Multimorbidity in Bangladesh: Burden and Correlates in the Bangladesh Longitudinal Investigation of Emerging Vascular and nonvascular Events (BELIEVE) Study
Background: Multimorbidity, a major global health concern nowadays, is increasing at an alarming rate worldwide, including in South Asian countries. Non-communicable diseases (NCDs) explain the majority of current global mortality and with an increasingly ageing population, NCD multimorbidity can overwhelm health systems worldwide. Although there is some evidence of several determinants and risks of multimorbidity from western populations, these cannot be generalised to apply to South Asian populations where the sociodemographics and lifestyles are quite different. Objectives: The main aims of this thesis are to 1) summarise the existing epidemiological evidence of multimorbidity in South Asia; 2) investigate the burden of multimorbidity and the cross-sectional association between multimorbidity and socioeconomic status; 3) identify the association between multimorbidity and adiposity measures; and 4) describe the association between multimorbidity and mental health. Methods: BELIEVE is a large-scale multicentre population-based prospective study from Bangladesh with a sample size of ~73,500, over three distinct sites covering urban, rural, and urban slum environments. BELIEVE has collected extensive baseline information on all participants' sociodemographic, economic, lifestyle and physical measures along with various health conditions. Therefore, it serves as a unique scientific resource to provide an indication of the burden and correlates of multimorbidity across a varied range of individuals in Bangladesh. Results: A systematic review demonstrated that there was a scarcity of published data on multimorbidity from South Asian countries. The retrieved literature indicated a wide range of prevalence estimates reflecting different study samples, methods, and definitions of multimorbidity. The most widely used was the World Health Organization’s definition, namely “two or more diseases in an individual, definition was adopted for the BELIEVE study with the focus on any two diseases from a total list of 10. Using this definition, the overall prevalence of multimorbidity in BELIEVE was 16.8% with males having a higher prevalence (18%) than females (15%). In terms of site of residence, urban participants had the highest prevalence of 18% followed by 10% in the slum and 6% in the rural site. Cross-sectional analyses of the BELIEVE data revealed that multimorbidity was strongly associated with higher socioeconomic status based on the highest individual income (OR 2.05, 95% CI 1.71-2.47) and the highest wealth quintile (OR 2.38, 95% CI 2.19-2.60). The prevalence of overweight/obesity was very high (around 70%) in the multimorbid BELIEVE participants and there was a strong association between greater general and central measures of adiposity and increased likelihood of multimorbidity. Total body fat % (general adiposity) (OR 1.74, 95% CI 1.66-1.82) and waist circumference (central adiposity) (OR 1.70, 95% CI 1.65-1.75) showed the strongest association with multimorbidity. Possible depression and possible anxiety affected an estimated 16.8% and 11.7% of the BELIEVE population respectively, with higher prevalence among those with multimorbidity. When considered separately both possible depression and anxiety showed a moderate association with the risk of multimorbidity, but the odds ratio of the risk of having multimorbidity (OR 1.89, 95% CI 1.51-2.36) was greater for participants with co-occurring probable depression and anxiety. Conclusion: The present analyses represent the largest cross-sectional study on multimorbidity in a South Asian population and focus on a diverse range of individuals. Results confirmed some previous associations with the risk of multimorbidity found in western populations, but also revealed some novel insights into the association of socioeconomic characteristics, adiposity measures and mental health status with multimorbidity that may be specific to Bangladesh. Owing to the cross-sectional nature of the study, causality cannot be assumed. Nevertheless, the findings may indicate certain subgroups that would benefit from targeted public health intervention to reduce NCD impact. It is hoped that the findings of this study will stimulate further longitudinal research allowing causal links to be determined and to help reduce the rising burden of multimorbidity in Bangladesh and other South Asian countries.
Bangladesh, Epidemiology, Multimorbidity, Non communicable diseases
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