What we know now and knowledge gaps
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The burden of non-communicable diseases (NCDs) is rising rapidly in middle-income countries (MICs), where NCDs are often undiagnosed, untreated and uncontrolled.
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From the limited number of studies in high-income countries, there is preliminary evidence that more comorbidities negatively impact treatment and control of NCDs. There are also mixed results on how concordant and discordant comorbidities influence treatment and control.
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There is a specific knowledge gap in MICs on how more comorbidities with a NCD is associated with the diagnosis, treatment, and control of the NCD.
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There is also a knowledge gap in MICs on how concordant and discordant comorbidities with a NCD are associated with the diagnosis, treatment, and control of the NCD.
What this study adds
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A higher number of comorbidities was associated with better diagnosis of some NCDs.
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However, this did not translate into better management and control of NCDs. More comorbidities associated with even worse control of NCDs.
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Comorbidity with concordant conditions was associated with improved diagnosis and treatment, compared to comorbidity with discordant conditions.
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Patients with more comorbidities have better diagnosis of chronic conditions, but this does not translate into better management and control of these conditions. Patients with multiple NCDs are high users of health services and are at an increased risk of adverse health outcomes. Hence, improving their access to care is a priority for healthcare systems.
Background
Methods
Sample and data
Variables
Chronic conditions
Predicting variables
Outcomes
Covariates
Statistical analysis
Results
Sample characteristics
China | India | Ghana | Russia | Mexico | South Africa | Pooled | |
---|---|---|---|---|---|---|---|
Total (N) | 14,906 | 11,159 | 5,067 | 4,330 | 2,618 | 3,477 | 41,557 |
Sex (%) | |||||||
Male | 46.7 | 38.74 | 52.65 | 35.64 | 38.20 | 39.72 | 43.01 |
Female | 53.3 | 61.26 | 47.35 | 64.36 | 61.80 | 60.28 | 56.99 |
Marital Status (%) | |||||||
Not married | 16.75 | 22.34 | 41.70 | 46.26 | 41.29 | 55.88 | 29.19 |
Married | 83.25 | 77.66 | 58.30 | 53.74 | 58.71 | 44.12 | 70.81 |
Age Group (%) | |||||||
18-29 | 1.44 | 14.27 | 2.53 | 2.26 | 2.18 | 2.04 | 5.20 |
30-39 | 3.41 | 14.75 | 5.94 | 3.39 | 6.49 | 2.59 | 6.89 |
40-49 | 6.05 | 12.54 | 7.20 | 3.95 | 7.30 | 3.36 | 7.57 |
50-59 | 38.70 | 26.16 | 33.04 | 33.76 | 16.23 | 40.47 | 32.86 |
60-69 | 26.46 | 19.92 | 23.60 | 24.57 | 34.91 | 29.59 | 24.95 |
70+ | 23.94 | 12.37 | 27.69 | 32.06 | 32.89 | 21.94 | 22.53 |
Multimorbidity (%) | |||||||
0 NCDs | 61.68 | 74.75 | 56.80 | 50.21 | 68.43 | 48.33 | 64.00 |
1 NCD | 24.47 | 10.47 | 26.02 | 11.13 | 14.76 | 33.95 | 17.00 |
2 or more NCDs | 13.85 | 14.78 | 17.18 | 38.66 | 16.81 | 17.72 | 19.00 |
Mean number of NCDs | 1.03 | 1.41 | 1.23 | 1.88 | 1.36 | 1.40 | 1.11 |
Education Level (%) | |||||||
No schooling | 23.93 | 45.18 | 50.74 | 0.95 | 17.07 | 24.04 | 30.09 |
Primary or lower | 35.66 | 25.79 | 23.03 | 9.01 | 59.43 | 47.66 | 31.20 |
Secondary | 21.27 | 12.47 | 5.51 | 18.15 | 10.62 | 14.75 | 15.44 |
Tertiary or higher | 19.14 | 16.55 | 20.72 | 71.89 | 12.87 | 13.55 | 23.27 |
Wealth Quintile (%) | |||||||
Q1 (lowest) | 19.03 | 17.85 | 19.44 | 17.78 | 20.59 | 20.13 | 18.82 |
Q2 | 19.82 | 19.23 | 19.62 | 19.40 | 20.55 | 20.19 | 19.67 |
Q3 | 20.01 | 19.14 | 19.76 | 19.98 | 18.56 | 19.64 | 19.62 |
Q4 | 20.66 | 21.02 | 20.70 | 20.35 | 20.66 | 20.07 | 20.68 |
Q5 (highest) | 20.48 | 22.75 | 20.49 | 22.49 | 19.63 | 19.96 | 21.20 |
Location (%) | |||||||
Rural | 50.87 | 74.53 | 59.05 | 24.32 | 26.70 | 33.62 | 52.49 |
Urban | 49.13 | 25.47 | 40.95 | 75.68 | 73.30 | 66.38 | 47.51 |
Insurance (%) | |||||||
No insurance | 12.97 | 95.91 | 63.77 | 0.48 | No data | 82.17 | 48.14 |
With insurance (mandatory/voluntary) | 87.03 | 4.09 | 36.23 | 99.52 | No data | 17.83 | 51.86 |
Undiagnosed NCDs
Non-communicable disease (%) | ||||||||||
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Hypertension (n= 9778) | Angina (n= 3274) | Arthritis (n= 540) | Asthma (n= 153) | Chronic Lung Disease (n= 2455) | Diabetes (n= 2735) | Cataracta (n= 3739) | Depression (n= 1129) | Stroke (n= 1205) | ||
Prevalence of subjects (%) | 1. Undiagnosed | 59.11 | 62.23 | 42.76 | 55.48 | 50.27 | NA | NA | 67.57 | NA |
2a. unT-last 2 weeks (untreated in the last 2 weeks) | 34.89 | 42.04 | 58.39 | 46.21 | 91.19 | 33.76 | NA | 70.45 | 57.66 | |
2b. unT-last 12 months (untreated in the last 12 months) | 17.43 | 18.11 | 31.74 | 27.84 | 84.84 | 24.48 | 59.98 | 63.54 | 42.47 | |
3a. unC-T-last 2 weeks (treated in the last 2 weeks, and uncontrolled) | 71.14 | 83.61 | 77.41 | 78.00 | 81.72 | NA | NA | 50.34 | NA | |
3b. unC-T-last 12 months (treated in the last 12 months, and uncontrolled) | 66.82 | 77.77 | 72.81 | 77.89 | 70.05 | NA | NA | 62.21 | NA |