Multimorbidity: Risk Groups, Challenges & Prevention

Table of Contents

What are Multimorbidity?

Multimorbidity is a condition where an individual suffers from two or more than two chronic health burden.
Multimorbidity/multiple morbidity is the co-existence of two or more chronic health problems in an individual.
Multimorbidity are also used to define the sum of injuries, the number, and brutality of morbidities, and the sum of number and severity of morbidities per coexisting restrictions in functional status or infirmity.
Multimorbidity is more common in underprivileged groups, therefore subsidizing to health disparities.
Multimorbidity is repeatedly long-term health situations, which includes multifaceted and continuing care, thus presents a complex, multifaceted challenge which demands integrated patient-centered care approach.
Non-Communicable diseases are commonly connected to multi-morbidity and disability.
It is also important to differentiate between comorbidity and multimorbidity as comorbidity includes one or more additional diseases co-occurring with a primary disease (e.g., diabetes with hypertension), while multimorbidity does not prioritize one condition over another, rather it views the individual holistically.

Diseases with More Multimorbidity

Multi-morbidity starting from Non-Communicable Diseases (NCDs), acute and chronic infections, HIV and AIDS, progressive problems from childhood and malnutrition altogether increase to the complete burden of adult ill health.
Non-Communicable Diseases (NCDs) frequently co-exist as ‘multi-morbidity’, which is furthermost, well defined as the occurrence of two or more durable physical or mental health settings.

High Risk Groups

Age and gender are the well-recognized contributing factor of multiple morbidities.
According to various study, age groups younger than 65 years were found to have multiple burdens of disease compared with the younger age groups.
In a developed country, more than 40% of the population including all ages had at least one chronic health condition and nearly 25% of the whole population had more than one chronic condition.
However, in present context multimorbidity is not only confined to older populations and developed countries.
In younger age groups, a combination of physical and mental health conditions was found to have multimorbidity.
Likewise, the cases of multimorbidity are also increasing in young and middle-aged adults in Low and Middle Income (LMIC) countries due to the epidemiological transitions.
On the other hand, cardiovascular disease (CVD) were found to be less predominant in women but psychogeriatric disease is more predominant.

Regional Prevalence of Multimorbidity

Region	Prevalence Estimate	Common Conditions
North America/Europe	25–65% (65+ population)	CVD, diabetes, arthritis and depression
South Asia	10–40%	Hypertension, diabetes, respiratory diseases and arthritis
Sub-Saharan Africa	5–20%	HIV and AIDS, hypertension, diabetes
Latin America and the Caribbean	25–35%	Obesity, diabetes, arthritis
East and Southeast Asia	20–45%	Stroke, diabetes, hypertension, chronic respiratory illness
Middle East and North Africa (MENA)	20–40%	Obesity, CVD, diabetes, hypertension and mental health

Factors Contributing to Multiple Morbidities

Age- Adult populations
Lifestyle factors like unhealthy diets, physical inactivity, tobacco use and harmful alcohol consumptions.
Poor Socioeconomic status
Previous chronic health conditions
No access to proper health care treatment
Genetic and biological factors
Ignorance of self-care and health care
Poor environmental conditions like poor sanitation and hygiene
Mental Health Problem
Person with disability
High blood pressure
Obesity
Chronic Kidney disease
Chronic Heart disease
Cancer
HIV and AIDS
Lack of effective guidelines for the treatment of chronic disease
Weak referral systems
Lack of macro and micro system levels by the policymakers in the health system
Lack of equity and equality in health services.
Low financing health systems
Lack of comprehensive health care
High health care costs.
Lack of organized health insurance system.
Lack of doctor-patient relationship
Lack of effective diagnostic tools and technology for chronic conditions
Occupational hazards.

Challenges in Managing Multimorbidity

Information Asymmetry in health system: Patients/families do not have adequate access to health information.
Lack of integrated approach: Health system is focused on specializing on specific diseases rather than treating them holistically.
Over the Counter (OTC) Drugs and Polypharmacy: OTC drugs have increased drug resistance among people and also increases the risk of adverse drug reactions making multimorbidity more complex and difficult to manage.
Inequity: Rising socio-economic inequity in the societies is increasing gap between the haves and have-nots of the society and have also led to experience limited access to health resources to the poorer segment of the community.

Prevention and Mitigation Measures

Preventive Measures

Changing a sedentary lifestyle to a healthy lifestyle
An early medication of chronic disease
Regular health checkup
Changing dietary pattern
Effective disease management system in community level
Alteration in habits i.e. changes in smoking, physical activity, etc.
Strict rules on food adulteration
Investments in food policies
Promoting Health equity and equality
Mass awareness programs on Health care and their consequences like multiple morbidities

Mitigation Measures

Expansion of strategic agenda for supervisory efforts to mitigate multiple morbidities
Integrated health care systems
Strengthening the Primary Health Care system
Comprehensive needs assessment and individual care planning tailored to the patient’s preferences, values and situations
An effective disease surveillance system
Use of technological innovations like mobile health (mHealth and Electronic Health (eHealth) to coordinate with the multimorbidity patient and their families.
Involvement of high-level representative in workgroup for the distribution of health staffs in respective hospitals, organizations and health centers for timely treatment.
Provision of advanced tools and technology to health-care, public health, and social service centers and workers.
Enable research to fill the gaps in knowledge and intervention programs evaluation.
Organizing health campaigns through existing national health programs, activities, and initiatives focused on improving the health of an individual;
Decision support for Health care professionals
Self-management provision
Multiprofessional partnership
Executing patient-centered care
Effective health care financing system.
Focusing on marginalized people and free health care
Provision of all levels of treatment from the local level.

Research and Policy Implications

Considering the speedy growing nature of multimorbidity, it requires systematic research and focused policy agenda to address the need of the people. Some of the major research and policy areas that requires specific attention to address multimorbidity are:

Tailored/context specific multimorbidity care models
Holistic integration of health system building blocks in managing multimorbidity
Strengthening of health information management systems
Capacity building of health workers to manage multimorbidity through integrated care approaches.
Health planning and financing through policy frameworks
Adopting Universal Health Coverage (UHC) targeted to the poorer segments of the society.