The patterns of Non-communicable disease Multimorbidity in Iran: A Multilevel Analysis

Zahra Khorrami,Shahin Yarahmadi,Mohammadesmail Kameli,Maysam Rezapour,Alireza Mahdavi Hezaveh,Narges Khanjani,Koorosh Etemad,Soheila Khodakarim

doi:10.1038/s41598-020-59668-y

Abstract

The prevalence of non-communicable diseases is increasing worldwide. Multimorbidity and long-term medical conditions is common among these patients. This study aimed to investigate the patterns of non-communicable disease multimorbidity and their risk factors at the individual and aggregated level. Data was inquired from the nationwide survey performed in 2011, according to the WHO stepwise approach on NCD risk factors. A latent class analysis on multimorbidity components (11 chronic diseases) was performed and the association of some individual and aggregated risk factors (urbanization) with the latent subclasses was accessed using multilevel multinomial logistic regression. Latent class analysis revealed four distinct subclasses of multimorbidity among the Iranian population (10069 participants). Musculoskeletal diseases and asthma classes were seen in both genders. In males, the odds of membership in the diabetes class was 41% less by increasing physical activity; but with increased BMI, the odds of membership in the diabetes class was 1.90 times higher. Tobacco smoking increased the odds of membership in the musculoskeletal diseases class, 1.37 and 2.30 times for males and females, respectively. Increased BMI and low education increased the chances of females’ membership in all subclasses of multimorbidity. At the province level, with increase in urbanization, the odds of membership in the diabetes class was 1.28 times higher among males (P = 0.027). Increased age, higher BMI, tobacco smoking and low education are the most important risk factors associated with NCD multimorbidity among Iranians. Interventions and policies should be implemented to control these risk factors.

Highlights

The World Health Organization (WHO) global status report on non-communicable diseases (NCDs) in 2014 reported that NCDs are globally the leading cause of death[1]
A systematic review in WHO Eastern Mediterranean countries in 2013 showed that the high mortality of NCDs is partially related to their multimorbidity[4]
NCD multimorbidity may occur 10–15 years earlier in individuals living in developing countries[8] and as mean population age increases, the growing prevalence of NCD multimorbidity has led to decreased quality of life among these patients[9,10,11]

Summary

Introduction

The World Health Organization (WHO) global status report on non-communicable diseases (NCDs) in 2014 reported that NCDs are globally the leading cause of death[1]. In 2016, NCDs killed 287000 people in Iran and the number of NCD related deaths and disability-adjusted life years (DALYs) have increased during the past decades. According to 2017 reports, in the past 20 years, NCD mortality has risen by 14.5%, in Iran; and an adult Iranian’s probability of dying prematurely (between 30 and 70 years) from one of the four main NCDs was 17%3. The mean prevalence of multimorbidity was 7.8% in 28 developing. NCD multimorbidity may occur 10–15 years earlier in individuals living in developing countries[8] and as mean population age increases, the growing prevalence of NCD multimorbidity has led to decreased quality of life among these patients[9,10,11]. People’s exposure to tobacco, unhealthy diets, and physical inactivity have increased as well[14]

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Conclusion