Multimorbidity In Women Research Articles

Multimorbidity in middle-aged women and COVID-19: binary data clustering for unsupervised binning of rare multimorbidity features and predictive modeling

BackgroundMultimorbidity is typically associated with deficient health-related quality of life in mid-life, and the likelihood of developing multimorbidity in women is elevated. We address the issue of data sparsity in non-prevalent features by clustering the binary data of various rare medical conditions in a cohort of middle-aged women. This study aims to enhance understanding of how multimorbidity affects COVID-19 severity by clustering rare medical conditions and combining them with prevalent features for predictive modeling. The insights gained can guide the development of targeted interventions and improved management strategies for individuals with multiple health conditions.MethodsThe study focuses on a cohort of 4477 female patients, (aged 45-60) in Piedmont, Italy, and utilizes their multimorbidity data prior to the COVID-19 pandemic from their medical history from 2015 to 2019. The COVID-19 severity is determined by the hospitalization status of the patients from February to May 2020. Each patient profile in the dataset is depicted as a binary vector, where each feature denotes the presence or absence of a specific multimorbidity condition. By clustering the sparse medical data, newly engineered features are generated as a bin of features, and they are combined with the prevalent features for COVID-19 severity predictive modeling.ResultsFrom sparse data consisting of 174 input features, we have created a low-dimensional feature matrix of 17 features. Machine Learning algorithms are applied to the reduced sparsity-free data to predict the Covid-19 hospital admission outcome. The performance obtained for the corresponding models are as follows: Logistic Regression (accuracy 0.72, AUC 0.77, F1-score 0.69), Linear Discriminant Analysis (accuracy 0.7, AUC 0.77, F1-score 0.67), and Ada Boost (accuracy 0.7, AUC 0.77, F1-score 0.68).ConclusionMapping higher-dimensional data to a low-dimensional space can result in information loss, but reducing sparsity can be beneficial for Machine Learning modeling due to improved predictive ability. In this study, we addressed the issue of data sparsity in electronic health records and created a model that incorporates both prevalent and rare medical conditions, leading to more accurate and effective predictive modeling. The identification of complex associations between multimorbidity and the severity of COVID-19 highlights potential areas of focus for future research, including long COVID and intervention efforts.

The association between depression during perimenopause and progression of chronic conditions and multimorbidity: results from a Chinese prospective cohort.

The association between perimenopausal depression and many chronic conditions among women has been well-established. However, the role of depression during perimenopause in the progression of multiple chronic conditions (multimorbidity) remains poorly understood. A total of 1,216 community-dwelling women in their perimenopause period between 2010 and 2016 were enrolled in our analysis, and followed up for the progression of multimorbidity. Depression, as well as its severity, was evaluated by the Center for Epidemiologic Studies Depression 10-item scale (CES-D-10). Progression of multimorbidity was defined as the first report of two or more chronic conditions for participants without multimorbidity or the new report of one or more conditions for those with multimorbidity. Univariable and multivariable Cox proportional hazards model and the restricted cubic spline regression model were performed to assess the prospective association between perimenopausal depression and the progression of multimorbidity. A total of 480 (39.5%) women reported depression during perimenopause, and 529 (43.5%) women progressed to multimorbidity. After adjusting for socio-demographic and lifestyle factors, perimenopausal depression was independently associated with the progression of multimorbidity (hazard ratio [HR]: 1.34; 95% confidence interval [CI]: 1.13 to 1.60). Moreover, the severity of depression was positively and linearly associated with the progression of multimorbidity (P < 0.05). Our finding reveals a prospective association between perimenopausal depression and the progression of multimorbidity, indicating interventions targeting perimenopausal depression may reduce the burden of chronic diseases and multimorbidity in women's post-menopausal life.

Prevalence of polypharmacy in pregnancy: a systematic review

ObjectivesThe use of medications among pregnant women has been rising over the past few decades but the reporting of polypharmacy has been sporadic. The objective of this review is to...

Impact of a digital health literacy intervention and risk predictors for multimorbidity among poor women of reproductive years: Results of a randomized-controlled trial

Objective The objective of this study was to deliver an intervention to improve health awareness for infection prevention, hygiene, and sanitation to assess its impact. Furthermore, it aimed to identify the risk of multimorbidity in women of reproductive years from low socio-economic background. Methods A randomized control trial was conducted in Pakistan among women aged 15–45 years. Overall, 820 women participated in the baseline survey; 388 women were part of the control group and 360 of the intervention group. A digital health literacy intervention was delivered by 91 trained community health workers. Data were analyzed using descriptive statistics and multivariate logistic regression. Results About 35.9% of women suffered from multimorbidity. The intervention group showed higher odds of confidence in managing health with respect to skill and technique acquisition (AOR = 2.21; 95% CI 1.01–4.84), self-monitoring and insight (AOR = 2.97; 95% CI 1.29–6.80) as well as sanitation and hygiene (AOR = 1.42; 95% CI 1.07–1.93). Two primary outcomes related to hand hygiene and protective behavior against infection did not show any significant improvement. The secondary outcomes of the study related to impact on overall health-related quality of life, social integration and support, and emotional well-being also did not show any significant improvement. Conclusions Digital health literacy interventions and multimorbidity management for women of reproductive years at the primary level are a way forward to alleviate communicable and non-communicable disease burden in developing countries like Pakistan. These efforts are also critical to improve maternal and child health in developing regions.

The association of multimorbidity and neuropsychological test scores in Canadian cohorts recruited in 1991 and 2015

AbstractBackgroundMultimorbidity is associated with cognitive decline. Little information exists regarding whether the relationship between multimorbidity and cognitive decline has changed over the last few decades.ObjectiveTo compare estimates of the association between multimorbidity (MM) and performance on cognitive tests in two prospective cohorts of Canadian community‐dwelling older adults recruited 24 years apart.MethodWe analyzed the two datasets separately, including participants ≥65 years from both baseline and first follow‐up of the Canadian Study of Health and Aging (CSHA, 1991 – 2001; first follow up in 1996) and the Canadian Longitudinal Study on Aging (CLSA, 2015 – ongoing; first follow up in 2018). We excluded participants with baseline dementia. In both cohorts, we defined MM as two or more conditions from a list of 14. The neuropsychological tests were Animal Naming Test (ANT) and the Rey Auditory Verbal Learning Test (RAVL) for both cohorts. Tests of frontal function were the Digit Symbol Substitution Test (DSST) in the CSHA and the Mental Alternation Task (MAT) in the CLSA. We performed multilevel linear modelling. We controlled for confounders, which were detected using a Directed Acyclic Graph.ResultWe included 497 participants from the CSHA and 9308 from the CLSA. The mean age was 78.0 in the CSHA and 72.0 in the CLSA, and male accounted for 36.4% in the CSHA and 50.2 in the CLSA. Mean MM was 2.1 in both cohorts, with a higher prevalence of MM in women (CSHA 63.9%; CLSA 64.2%) than in men (CSHA 55.8%; CLSA 59.5%). When comparing both cohorts, we found that baseline MM was not associated with changes in the Z‐scores for the ANT (CSHA: 0.16, CI95: ‐0.014 to 0.34; CLSA: ‐0.002, CI95: ‐0.044 to 0.04), RAVL delayed recall (CSHA ‐0.033, CI95: ‐0.23 to 0.16; CLSA: 0.031, IC95: ‐0.013 to 0.074), or DSST in CSHA (0.1, CI95: ‐0.084 to 0.29) / MAT in CLSA (0.008, CI95: ‐0.035 to 0.052).ConclusionWe did not find differences in Z‐scores changes over 5 years follow up in the CSHA and 3 years follow up in the CLSA, for three neuropsychological tests among Canadians ≥65 years recruited over two decades apart.

Dietary patterns and prevalence of multimorbidity in women in southern Brazil.

This study aimed to investigate the association between dietary patterns and prevalence of multimorbidity in women. This population-based cross-sectional study was conducted in 2015 and included 1,128 women aged 20 to 69 years living in the urban area of São Leopoldo municipality, southern Brazil. Multimorbidity was defined as the presence of two or more chronic conditions, among the 26 identified. Poisson regression with robust variance was used to investigate the association between the three dietary patterns (healthy, risk, and Brazilian), using different models adjusted for sociodemographic, behavioral, and nutritional status variables. The results showed differences in the prevalence of adherence to different dietary patterns and multimorbidity across age groups, with a prevalence of multimorbidity and a healthy dietary pattern showing a direct linear trend with age, whereas the risk dietary pattern showed an inverse linear trend with age. The prevalence of the Brazilian dietary pattern remained constant despite differences in age. After adjustment, we found that women with greater adherence to the Brazilian dietary pattern showed a 40% reduction in the prevalence of multimorbidity compared with those with less adherence (prevalence ratio, 0.60; 95% confidence interval, 0.40-0.86). The results revealed that the prevalence of multimorbidity was significantly lower in women with greater adherence to the Brazilian dietary pattern and highlight the importance of dietary interventions in early adulthood as a way to prevent multimorbidity in women.

Ethnic inequalities in mental and physical multimorbidity in women of reproductive age: a data linkage cohort study

ObjectivesExplore inequalities in risk factors, mental and physical health morbidity in non-pregnant women of reproductive age in contact with mental health services and how these vary per ethnicity.DesignRetrospective cohort study.SettingData...

Ethnic disparities in multi-morbidity in women of reproductive age in the UK: a data linkage study

IntroductionFew studies have explored ethnic inequalities in physical and mental health in women at preconception.ObjectivesExplore inequalities in multimorbidity in women of reproductive age.MethodsData from Lambeth DataNet, anonymized primary care records of this ethnically diverse London borough, linked to anonymized electronic mental health records (“CRIS secondary care database”) were extracted on preconception risk factors including BMI, smoking, alcohol, substance misuse, micronutrient deficiencies and physical health diagnoses for women aged 15-40 with an episode of secondary mental health care (January 2008-December 2018) and no pregnancy codes (n=3,633) and a 4:1 age-matched comparison cohort (n=14,532) .ResultsWomen in contact with mental health services (whether with or without SMI diagnoses) had a higher prevalence of all risk factors and physical health diagnoses studied after adjustment for deprivation and ethnicity. Women from minority ethnic groups [79.5% of total sample] were less likely to be diagnosed with depression in primary care compared to White British women [adj OR 0.66 (0.55- 0.79) p&lt;0.001] and Black women were more likely to have a severe mental illness [adj OR 3.41(2.63-4.43), p&lt;0.001]. Black and Asian women were less likely to smoke or misuse substances and more likely to be vitaminD deficient. Black women were also significantly more likely to be overweight [adj OR 4.56(3.96-5.24 p &lt;0.001] and have two or more physical health conditions [adj OR 2.98(2.19-4.07) p&lt;0.001] than White British women after adjustment for deprivation and SMI diagnoses.ConclusionsOur results highlight a need for culturally centered integrative models of care across primary and secondary mental health services.DisclosureClosing the Gap is funded by UK Research and Innovation and their support is gratefully acknowledged (Grant reference: ES/S004459/1). Any views expressed here are those of the project investigators and do not necessarily represent the views of the Closing

Association Between Living Risk and Healthy Life Years Lost Due to Multimorbidity: Observations From the China Health and Retirement Longitudinal Study.

BackgroundMultimorbidity has an effect on life expectancy, while its effect on healthy life years is unclear. This study aims to investigate the associations between healthy life years lost due to multimorbidity and living risk.MethodsThe participants of The China Health and Retirement Longitudinal Study (CHARLS) were assessed at four visits between 2011 (baseline) and 2018. At baseline, 13,949 individuals were administered surveys. A combined score based on seven health-related factors was calculated, and the participants were classified into 3 groups based on living risk. We used the adjusted Cox regression methods to examine the associations between living risk groups and multimorbidity. We estimated the healthy life years lost due to multimorbidity using the Sullivan method.ResultsA total of 9,091 adults aged 45 years or older (mean age of 59.55 ± 9.50 years with one disease, 52.60% women) were analyzed in the CHARLS. The probability of no multimorbidity over 7 years decreased from 0.9947 to 0.9697 in the low-risk group, whereas the probability of multimorbidity in low living risk was lower than that of high living risk, ranging from HR 1.253 (95% CI.992–1.581; P = 0.058) to 1.431 (1.05–1.949; P = 0.023) in sex, and ranging from HR 1.340 (95% CI 1.106–1.623; P = 0.003) to 2.002 (1.058–3.787; P = 0.033) in area. At 45 years, the healthy life years lost in men was <0.27 years compared to women in the low-risk group. Hypertension increased the risk of multimorbidity with an HR of 1.5 (95% CI 1.21–1.91; P < 0.001) in men. In urban areas, participants with diabetes had 3.2 times (95% CI 1.75–5.94, P < 0.001) higher risk of multimorbidity than participants without diabetes.ConclusionsThese findings indicate that a low-risk lifestyle could decrease the loss of healthy life years under multimorbidity. The probability of multimorbidity in women and in urban areas was high. Hypertension was correlated with the hazard risk of multimorbidity.

Sex Differences in the Associations of Handgrip Strength and Asymmetry With Multimorbidity: Evidence From the English Longitudinal Study of Ageing.

To determine the sex-specific associations of handgrip strength (HGS) and asymmetry with incident multimorbidity and examine whether these relationships differ by sex. Prospective cohort study. Secondary analyses of data from the English Longitudinal Study of Ageing (ELSA, waves 2-8). The analytic sample included 3977 participants (51.4% female) aged ≥50years who had data for HGS on both hands and were living without multimorbidity at baseline. HGS was assessed with a handheld dynamometer. Individuals in the lowest tertile of sex-specific age-adjusted HGS were defined as having low HGS. The largest HGS readings from the nondominant and dominant hand were used to calculate HGS ratio [nondominant HGS (kg)/dominant HGS (kg)]. Those with HGS ratio <0.90 or >1.10 had any HGS asymmetry. Further, those with HGS ratio <0.90 had dominant HGS asymmetry, whereas those with HGS ratio >1.10 had nondominant HGS asymmetry. Multimorbidity was defined as the coexistence of ≥2 chronic diseases. Cox proportional hazards regression models were conducted for analyses. Low HGS was associated with multimorbidity among older men [hazard ratio (HR) 1.20, 95% confidence interval (CI) 1.03-1.40] and women (HR 1.19, 95% CI 1.03-1.38). No significant effect modification by sex was observed (P-interaction= .71). HGS asymmetry increased the risk of multimorbidity in women only (HR 1.23, 95% CI 1.07-1.41). The relationship between HGS asymmetry and multimorbidity risk differed by sex (P-interaction= .01). Similarly, both dominant HGS asymmetry (HR 1.21, 95% CI 1.05-1.40) and nondominant HGS asymmetry (HR 1.32, 95% CI 1.03-1.68) were related to incident multimorbidity in women only. There was a significant interaction between dominant HGS asymmetry and sex (P-interaction = .02). Examining HGS asymmetry in HGS test protocols can provide novel insights for the predictive power of HGS in the accumulation of diseases, particularly in women.

Negative Self-Assessment of Health in Women: Association with Sociodemographic Characteristics, Physical Inactivity and Multimorbidity.

Introduction: Women present a higher prevalence of negative self-assessment of health (NSAH) when compared to men. However, there is a gap in the literature of factors associated with NSAH in women from developing countries such as Brazil. In addition, few studies have assessed the magnitude of the association between multimorbidity and NSAH in this population. Thus, the aim of this study was to evaluate the association between NSAH and sociodemographic characteristics, lifestyle and multimorbidity in women from the Midwest region of Brazil. Methods: A study based on data from the National Health Survey, a household survey that investigated health situation, lifestyle and risk factors for chronic diseases in the adult population of Brazil, was held. Sampling was performed in multiple stages. The selected women answered a standardized questionnaire on sociodemographic data, self-assessment of health and potential determinants. Poisson regression was used to analyze the association between NSAH and sociodemographic characteristics, lifestyle and multimorbidity. A significance level of 0.05% was established. Results: The study included 4233 women. The prevalence of NSAH found was 6.0% (95% Confidence Interval [95% CI]: 5.1–7.0%). There was an association between NSAH and advancing age, low schooling, physical inactivity and multimorbidity. Furthermore, there was an association between NSAH and diseases/disorders such as chronic back pain, systemic arterial hypertension, mental disorders, depression, cardiovascular diseases, stroke, cancer, hypercholesterolemia and diabetes mellitus. Conclusion: The prevalence of NSAH was low. A strong association was found between this variable and multimorbidity. In addition, increased age, low schooling and physical inactivity were predictors of NSAH in women.

Multimorbidity among Women of Reproductive Age in Desertified and Degraded Districts of India

Multimorbidity or co-morbidity is defined as the co-occurrence of two or more chronic conditions in an individual. This paper analyses the prevalence of multimorbidity among women of reproductive age in backward districts of India. Multivariate linear regression is applied using the enter method to study factors independently associated with multimorbidity in women of reproductive age (15 and 49 years) in 75 desertified and degraded districts of India. Separate regressions are performed for women in both the rural and urban areas. The findings of the study reveal that the weighted prevalence of multimorbidity among reproductive women is 17.2 per cent. Further, regression analyses show that, among all explanatory variables, ageing and high income strongly affect multimorbidity among women aged between 15 and 49 years. However, the adverse effects of land degradation on multimorbidity could not be confirmed.

Lifestyle, high Body Mass Index, and markers of socioeconomic conditions associated with multimorbidity in women.

This study aimed to identify the prevalence of multimorbidity and its associated factors in women in southern Brazil. We conducted a cross-sectional, population-based study with a sample of 1,128 women (age 20-69 years), living in São Leopoldo, southern Brazil. Multimorbidity was defined as two or more chronic conditions measured using the therapeutic and chemical anatomical classification of continuous use medications prescribed by a physician. Poisson regression model with robust variance was used to assess the association between sociodemographic and lifestyle variables and multimorbidity. The prevalence of multimorbidity was 21.7% (95%CI 19.3-24.2), and 26 chronic conditions were identified. A direct linear association was observed with age and income and an inverse association with education. Being unemployed was a risk factor for multimorbidity (PR 1.95; 95%CI 1.51-2.52). Alcohol consumption (moderate or excessive) had a protective effect. Overweight and obese women were 53% (PR 1.53; 95%CI 1.09-2.15) and 76% (PR 1.76; 95%CI 1.27-2.45) more likely to have multimorbidity than eutrophic women. Over 20% of the adult women had multimorbidity, and its occurrence was strongly associated with socioeconomic characteristics, such as fewer years of schooling, higher income, and not having an occupation. The results regarding alcohol consumption are still insufficient to propose a public policy for the prevention of multimorbidity. Excess weight was an independent risk factor and should be addressed in public health policies for the prevention and management of multimorbidity.

Racial and ethnic disparities in multimorbidity in non-pregnant women of reproductive age in Lambeth, UK: a data linkage study

BackgroundFew studies have explored ethnic inequalities in physical and mental health in non-pregnant women of reproductive age. We aimed to assess the differences in multimorbidity in women according whether they had been in contact with mental health services or not, and differences in primary care in women according to ethnicity. MethodsIn this data linkage study, we extracted data in May, 2021, from Lambeth DataNet (LDN; anonymised primary care records of residents of the ethnically diverse inner-city London borough of Lambeth), linked to anonymised electronic mental health records (Clinical Record Interactive Search [CRIS] secondary care database), on selected risk factors for morbidity including low or high body-mass index, smoking, alcohol consumption, substance misuse, micronutrient deficiencies, and physical health diagnoses for women aged 15–40 years who had received secondary mental health care between January, 2008, and December, 2018, and whose record contained no current or historical antenatal or postnatal codes, and an age-matched comparison cohort (case-to-control ratio of 1:4). Univariate and multivariate logistic regression analyses were used to examine the rate of outcomes across cases in contact with mental health services versus controls, and to explore disparities between different ethnic groups in primary care. CRIS was approved by the Oxfordshire Research Ethics Committee in 2008 (reference 18/SC/0372). Approval for linkage with LDN was granted by Lambeth Clinical Commissioning Group and Information Governance Steering Group. FindingsWe extracted data for 3633 women in contact with mental health services, and 14 532 controls. Women in contact with mental health services (with or without severe mental illness diagnoses) had a higher prevalence of all risk factors and physical health diagnoses studied after adjustment for deprivation and ethnicity than did controls. Women from minority ethnic groups (12 234 [79·0%] of all 15 491 women with data on ethnicity, comprising 5503 [35·5%] who reported as White Other, 2050 [13·2%] as Black, 1011 [6·5%] as Asian, and 3670 [23·7%] as Mixed or Other) were less likely to be diagnosed with depression in primary care than were White British women (adjusted odds ratio [OR] 0·66, 95% CI 0·55–0·79; p<0·0001), and Black women were more likely to have a severe mental illness than were White British women (adjusted OR 3·41, 2·63–4·43; p<0·0001). Black and Asian women were less likely to smoke (p<0·0001) or misuse substances (p<0·0001) and more likely to be vitamin D deficient (p<0·0001) than were White British women. Compared with White British women, Black women were more likely to be overweight (adjusted OR 4·56, 3·96–5·24); p<0·0001, be diagnosed with hypertension (8·18, 5·59–12·00; p<0·0001), and have two or more physical health conditions (2·98, 2·19–4·07; p<0·0001) after adjustment for deprivation and severe mental illness diagnoses. InterpretationThe differences in multimorbidity present across ethnic groups with and without mental illness in non-pregnant women without children highlight a need for culturally centered integrative models of care across primary and secondary mental health services. Our data also indicate that there are mental and physical health needs of women in contact with mental health services that are not being met by the current model of service provision. FundingClosing the Gap network.

The prevalence of multimorbidity and its association with physical activity and sleep duration in middle aged and elderly adults: a longitudinal analysis from China

BackgroundPreventing chronic disease is important in health policy in countries with significantly ageing populations. This study aims to examine the prevalence of chronic disease multimorbidity and its association with physical activity and sleep duration; and to understand whether physical activity modifies associations between sleep duration and multimorbidity.MethodsWe utilized longitudinal data of a nationally-representative sample from the China Health and Retirement Longitudinal Study (in year 2011 and 2015; N = 5321; 54.7% female; age ≥ 45 years old). Fourteen chronic diseases were used to measure multimorbidity (ten self-reported, and four by blood test). Participants were grouped into high, moderate, and low level based on self-reported frequencies and durations of physical activity with different intensities for at least 10 min at a time in a usual week. Poor and good sleepers were categorized according to average hours of actual sleep at each night during the past month. Panel data method of random-effects logistic regression model was applied to estimate the association of physical activity and sleep with multimorbidity, adjusting for social-demographic and behavioural confounders.ResultsFrom 2011 to 2015, the prevalence of multimorbidity increased from 52.2 to 62.8%. In 2015, the proportion of participants engaging in high, moderate, and low level of physical activity was 30.3, 24.4 and 45.3%, respectively, and 63.6% of adults had good sleep. For both genders, compared with good sleep, poor sleep was associated with higher odds of multimorbidity (OR = 1.527, 95% CI: 1.277, 1.825). Compared to the high-level group, participants with a low level of physical activity were significantly more likely to have multimorbidity (OR = 1.457, 95% CI: 1.277, 1.825), but associations were stronger among women. The relative excess risk due to interaction between poor sleep and moderate or low physical activity was positive but non-significant on multimorbidity.ConclusionsThe burden of multimorbidity was high in China. Low physical activity and poor sleep was independently and significantly associated with a higher likelihood of multimorbidity in women and both genders, separately. Physical activity could modify the association between sleep and multimorbidity.

Maternal multimorbidity during pregnancy and after childbirth in women in low- and middle-income countries: a systematic literature review

BackgroundFor every maternal death, 20 to 30 women are estimated to have morbidities related to pregnancy or childbirth. Much of this burden of disease is in women in low- and middle-income countries. Maternal multimorbidity can include physical, psychological and social ill-health. Limited data exist about the associations between these morbidities. In order to address all health needs that women may have when attending for maternity care, it is important to be able to identify all types of morbidities and understand how each morbidity influences other aspects of women’s health and wellbeing during pregnancy and after childbirth.MethodsWe systematically reviewed published literature in English, describing measurement of two or more types of maternal morbidity and/or associations between morbidities during pregnancy or after childbirth for women in low- and middle-income countries. CINAHL plus, Global Health, Medline and Web of Science databases were searched from 2007 to 2018. Outcomes were descriptions, occurrence of all maternal morbidities and associations between these morbidities. Narrative analysis was conducted.ResultsIncluded were 38 papers reporting about 36 studies (71,229 women; 60,911 during pregnancy and 10,318 after childbirth in 17 countries). Most studies (26/36) were cross-sectional surveys. Self-reported physical ill-health was documented in 26 studies, but no standardised data collection tools were used. In total, physical morbidities were included in 28 studies, psychological morbidities in 32 studies and social morbidities in 27 studies with three studies assessing associations between all three types of morbidity and 30 studies assessing associations between two types of morbidity. In four studies, clinical examination and/or basic laboratory investigations were also conducted. Associations between physical and psychological morbidities were reported in four studies and between psychological and social morbidities in six. Domestic violence increased risks of physical ill-health in two studies.ConclusionsThere is a lack of standardised, comprehensive and routine measurements and tools to assess the burden of maternal multimorbidity in women during pregnancy and after childbirth. Emerging data suggest significant associations between the different types of morbidity.Systematic review registration numberPROSPERO CRD42018079526.

The multimorbidity profile of South African women newly diagnosed with breast cancer.

Multimorbidity in women with breast cancer may delay presentation, affect treatment decisions and outcomes. We described the multimorbidity profile of women with breast cancer, its determinants, associations with stage at diagnosis and treatments received. We collected self-reported data on five chronic conditions (hypertension, diabetes, cerebrovascular diseases, asthma/chronic obstructive pulmonary disease, tuberculosis), determined obesity using body mass index (BMI) and tested HIV status, in women newly diagnosed with breast cancer between January 2016 and April 2018 in five public hospitals in South Africa. We identified determinants of ≥2 of the seven above-mentioned conditions (defined as multimorbidity), multimorbidity itself with stage at diagnosis (advanced [III-IV] vs. early [0-II]) and multimorbidity with treatment modalities received. Among 2,281 women, 1,001 (44%) presented with multimorbidity. Obesity (52.8%), hypertension (41.3%), HIV (22.0%) and diabetes (13.7%) were the chronic conditions that occurred most frequently. Multimorbidity was more common with older age (OR = 1.02; 95% CI 1.01-1.03) and higher household socioeconomic status (HSES) (OR = 1.06; 95% CI 1.00-1.13). Multimorbidity was not associated with advanced-stage breast cancer at diagnosis, but for self-reported hypertension there was less likelihood of being diagnosed with advanced-stage disease in the adjusted model (OR 0.80; 95% CI 0.64-0.98). Multimorbidity was associated with first treatment received in those with early-stage disease, p = 0.003. The prevalence of multimorbidity is high among patients with breast cancer. Our findings suggest that multimorbidity had a significant impact on treatment received in those with early-stage disease. There is need to understand the impact of multimorbidity on breast cancer outcomes.

Short-term weight gain is associated with accumulation of multimorbidity in mid-aged women: a 20-year cohort study.

Although weight change has been studied in relation to many individual chronic conditions, limited studies have focused on weight change and multimorbidity. This study examines the relationship between short-term weight change and the accumulation of multimorbidity in midlife. We used data from 7357 women aged 45-50 years without a history of any chronic conditions. The women were surveyed approximately every 3 years from 1996 to 2016. Associations between short-term weight change and accumulation of multimorbidity (two or more of nine chronic conditions) over each 3-year period, adjusting for baseline body mass index (BMI) or time-varying BMI (3-year period), were examined using repeated measures models. Short-term weight change was categorised into seven groups of annual weight change from high weight loss ( ≤ -5%) to high weight gain (> + 5%). Over 20 years, 60.4% (n = 4442) of women developed multimorbidity. Baseline BMI, time-varying BMI and short-term weight gain were all associated with the accumulation of multimorbidity. After controlling for sociodemographic, lifestyle factors and menopausal status, high weight gain was associated with a 25% increased odds of multimorbidity (odds ratio (OR) 1.25, 95% confidence interval (CI) 1.08-1.45) compared with maintaining a stable weight. The results were consistent among models adjusting for baseline BMI (OR 1.24, 95% CI 1.07-1.44) or time-varying BMI (OR 1.34, 95% CI 1.16-1.54). Weight loss was associated with increased odds of multimorbidity in women with normal BMI (baseline or time-varying). Short-term weight gain is associated with significantly increased odds of multimorbidity in mid-aged women. This association is independent from baseline BMI (at 45-50 years) and time-varying BMI. These findings support a persistent weight management regime and prevention of weight gain throughout women's midlife.

Prevalence and patterns of multimorbidity in Amazon Region of Brazil and associated determinants: a cross-sectional study

ObjectivesTo estimate the prevalence of multimorbidity and to identify factors associated with it in the adult population from the metropolitan region of Manaus.DesignCross-sectional population-based study.SettingInterviews conducted between May and August...

Pre-Frailty, Frailty, and Multimorbidity: Prevalences and Associated Characteristics from Two French National Surveys.

To estimate the prevalence of pre-frailty, frailty and multimorbidity in individuals without disability in France. To describe independent determinants of each indicators. Two nationally representative cross-sectional French surveys. Wave 2012 of the Health, Health Care and Insurance Survey (Enquête Santé et Protection Sociale, ESPS) and data from the Disability Healthcare Household section Survey (Enquête Handicap Santé - Ménages, HSM) from 2008. Two representative samples of the French population aged 55 and older (n=4,328 and n=12,295). Frailty was assessed using Fried's frailty phenotype and multimorbidity was defined as having had at least two groups of the following groups of comorbidities in the last 12 months (cardio or cerebrovascular disease, diabetes, chronic respiratory disease, arthralgia, depression). Independent determinants were studied using weighted logistic regressions. In the French population over 55 and free of disability, 55 to 62% of individuals were either frail, pre-frail or multimorbid, 22 to 25% being frail or multimorbid. ESPS and HSM prevalences for frailty (11.1% [9.3%-12.1%] and 12.3% [11.5%-13.0%]) and multimorbidity (14.9% [13.6%-16.2%] and 16.8% [15.9%-17.7%]) were consistent across studies. Both frailty and multimorbidity prevalences were associated with age. On the other hand, pre-frailty prevalence varied consistently between studies (from 38 to 48%) and was not significantly associated with age. We found that more than 60% of frail subjects did not present with multimorbidity and around 70% of subjects with multimorbidity were not frail. Determinants of pre-frailty and multimorbidity but not frailty depended on sex. Similar factors were associated with frailty and multimorbidity in women (older age, functional decline, poor mental health, financial difficulties) while only poor mental health was independently associated with both indicators in men. Our study highlights that in France, among individuals older than 55 years-old and free of disability, around 25% are either frail or multimorbid; another 30% to 40% being pre-frail. Pre-frailty, frailty and multimorbidity are known to be associated with adverse health outcomes and important economic costs. The health system must adapt to respond to the needs of its aging population. In addition, given the efficient impact of prevention actions, our findings emphasize the need to implement prevention strategies against Frailty and multimorbidity in France.