Multimorbidity and the inequalities of global ageing: a cross-sectional study of 28 countries using the World Health Surveys.
BACKGROUND
Multimorbidity defined as the "the coexistence of two or more chronic diseases" in one individual, is increasing in prevalence globally. The aim of this study is to compare the prevalence of multimorbidity across low and middle-income countries (LMICs), and to investigate patterns by age and education, as a proxy for socio-economic status (SES).


METHODS
Chronic disease data from 28 countries of the World Health Survey (2003) were extracted and inter-country socio-economic differences were examined by gross domestic product (GDP). Regression analyses were applied to examine associations of education with multimorbidity by region adjusted for age and sex distributions.


RESULTS
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 suggest that there are intergenerational differences, with a more inverse education gradient for younger adults compared to older adults. Higher education was significantly associated with a decreased risk of multimorbidity in the all-region analyses.


CONCLUSIONS
Multimorbidity is a global phenomenon, not just affecting older adults in HICs. Policy makers worldwide need to address these health inequalities, and support the complex service needs of a growing multimorbid population.
Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK. sa2706@soton.ac.uk.
Sara
S
Afshar
Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK. pjr@soton.ac.uk.
Paul J
PJ
Roderick
University of Newcastle Research Centre for Gender, Health and Ageing, Newcastle, NSW, Australia. kowalp@who.int.|World Health Organization's Study on global AGEing and adult health (SAGE), Geneva, Switzerland. kowalp@who.int.
Paul
P
Kowal
Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK. b.dimitrov@soton.ac.uk.
Borislav D
BD
Dimitrov
Academic Unit of Social Statistics and Demography, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK. ah4e10@soton.ac.uk.
Allan G
AG
Hill
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000375:Aging; D002908:Chronic Disease / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D014943:Global Health; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D017678:Sex Distribution; D012959:Socioeconomic Factors; D055815:Young Adult