Patients with more comorbidities have better detection of chronic conditions, but poorer management and control: findings from six middle-income countries

• Published in: BMC public health Vol. 20; no. 1; p. 9
• Main Authors: Sum, Grace, Koh, Gerald Choon-Huat, Mercer, Stewart W, Wei, Lim Yee, Majeed, Azeem, Oldenburg, Brian, Lee, John Tayu
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 06.01.2020; BioMed Central; BMC
• Subjects: Access to care; Adolescent; Adult; Aged; Ageing; Aging; Analysis; Angina; Angina pectoris; Arthritis; Asthma; Blood pressure; Care and treatment; China - epidemiology; Chronic conditions; Chronic Disease - epidemiology; Chronic Disease - prevention & control; Chronic diseases; Chronic illnesses; Comorbid patients; Comorbidity; Comparative analysis; Control; Cross-Sectional Studies; Demographic aspects; Diabetes; Diagnosis; Female; Forecasts and trends; Ghana - epidemiology; Health care access; Health monitoring; Health services; High income; Humans; Hypertension; Income; India - epidemiology; Male; Medical case management; Medical diagnosis; Mexico - epidemiology; Middle Aged; Mortality; Non-communicable diseases; Patients; Russia - epidemiology; South Africa - epidemiology; Studies; Variables; Young Adult; Mexico; South Africa; Ghana; China; India; Russia; Health monitoring; Access to care; Chronic conditions; Non-communicable diseases; Comorbidity; Ageing
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/s12889-019-8112-3

The burden of non-communicable diseases (NCDs) is rising rapidly in middle-income countries (MICs), where NCDs are often undiagnosed, untreated and uncontrolled. How comorbidity impacts diagnosis, treatment, and control of NCDs is an emerging area of research inquiry and have important clinical implications as highlighted in the recent National Institute for Health and Care Excellence guidelines for treating patients suffering from multiple NCDs. This is the first study to examine the association between increasing numbers of comorbidities with being undiagnosed, untreated, and uncontrolled for NCDs, in 6 large MICs. Cross-sectional analysis of the World Health Organisation Study of Global Ageing and Adult Health (WHO SAGE) Wave 1 (2007-10), which consisted of adults aged ≥18 years from 6 populous MICs, including China, Ghana, India, Mexico, Russia and South Africa (overall n = 41, 557). A higher number of comorbidities was associated with better odds of diagnosis for hypertension, angina, and arthritis, and higher odds of having treatment for hypertension and angina. However, more comorbidities were associated with increased odds of uncontrolled hypertension, angina, arthritis, and asthma. Comorbidity with concordant conditions was associated with improved diagnosis and treatment of hypertension and angina. 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.