Multimorbidity as a correlate of dementia among older people in Central Africa: The EPIDEMCA study

Abstract

AbstractBackgroundWith global ageing, multimorbidity becomes a priority for global health research. Multimorbidity prevalence increases with age and is associated with poorer health outcomes. As people live longer, chronic conditions, including dementia, are rising in low‐ and middle‐income countries (LMIC) but the relationship between multimorbidity and dementia is not well studied despite its importance for dementia prevention. The aim of this study is to investigate the association between multimorbidity and dementia among older people in Central African countries.MethodsA multicentre population‐based study was carried out in Central African Republic and Republic of Congo between 2011 and 2012 including both urban and rural sites. Participants aged ≥65 years old were interviewed using a structured questionnaire (sociodemographic data, clinical history) and underwent a physical examination. Multimorbidity (ie. the presence of two or more chronic diseases in the same individual) was ascertained as a count of up to 12 mental, cognitive and physical health conditions. Conditions were either collected through self‐report or assessed during the physical exam. DSM‐IV criteria were required for dementia diagnoses. The association of multimorbidity with dementia was assessed using logistic regression models.ResultsAt baseline, 2002 participants were included across the two countries (mean age 73.3 ± 6.7 years, sex‐ratio M/F = 0.62) and 135 were diagnosed with dementia. Overall 55.3% of the participants had 2 or more chronic diseases, with hypertension, depression, heart disease, pulmonary conditions, and visual impairment as the most common comorbidities. A higher prevalence of multimorbidity was found in Congo than in Central African Republic. Dementia was significantly associated with the presence of multimorbidity (OR=1.45, 95%CI 1.01‐2.00), however the effect disappeared after adjustment on age, sex and study site. There was a non‐significant trend of greater odds of dementia with an increasing number of comorbidities.ConclusionsThe results support a high prevalence of multimorbidity among these older populations, especially among people with dementia. However, odds of dementia seemed to not be significantly impacted by multimorbidity in this context. Due to its high prevalence and low access to healthcare, this evidence remains of importance for medical care of comorbidities in older populations of sub‐Saharan Africa.