Chowdhury Saifur Rahman, Chandra Das Dipak, Sunna Tachlima Chowdhury, Beyene Joseph, Hossain Ahmed
Department of Public Health, North South University, Dhaka, Bangladesh.
Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada.
EClinicalMedicine. 2023 Feb 16;57:101860. doi: 10.1016/j.eclinm.2023.101860. eCollection 2023 Mar.
Knowing the prevalence of multimorbidity among adults across continents is a crucial piece of information for achieving Sustainable Development Goal 3.4, which calls for reducing premature death due to non-communicable diseases. A high prevalence of multimorbidity indicates high mortality and increased healthcare utilization. We aimed to understand the prevalence of multimorbidity across WHO geographic regions among adults.
We performed a systematic review and meta-analysis of surveys designed to estimate the prevalence of multimorbidity among adults in community settings. We searched PubMed, ScienceDirect, Embase and Google Scholar databases for studies published between January 1, 2000, and December 31, 2021. The random-effects model estimated the pooled proportion of multimorbidity in adults. Heterogeneity was quantified using I statistics. We performed subgroup analyses and sensitivity analyses based on continents, age, gender, multimorbidity definition, study periods and sample size. The study protocol was registered with PROSPERO (CRD42020150945).
We analyzed data from 126 peer-reviewed studies that included nearly 15.4 million people (32.1% were male) with a weighted mean age of 56.94 years (standard deviation of 10.84 years) from 54 countries around the world. The overall global prevalence of multimorbidity was 37.2% (95% CI = 34.9-39.4%). South America (45.7%, 95% CI = 39.0-52.5) had the highest prevalence of multimorbidity, followed by North America (43.1%, 95% CI = 32.3-53.8%), Europe (39.2%, 95% CI = 33.2-45.2%), and Asia (35%, 95% CI = 31.4-38.5%). The subgroup study highlights that multimorbidity is more prevalent in females (39.4%, 95% CI = 36.4-42.4%) than males (32.8%, 95% CI = 30.0-35.6%). More than half of the adult population worldwide above 60 years of age had multimorbid conditions (51.0%, 95% CI = 44.1-58.0%). Multimorbidity has become increasingly prevalent in the last two decades, while the prevalence appears to have stayed stable in the recent decade among adults globally.
The multimorbidity patterns by geographic regions, time, age, and gender suggest noticeable demographic and regional differences in the burden of multimorbidity. According to insights about prevalence among adults, priority is required for effective and integrative interventions for older adults from South America, Europe, and North America. A high prevalence of multimorbidity among adults from South America suggests immediate interventions are needed to reduce the burden of morbidity. Furthermore, the high prevalence trend in the last two decades indicates that the global burden of multimorbidity continues at the same pace. The low prevalence in Africa suggests that there may be many undiagnosed chronic illness patients in Africa.
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了解各大洲成年人中多种疾病并存的患病率，是实现可持续发展目标3.4的关键信息，该目标要求降低非传染性疾病导致的过早死亡。多种疾病并存的高患病率表明高死亡率和医疗保健利用率的增加。我们旨在了解世界卫生组织各地理区域成年人中多种疾病并存的患病率。
我们对旨在估计社区环境中成年人多种疾病并存患病率的调查进行了系统评价和荟萃分析。我们在PubMed、ScienceDirect、Embase和谷歌学术数据库中搜索了2000年1月1日至2021年12月31日期间发表的研究。随机效应模型估计了成年人中多种疾病并存的合并比例。使用I统计量对异质性进行量化。我们基于各大洲、年龄、性别、多种疾病并存的定义、研究时期和样本量进行了亚组分析和敏感性分析。该研究方案已在国际前瞻性系统评价注册库（PROSPERO，注册号：CRD42020150945）注册。
我们分析了来自126项同行评审研究的数据，这些研究涵盖了来自全球54个国家的近1540万人（32.1%为男性），加权平均年龄为56.94岁（标准差为10.84岁）。多种疾病并存的全球总体患病率为37.2%（95%置信区间=34.9-39.4%）。南美洲（45.7%，95%置信区间=39.0-52.5%）多种疾病并存的患病率最高，其次是北美洲（43.1%，95%置信区间=32.3-53.8%）、欧洲（39.2%，95%置信区间=33.2-45.2%）和亚洲（35%，95%置信区间=31.4-38.5%）。亚组研究强调，多种疾病并存在女性中（39.4%，95%置信区间=36.4-42.4%）比男性中（32.8%，95%置信区间=30.0-35.6%）更普遍。全球60岁以上的成年人口中，超过一半患有多种疾病（51.0%，95%置信区间=44.1-58.0%）。在过去二十年中，多种疾病并存变得越来越普遍，而在最近十年中，全球成年人中的患病率似乎保持稳定。
按地理区域、时间、年龄和性别划分的多种疾病并存模式表明，在多种疾病并存的负担方面存在明显的人口统计学和区域差异。根据对成年人患病率的洞察，来自南美洲、欧洲和北美洲的老年人需要有效的综合干预措施。南美洲成年人中多种疾病并存的高患病率表明需要立即采取干预措施以减轻发病负担。此外，过去二十年中的高患病率趋势表明全球多种疾病并存的负担继续以相同的速度增长。非洲的低患病率表明非洲可能有许多未被诊断的慢性病患者。
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