Transcript multimorbidity

The Global Burden of Multimorbidity
Presented by Sara Afshar, PhD Student for the Population Health
Conference “Tackling Population Health Challenges”
Joint Supervision - Faculty of Medicine & Faculty of Social Sciences
Supervisors: Prof. Paul Roderick, Prof. Allan Hill & Dr. Borislav Dimitrov
Background
• Due to demographic and epidemiological transition, there is a
greater disease burden from NCDs, paralleled by a rapidly
ageing population globally
•Although there is no consensus, multimorbidity commonly
defined as presence of ≥ 2 chronic diseases within an individual
• Multimorbidity is a consequence of human ageing and NCD
burden, although relatively understudied, particularly in LMICs
• Global morbidity studies largely single-disease focused
In HIC, multimorbidity is:
• associated with lower SES (Barnett et al, 2012),
• assocated with increased health service utilisation and health
expenditure; poorer health outcomes and quality of life;
reduced functional capacity; and decreased survival
• described as the ‘norm rather than the exception’ – majority
of patients attending primary care >65 have MM
Prevalence of Multimorbidity by age and socioeconomic status
Source: Barnett et al. Lancet (2012)
Aims
To compare the prevalence of multimorbidity across LMIC and
HIC, and by age and SES (defined by education)
Examining inter and intra country differences,
how does multimorbidity prevalence vary across income group
and within countries , respectively using GDP per capita and SES
(education)?
how does multimorbidity prevalence vary across age groups?
Methods
• Data taken from the World Health Surveys (WHS) and Wave 1 of
English Longitudinal Survey of Aging (ELSA)
• WHS: a cross-sectional national survey, uses multi-stage clustering
design to produce nationally representative samples; ages >18 years,
2003
• ELSA: a longitudinal survey of 11,500 people in England >50 years,
multistage clustering design. Wave 1, 2003.
• Multimorbidity defined as the presence of 2 or more of following
doctor diagnosed conditions (n=6): arthritis, angina, asthma, diabetes,
depression and schizophrenia
Methods
•Countries selected to represent all regions of the world with
specific focus on middle-income countries
• Countries excluded if RR to chronic disease questions <90%
•Survey weights and post-stratification corrections applied to
produce nationally representative samples
•Age adjusted prevalence directly standardised to WHO Standard
Population
•Individual countries weighted by survey size to produce regional
estimates for MM by SES (education)
Multimorbidity/ %
GDP, per capita
Figure 1 : World Standardised Multimorbidity Prevalence by GDP across World Health Survey Countries (n=28) in
2003; with confidence intervals Notes: a) GDP are based on those provided by United Nations Statistical Division for 2003 estimates b) National Estimates
have been adjusted to the WHO Standard Population Distribution (2000-2025) c) Human Development grouping based on Human Development Report estimates for 2003
Results
Figure 2: Age specific multimorbidity prevalence across World Health Survey
Countries (n=28) in 2003 and the English Longitudinal Survey of Ageing (ELSA)
Figure 3: Regional multimorbidity by socioeconomic status (education)
Prevalence ratios for < 55 years
Prevalence ratios for ≥ 55 years
Notes: a) Lightest shade represents first category (secondary education achieved); darkest shade represents final category (less
than primary school education achieved) b) Multimorbidity Prevalence ratios based on prevalence of multimorbidity in second
category set at 1.
Discussion
• Implications for future is that LMIC is transitioning towards a
HIC pattern; as younger generations age, there will be a higher
burden in elderly population
Limitations
• Limited set of conditions in WHS; evidence from ELSA shows
that increasing the number of conditions increases MM
prevalence
• Low response rate in low income countries means not
represented
• Doctor diagnosed conditions may be correlated to greater health
access, although lower prevalence in Spain and England suggest
more complex story
Conclusion
• Multimorbidity a global phenomenon and not just affecting older
adults in HIC
• Evidence of a MM transition in LMIC with increased
multimorbidity prevalence, particularly for young adults in
LMIC: suggests a change in lifestyle and accumulation of risk for
NCDS
• Implications for health care provision, planning, policy and
public health intervention.
Thank you.
Any questions?