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Multimorbidity and the inequalities of global ageing: a cross-sectional study of 28 countries using the World Health Surveys

By Sara Afshar

Multimorbidity defined as the “the coexistence of two or more chronic diseases” in one individual, is
increasing in prevalence globally. Despite the growing recognition of the prevalence of multimorbidity amongst older adults, global prevalence have largely remained single-disease focused. Internationally, there is still limited evidence on the prevalence and social determinants of multimorbidity, particularly in low and middle income countries (LMICs).

In collaboration with the University of Southampton and the World Health Organisation, we examined the global patterns of multimorbidity and compared prevalence across different countries including LMICs. We extracted chronic disease data from 28 countries of the World Health Survey (2003) and examined the inter-country socio-economic differences by gross domestic product (GDP). Regression analyses were applied to examine associations of education with multimorbidity by region adjusted for age and sex distributions.

We found that the mean world standardized multimorbidity prevalence for LMICs was 7.8 % (95 % CI, 7.79 % – 7.83 %). In all countries, multimorbidity increased significantly with age. A positive but non–linear relationship was found between country GDP and multimorbidity prevalence. Trend analyses of multimorbidity by education suggested that there are intergenerational differences, with a more inverse education gradient for younger adults compared to older adults. Furthermore, higher education was significantly associated with a decreased risk of multimorbidity in the all-region analyses.

We concluded that multimorbidity is a global phenomenon, not just affecting older adults in high income countries. Policy makers worldwide therefore need to address these health inequalities, and support the complex service needs of a growing multimorbid population.

Afshar S, Roderick PJ, Kowal P, Dimitrov B and Hill AG. Multimorbidity and the inequalities of global ageing: a cross-sectional study of 28 countries using the World Health Surveys. BMC Public Health. 2015. 15:776

To access the full article: http://www.biomedcentral.com/1471-2458/15/776

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