Patterns of comorbidity and multimorbidity among middle-aged and elderly women in peri-urban Tanzania
Laura-Marie StieglitzTill BärnighausenGermana LeynaPatrick KazondaJaphet KillewoJulia K. RohrStefan Köhler
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Background Multimorbidity poses an increasing challenge to health care systems in Sub-Saharan Africa. We studied the extent of multimorbidity and patterns of comorbidity among women aged 40 years or older in a peri-urban area of Dar es Salaam, Tanzania. Methods We assessed 15 chronic conditions in 1528 women who participated in a cross-sectional survey that was conducted within the Dar es Salaam Urban Cohort Study (DUCS) from June 2017 to July 2018. Diagnoses of chronic conditions were based on body measurements, weight, blood testing, screening instruments, and self-report. Results The five most prevalent chronic conditions and most common comorbidities were hypertension (49.8%, 95% CI 47.2 to 52.3), obesity (39.9%, 95% CI 37.3 to 42.4), anemia (36.9%, 95% CI 33.3 to 40.5), signs of depression (32.5%, 95% CI 30.2 to 34.9), and diabetes (30.9%, 95% CI 27.6 to 34.2). The estimated prevalence of multimorbidity (2+ chronic conditions) was 73.8% (95% CI 71.2 to 76.3). Women aged 70 years or older were 4.1 (95% CI 1.5 to 10.9) times mores likely to be affected by multimorbidity and had 0.7 (95% CI 0.3 to 1.2) more chronic conditions than women aged 40 to 44 years. Worse childhood health, being widowed, not working, and higher food insecurity in the household were also associated with a higher multimorbidity risk and level. Conclusion A high prevalence of multimorbidity in the general population of middle-aged and elderly women suggests substantial need for multimorbidity care in Tanzania. Comorbidity patterns can guide multimorbidity screening and help identify health care and prevention needs.Keywords:
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Comorbidities are concomitant diseases and may include physical or mental health and may refer to the coexistence of two or more pathologies, which appeared at the same time, or at different times, affecting a system or different systems. Comorbidities have a great effect on the life of patients because the presence of a social disease can lead to an increase in the inability to work, reducing the cost of living, the management of the disease becomes more complex and significantly reduces the productivity of a society. Within the last decade, the group of co-morbidities has become a growing health problem, as well as the leading causes of death on a global level and will continue to challenge healthcare professionals in the upcoming years. While previously individuals had a known chronic pathology, currently people live with more than one chronic pathology, known as comorbidity or multimorbidity. The terms comorbidity and multimorbidity are often used interchangeably to refer to co-occurring conditions, however, they have an important distinction. While both terms state the occurrence of multiple conditions within the same individual, comorbidity refers to one or more additional conditions in reference to an index condition such as comorbidity in diabetes mellitus. In comparison, multimorbidity describes that no one condition is holding priority over any of the co-occurring conditions. Therefore, the complexity of comorbidity and multimorbidity has brought great challenges to the health care system, health care professionals and the person living with them.
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Identify the medication adherence determinants in older adults with multimorbidity and polypharmacy.A cross-sectional study was conducted in a non-probabilistic sample of 245 adults ≥65 years recruited in a general medical ward of one teaching hospital. Data were collected during hospital stay using a face-to-face interview based on a set of validated questionnaires, such as the measure treatment adherence, the beliefs about medicines questionnaire-specific and the geriatric depression scale. Descriptive and multiple linear regression analysis were performed.Participants' mean age was 78.32 (SD: 6.95) years and 50.6% were women. Older adults lived with an average of 7.51 (SD: 1.95) chronic conditions and had a mean of 7.95 (min. 4; max. 18) medications prescribed. The proportion of older adults adherent to medication was 43.7%. Depression ( β = -0.142; p = 0.031), beliefs about treatment necessity ( β = 0.306; p = 0.001) and concerns about the medication ( β = -0.204; p = 0.001) were found as independent determinants of adherence.Self-reported medication non-adherence appears to be common in older adults with multimorbidity and polypharmacy. Depression, necessity and concerns should be considered when assessing medication non-adherence in practice. This study will also contribute to develop an intervention to manage adherence in older people, as part of a doctoral research project.
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Comorbidity and multimorbidity represent one of the greatest chalenge to academic medicine. Many disorders are often comorbidly expressed in diverse combinations. In clinical practice comorbidity and multimorbidity are underrecognized, underdiagnosed, underestimated and undertreated. So that one can speak about comorbidity and multimorbidity anosognosia. Comorbidities and multimorbidities are indifferent to medical specializations, so the integrative and complementary medicine is an imperative in the both education and practice. Shifting the paradigm from vertical/mono-morbid interventions to comorbidity and multimorbidity approaches enhances effectiveness and efficiency of human resources utilization. Comorbidity and multimorbidity studies have been expected to be an impetus to research on the validity of current diagnostic systems as well as on establishing more effective and efficient treatment including individualized and personalized pharmacotherapy.
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Cohort Profile : The Epidemiology of Chronic Diseases and Multimorbidity. The EpiChron Cohort Study
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Background : Our aim was to assess the prevalence and “predictors” of comorbidity and multimorbidity in adult patients in Albania, a former communist country in the Western Balkans. Methods : This was a case-series study conducted during August 2013–June 2014 including 974 patients (46.6% men aged 61.2±13.8 years and 53.4% women aged 61.3±13.1 years) admitted at the Service of Internal Medicine and Hypertension, University Hospital Center “Mother Teresa”, Tirana. Data on socio-demographic factors, lifestyle characteristics and a detailed clinical profile was collected for all study participants. Binary logistic regression was used to assess the association between comorbidity and multimorbidity with socio-demographic characteristics and lifestyle factors. Results : About 54% of the patients were ≥61 years old; about 38% of participants were residing in Tirana; and about 46% of the patients were currently employed. Overall, the prevalence of smoking was 16% (30.4% in men vs. 3.5% in women, P Conclusion : T his study informs about the prevalence and selected determinants of comorbidity and multimorbidity among Albanian hospitalized patients. Our findings indicate that the burden of comorbidity and multimorbidity is high in the Albanian patients, especially among the older people. Future studies should estimate the magnitude and distribution of comorbidity and multimorbidity in the general population of Albania. Keywords: Albania, comorbidity, concomitant disease, internal medicine, multimorbidity.
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Abstract Background Multimorbidity is better prevented in younger ages than in older ages. This study aims to identify the differences in comorbidity patterns in middle-aged inpatients from China and the United Kingdom (UK). Methods We utilized 184,133 and 180,497 baseline hospitalization records in middle-aged populations (40–59 years) from Shaanxi, China, and UK Biobank. Logistic regression was used to calculate odds ratios and P values for 43,110 unique comorbidity patterns in Chinese inpatients and 21,026 unique comorbidity patterns in UK inpatients. We included the statistically significant ( P values adjusted by Bonferroni correction) and common comorbidity patterns (the pattern with prevalence > 1/10,000 in each dataset) and employed network analysis to construct multimorbidity networks and compare feature differences in multimorbidity networks for Chinese and UK inpatients, respectively. We defined hub diseases as diseases having the top 10 highest number of unique comorbidity patterns in the multimorbidity network. Results We reported that 57.12% of Chinese inpatients had multimorbidity, substantially higher than 30.39% of UK inpatients. The complete multimorbidity network for Chinese inpatients consisted of 1367 comorbidities of 341 diseases and was 2.93 × more complex than that of 467 comorbidities of 215 diseases in the UK. In males, the complexity of the multimorbidity network in China was 2.69 × more than their UK counterparts, while the ratio was 2.63 × in females. Comorbidities associated with hub diseases represented 68.26% of comorbidity frequencies in the complete multimorbidity network in Chinese inpatients and 55.61% in UK inpatients. Essential hypertension, dyslipidemia, type 2 diabetes mellitus, and gastritis and duodenitis were the hub diseases in both populations. The Chinese inpatients consistently demonstrated a higher frequency of comorbidities related to circulatory and endocrine/nutritional/metabolic diseases. In the UK, aside from these comorbidities, comorbidities related to digestive and genitourinary diseases were also prevalent, particularly the latter among female inpatients. Conclusions Chinese inpatients exhibit higher multimorbidity prevalence and more complex networks compared to their UK counterparts. Multimorbidity with circulatory and endocrine/nutritional/metabolic diseases among both Chinese and UK inpatients necessitates tailored surveillance, prevention, and intervention approaches. Targeted interventions for digestive and genitourinary diseases are warranted for the UK.
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Purpose: Assessment of frailty is a key method to identify older people in need of holistic care. However, agreement between different frailty instrument varies. Thus, groups classified as frail by different instruments are not completely overlapping. This study evaluated differences in sociodemographic factors, cognition, functional status, and quality of life between older persons with multimorbidity who were discordantly classified by five different frailty instruments, with focus on the Clinical Frailty Scale (CFS) and Fried's Frailty Phenotype (FP). Participants and Methods: This was a cross-sectional study in a community-dwelling setting. Inclusion criteria were as follows: ≥ 75 years old, ≥ 3 visits to the emergency department the past 18 months, and ≥ 3 diagnoses according to ICD-10. 450 participants were included. Frailty was assessed by CFS, FP, Short Physical Performance Battery (SPPB), Grip Strength and Walking Speed. Results: 385 participants had data on all frailty instruments. Prevalence of frailty ranged from 34% (CFS) to 75% (SPPB). Nine percent of participants were non-frail by all instruments, 20% were frail by all instruments and 71% had discordant frailty classifications. Those who were frail according to CFS but not by the other instruments had lower cognition and functional status. Those who were frail according to FP but not CFS were, to a larger extent, women, lived alone, had higher cognitive ability and functional status. Conclusion: The CFS might not identify physically frail women in older community-dwelling people with multimorbidity. They could thus be at risk of not be given the attention their frail condition need. Keywords: geriatrics, frailty phenotype, clinical frailty scale, outpatient assessment
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