The rising complexity and burden of multimorbidity in a middle-income country

• Published in: PloS one 2020-12, Vol.15 (12), p.e0243614-e0243614
• Main Authors: Prathapan, Shamini, Fernando, Gunasekara Vidana Mestrige Chamath, Matthias, Anne Thushara, Bentota Mallawa Arachchige Charuni, Yashodara, Abeygunawardhana, Herath Mudiyanselage Gayan, Somathilake, Batheegama Gamarachchige Gayasha Kavindi
• Format: Article
• Language: English
• Subjects: Adult; Age; Aged; Analysis; Cardiovascular diseases; Chronic illnesses; Comorbidity; Coronary artery disease; Cost of Illness; Cross-Sectional Studies; Developing countries; Diabetes; Diabetes mellitus; Epidemiology; Female; Forecasts and trends; Health aspects; Health care; Heart diseases; Humans; Hypertension; Income; International organizations; Male; Medical referrals; Medicine; Medicine and Health Sciences; Mental disorders; Mental health; Middle Aged; Multimorbidity; Patient outcomes; Patient safety; Patients; People and places; Population; Primary care; Psychological factors; Public health; Regression analysis; Risk analysis; Risk factors; Sri Lanka - epidemiology; Statistics; Sustainable development; Syndemics; Teaching hospitals; Tertiary Care Centers - economics; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0243614

The limited knowledge on aetiology, epidemiology and risk factors for multimorbidity especially evident from low and middle-income countries curtail the development and implementation of sustainable healthcare models. Sri Lanka, boasting for one of South Asia's most efficient public health systems that is accessible free-of-charge by the citizens is presently transitioning from lower-middle to upper-middle-income tier. Faced with the triple burden of disease, it is imperative for Sri Lanka to incorporate an integrated model to manage multimorbidity. A descriptive cross-sectional study was carried out in medical clinics of a tertiary care hospital and a University primary care department. Data were extracted on to a form from the clinical records of patients over the age of 20 years with at least one non-communicable disease (NCD) and analysed. Multimorbidity was present among 64.1% of patients (n = 1600). Nearly 44.44% of the patients aged 20-35 years have a minimum of two disorders, and by the time they reach 50 years, nearly 64% of the patients have two or more non-communicable diseases. Nearly 7% of those aged over 65 years were diagnosed with four or more disorders. A fourth of the sample was affected by co-morbid diabetes mellitus and hypertension, whereas the combinations of coronary heart disease with hypertension and diabetes mellitus were also found to be significantly prevalent. A salient revelation of the binomial logistic regression analysis was that the number of disorders was positively correlated to the presence of mental disorders 7.25 (95% CI = 5.82-8.68). Multimorbidity is highly prevalent among this population and seemingly has a detrimental effect on the psychological wellbeing of those affected. Therefore, the need for horizontal integration of all primary to tertiary care disciplines, including mental health, to manage multimorbidity by policymakers is emphasized as a priority task.