Article Text

Original research
Multimorbidity of non-communicable diseases in low-income and middle-income countries: a systematic review and meta-analysis
  1. Ogechukwu Augustina Asogwa1,2,
  2. Daniel Boateng1,3,
  3. Anna Marzà-Florensa1,
  4. Sanne Peters1,4,
  5. Naomi Levitt5,
  6. Josefien van Olmen6,7,
  7. Kerstin Klipstein-Grobusch1,8
  1. 1Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands
  2. 2Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
  3. 3Department of Epidemiology & Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
  4. 4The George Institute for Global Health, Imperial College London, London, UK
  5. 5Division of Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
  6. 6Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerpen, Belgium
  7. 7Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
  8. 8Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  1. Correspondence to Dr Daniel Boateng; d.boateng-2{at}umcutrecht.nl

Abstract

Introduction Multimorbidity is a major public health challenge, with a rising prevalence in low/middle-income countries (LMICs). This review aims to systematically synthesise evidence on the prevalence, patterns and factors associated with multimorbidity of non-communicable diseases (NCDs) among adults residing in LMICs.

Methods We conducted a systematic review and meta-analysis of articles reporting prevalence, determinants, patterns of multimorbidity of NCDs among adults aged >18 years in LMICs. For the PROSPERO registered review, we searched PubMed, EMBASE and Cochrane libraries for articles published from 2009 till 30 May 2020. Studies were included if they reported original research on multimorbidity of NCDs among adults in LMICs.

Results The systematic search yielded 3272 articles; 39 articles were included, with a total of 1 220 309 participants. Most studies used self-reported data from health surveys. There was a large variation in the prevalence of multimorbidity; 0.7%–81.3% with a pooled prevalence of 36.4% (95% CI 32.2% to 40.6%). Prevalence of multimorbidity increased with age, and random effect meta-analyses showed that female sex, OR (95% CI): 1.48, 1.33 to 1.64, being well-off, 1.35 (1.02 to 1.80), and urban residence, 1.10 (1.01 to 1.20), respectively were associated with higher odds of NCD multimorbidity. The most common multimorbidity patterns included cardiometabolic and cardiorespiratory conditions.

Conclusion Multimorbidity of NCDs is an important problem in LMICs with higher prevalence among the aged, women, people who are well-off and urban dwellers. There is the need for longitudinal data to access the true direction of multimorbidity and its determinants, establish causation and identify how trends and patterns change over time.

PROSPERO registration number CRD42019133453.

  • epidemiology
  • public health
  • primary care

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article or uploaded as supplementary information. Extra data are available by emailing the corresponding author (d.boateng-2@umcutrecht.nl).

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article or uploaded as supplementary information. Extra data are available by emailing the corresponding author (d.boateng-2@umcutrecht.nl).

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Footnotes

  • OAA and DB are joint first authors.

  • Twitter @DanBoat98, @amarzafl

  • Contributors OAA, AMF, DB and KK-G conceptualised the study. OAA and AMF carried out the literature search, data extraction and risk of bias assessment with support from DB. DB and OAA conducted the narrative synthesis and statistical analyses and wrote the first draft of the manuscript. All authors (OAA, DB, AMF, SP, NL, JvO and KK-G) critically reviewed and approved the manuscript. DB is responsible for the overall content as guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.