Faculty of Medical Sciences, Population Health Sciences Institute, Baddiley-Clark Building, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK.
BMC Public Health. 2022 Oct 14;22(1):1918. doi: 10.1186/s12889-022-14340-0.
This paper aims to describe the prevalence and socio-economic associations with multimorbidity, by both self-report and clinical assessment/screening methods in community-dwelling older people living in rural Tanzania.
A randomised frailty-weighted sample of non-institutionalised adults aged ≥ 60 years underwent comprehensive geriatric assessment and in-depth assessment. The comprehensive geriatric assessment consisted of a history and focused clinical examination. The in-depth assessment included standardised questionnaires, screening tools and blood pressure measurement. The prevalence of multimorbidity was calculated for self-report and non-self-reported methods (clinician diagnosis, screening tools and direct measurement). Multimorbidity was defined as having two or more conditions. The socio-demographic associations with multimorbidity were investigated by multiple logistic regression.
A sample of 235 adults participated in the study, selected from a screened sample of 1207. The median age was 74 years (range 60 to 110 inter-quartile range (IQR) 19) and 136 (57.8%) were women. Adjusting for frailty-weighting, the prevalence of self-reported multimorbidity was 26.1% (95% CI 16.7-35.4), and by clinical assessment/screening was 67.3% (95% CI 57.0-77.5). Adjusting for age, sex, education and frailty status, multimorbidity by self-report increased the odds of being financially dependent on others threefold (OR 3.3 [95% CI 1.4-7.8]), and of a household member reducing their paid employment nearly fourfold (OR 3.8. [95% CI 1.5-9.2]).
Multimorbidity is prevalent in this rural lower-income African setting and is associated with evidence of household financial strain. Multimorbidity prevalence is higher when not reliant on self-reported methods, revealing that many conditions are underdiagnosed and undertreated.
本研究旨在描述坦桑尼亚农村社区居住的老年人中，通过自我报告和临床评估/筛查方法，报告和评估多种疾病的流行情况及其与社会经济因素的关联。
对非住院的年龄≥60 岁的成年人进行了随机虚弱加权抽样，并进行了全面老年评估和深入评估。全面老年评估包括病史和重点临床检查。深入评估包括标准化问卷、筛查工具和血压测量。自我报告和非自我报告方法（临床医生诊断、筛查工具和直接测量）计算多种疾病的患病率。多种疾病定义为存在两种或两种以上疾病。采用多因素逻辑回归分析社会人口统计学因素与多种疾病的关联。
从筛选出的 1207 名样本中，有 235 名成年人参加了这项研究。参与者的中位年龄为 74 岁（范围为 60-110 岁，四分位间距 19 岁），136 名（57.8%）为女性。在调整虚弱加权后，自我报告的多种疾病患病率为 26.1%（95%可信区间 16.7-35.4%），临床评估/筛查的患病率为 67.3%（95%可信区间 57.0-77.5%）。在调整年龄、性别、教育和虚弱状态后，自我报告的多种疾病使对他人经济依赖的可能性增加两倍（比值比 3.3[95%可信区间 1.4-7.8]），使家庭成员减少有薪就业的可能性增加近四倍（比值比 3.8[95%可信区间 1.5-9.2]）。
在这种农村低收入的非洲环境中，多种疾病很普遍，并与家庭经济压力的证据有关。当不依赖自我报告方法时，多种疾病的患病率更高，这表明许多疾病的诊断和治疗不足。
