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Chronic multimorbidity among older adults in rural South Africa
  1. Angela Y Chang1,
  2. Francesc Xavier Gómez-Olivé2,
  3. Collin Payne3,
  4. Julia K Rohr4,
  5. Jennifer Manne-Goehler5,
  6. Alisha N Wade2,
  7. Ryan G Wagner2,
  8. Livia Montana4,
  9. Stephen Tollman2,
  10. Joshua A Salomon6
  1. 1Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
  2. 2MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  3. 3School of Demography, The Australian National University, Canberra, Australian Capital Territory, Australia
  4. 4Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, USA
  5. 5Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  6. 6Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
  1. Correspondence to Dr Angela Y Chang; angela.chang{at}


Introduction The rapid ageing of populations around the world is accompanied by increasing prevalence of multimorbidity. This study is one of the first to present the prevalence of multimorbidity that includes HIV in the complex epidemiological setting of South Africa, thus filling a gap in the multimorbidity literature that is dominated by studies in high-income or low-HIV prevalence settings.

Methods Out of the full sample of 5059 people aged 40+, we analysed cross-sectional data on 10 conditions from 3889 people enrolled in the Health and Ageing in Africa: A longitudinal study of an INDEPTH Community in South Africa (HAALSI) Programme. Two definitions of multimorbidity were applied: the presence of more than one condition and the presence of conditions from more than one of the following categories: cardiometabolic conditions, mental disorders, HIV and anaemia. We conducted descriptive and regression analyses to assess the relationship between prevalence of multimorbidity and sociodemographic factors. We examined the frequencies of the most prevalent combinations of conditions and assessed relationships between multimorbidity and physical and psychological functioning.

Results 69.4 per cent (95% CI 68.0 to 70.9) of the respondents had at least two conditions and 53.9% (52.4–55.5) of the sample had at least two categories of conditions. The most common condition groups and multimorbid profiles were combinations of cardiometabolic conditions, cardiometabolic conditions and depression, HIV and anaemia and combinations of mental disorders. The commonly observed positive relationships between multimorbidity and age and decreasing wealth were not observed in this population, namelydue to different epidemiological profiles in the subgroups, with higher prevalence of HIV and anaemia in the poorer and younger groups, and higher prevalence of cardiometabolic conditions in the richer and older groups. Both physical functioning and well-being negatively associated with multimorbidity.

Discussion More coordinated, long-term integrated care management across multiple chronic conditions should be provided in rural South Africa.

  • ageing
  • multimorbidity
  • south africa
  • HIV

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  • Handling editor Seye Abimbola

  • Contributors FXGO, AW, LM, ST, and JAS contributed to the design of the HAALSI study and coordinated baseline data collection and data preparation. AYC and JAS conceived and designed the study. AYC conducted theanalysis and developed the initial draft of the manuscript. FXGO contributed to early conceptual and technical support in the study design and data interpretation phases. All authors substantively reviewed, revised, and approved the final manuscript.

  • Funding The HAALSI study, funded by the National Institute on AgingAgeing (P01 AG041710), is nested within the Agincourt Health and Demographic Surveillance System site, supported by the University of the Witwatersrand and Medical Research Council, South Africa, and the Wellcome Trust, UK (grants 058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z; 085477/B/08/Z). ANW is supported by the Fogarty International Centre (NIH) under Award Number K43TW010698. This paper describes the views of the authors and does not necessarily represent the official views of the National Institutes of Health.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study received ethical approvals from the University of the Witwatersrand Human Research Ethics Committee, the Mpumalanga Provincial Research and Ethics Committee, and the Harvard T.H. Chan School of Public Health Office of Human Research Administration.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available.