型：
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作者：
Arokiasamy P;Uttamacharya U;Jain K;Biritwum RB;Yawson AE;Wu F;Guo Y;Maximova T;Espinoza BM;Rodríguez AS;Afshar S;Pati S;Ice G;Banerjee S;Liebert MA;Snodgrass JJ;Naidoo N;Chatterji S;Kowal P
慢性病在低收入和中等收入国家的疾病负担中占很大比例。慢性疾病有同时发生的趋势，如果有两种或两种以上这样的情况，这被称为“多病”。多发病与不良健康结果相关，但在中低收入国家开展的研究有限。因此，本研究考察了6个低收入中等收入国家中多重发病的患病率和相关因素，以及多重发病与自评健康、日常生活活动（ADLs）、生活质量和抑郁之间的关系。数据来自世卫组织全球老龄化与成人健康研究（SAGE）第1波（2007/10）。这是一项在中低收入国家进行的基于人口的横断面调查，即中国、加纳、印度、墨西哥、俄罗斯和南非，包括42236名18岁及以上的成年人。多病是指同时存在两种或以上的八种慢性疾病，包括心绞痛、关节炎、哮喘、慢性肺病、糖尿病、高血压、中风和视力障碍。研究了与四种健康结果的关系，即ADL限制、自评健康、抑郁和生活质量指数。对来自六个国家的汇总数据使用随机截距多水平回归模型。在6个国家的合并样本中，发病率和多重发病率分别为54.2%和21.9%。俄罗斯多病患病率最高（34.7%），而中国最低（20.3%）。多病的可能性在年龄较大的人群中较高，而在社会经济地位较高的人群中较低。在合并样本中，1+ ADL限制患病率为14%，抑郁症患病率为5.7%，自评健康不良患病率为11.6%，平均生活质量评分为54.4。在四项健康结果测量指标中发现了巨大的跨国差异。随着疾病数量的增加，1+ ADL限制、不良自我评价健康和抑郁的患病率增加，而生活质量明显下降。研究结果强调了中低收入国家，特别是社会经济地位较低群体中多重疾病的挑战，以及考虑到多重疾病的分布及其对健康结果的不利影响，迫切需要重新定位卫生保健资源。本文的在线版本（doi:10.1186/s12916-015-0402-8）包含补充材料，可供授权用户使用。
Chronic diseases contribute a large share of disease burden in low- and middle-income countries (LMICs). Chronic diseases have a tendency to occur simultaneously and where there are two or more such conditions, this is termed as ‘multimorbidity’. Multimorbidity is associated with adverse health outcomes, but limited research has been undertaken in LMICs. Therefore, this study examines the prevalence and correlates of multimorbidity as well as the associations between multimorbidity and self-rated health, activities of daily living (ADLs), quality of life, and depression across six LMICs. Data was obtained from the WHO’s Study on global AGEing and adult health (SAGE) Wave-1 (2007/10). This was a cross-sectional population based survey performed in LMICs, namely China, Ghana, India, Mexico, Russia, and South Africa, including 42,236 adults aged 18 years and older. Multimorbidity was measured as the simultaneous presence of two or more of eight chronic conditions including angina pectoris, arthritis, asthma, chronic lung disease, diabetes mellitus, hypertension, stroke, and vision impairment. Associations with four health outcomes were examined, namely ADL limitation, self-rated health, depression, and a quality of life index. Random-intercept multilevel regression models were used on pooled data from the six countries. The prevalence of morbidity and multimorbidity was 54.2 % and 21.9 %, respectively, in the pooled sample of six countries. Russia had the highest prevalence of multimorbidity (34.7 %) whereas China had the lowest (20.3 %). The likelihood of multimorbidity was higher in older age groups and was lower in those with higher socioeconomic status. In the pooled sample, the prevalence of 1+ ADL limitation was 14 %, depression 5.7 %, self-rated poor health 11.6 %, and mean quality of life score was 54.4. Substantial cross-country variations were seen in the four health outcome measures. The prevalence of 1+ ADL limitation, poor self-rated health, and depression increased whereas quality of life declined markedly with an increase in number of diseases. Findings highlight the challenge of multimorbidity in LMICs, particularly among the lower socioeconomic groups, and the pressing need for reorientation of health care resources considering the distribution of multimorbidity and its adverse effect on health outcomes. The online version of this article (doi:10.1186/s12916-015-0402-8) contains supplementary material, which is available to authorized users.