Epidemiology of multimorbidity in low-income countries of sub-Saharan Africa: Findings from four population cohorts.
Epidemiology of multimorbidity in low-income countries of sub-Saharan Africa: Findings from four population cohorts.
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DOI：
10.1371/journal.pgph.0002677
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发表时间：
2023
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我们调查了撒哈拉以南非洲三个低收入国家中患有多重疾病（≥2种长期疾病）的成年人的患病率和人口统计学特征，使用了来自四个队列的二级人口水平数据；马拉维（城市和农村）、冈比亚（农村）和乌干达（农村）。信息;所有队列均可测量高血压、糖尿病和肥胖症；测量的高胆固醇血症、HIV和自我报告的哮喘在两个队列中可用，临床诊断的癫痫在一个队列中可用。分析包括使用回归模型计算年龄标准化多病患病率和多病与人口统计学/生活方式因素的横断面关联。马拉维城市、马拉维农村、冈比亚和乌干达的参与者年龄中位数分别为29岁（四分位数间距-IQR 22-38）、34岁（IQR25-48）、32岁（IQR 22-53）和37岁（IQR 26-51）。马拉维城市和农村的年龄标准化多病患病率较高（22.5%；95%可信区间- ci 21.6-23.4%）和11.7%；（95%CI分别为11.1-12.3），高于冈比亚（2.9%;95%CI 2.5-3.4%）和乌干达（8.2%;95%CI 7.5-9%）队列。在多变量模型中，马拉维（发病率比-IRR 1.97, 95%CI 1.79-2.16城市和IRR 2.10, 95%CI 1.86-2.37农村）和乌干达（IRR- 1.60, 95%CI 1.32-1.95）的女性多病风险高于男性，冈比亚（IRR 1.16, 95%CI 0.86-1.55）没有证据表明两性之间存在差异。有强有力的证据表明，在所有人群中，随着年龄的增长，多病风险增加（p值<0.001）。在马拉维（IRR 1.78，城市95% CI 1.60-1.98，农村IRR 2.37, 95% CI 1.74-3.23）和乌干达（IRR 2.40, 95% CI 1.76-3.26），较高的教育程度与多病风险增加相关，但在冈比亚（IRR 1.48, 95% CI 0.56-3.87）没有关联。需要进一步研究撒哈拉以南非洲的多病流行病学，重点是为各种各样的长期条件收集强有力的人口水平数据，并确保男女以及城市和农村地区的比例代表性。
We investigated prevalence and demographic characteristics of adults living with multimorbidity (≥2 long-term conditions) in three low-income countries of sub-Saharan Africa, using secondary population-level data from four cohorts; Malawi (urban & rural), The Gambia (rural) and Uganda (rural). Information on; measured hypertension, diabetes and obesity was available in all cohorts; measured hypercholesterolaemia and HIV and self-reported asthma was available in two cohorts and clinically diagnosed epilepsy in one cohort. Analyses included calculation of age standardised multimorbidity prevalence and the cross-sectional associations of multimorbidity and demographic/lifestyle factors using regression modelling. Median participant age was 29 (Inter quartile range-IQR 22–38), 34 (IQR25-48), 32 (IQR 22–53) and 37 (IQR 26–51) in urban Malawi, rural Malawi, The Gambia, and Uganda, respectively. Age standardised multimorbidity prevalence was higher in urban and rural Malawi (22.5%;95% Confidence intervals-CI 21.6–23.4%) and 11.7%; 95%CI 11.1–12.3, respectively) than in The Gambia (2.9%; 95%CI 2.5–3.4%) and Uganda (8.2%; 95%CI 7.5–9%) cohorts. In multivariate models, females were at greater risk of multimorbidity than males in Malawi (Incidence rate ratio-IRR 1.97, 95% CI 1.79–2.16 urban and IRR 2.10; 95%CI 1.86–2.37 rural) and Uganda (IRR- 1.60, 95% CI 1.32–1.95), with no evidence of difference between the sexes in The Gambia (IRR 1.16, 95% CI 0.86–1.55). There was strong evidence of greater multimorbidity risk with increasing age in all populations (p-value <0.001). Higher educational attainment was associated with increased multimorbidity risk in Malawi (IRR 1.78; 95% CI 1.60–1.98 urban and IRR 2.37; 95% CI 1.74–3.23 rural) and Uganda (IRR 2.40, 95% CI 1.76–3.26), but not in The Gambia (IRR 1.48; 95% CI 0.56–3.87). Further research is needed to study multimorbidity epidemiology in sub-Saharan Africa with an emphasis on robust population-level data collection for a wide variety of long-term conditions and ensuring proportionate representation from men and women, and urban and rural areas.