Living with multiple chronic conditions cuts lives short – but Africans are overlooked in research:
When a person suffers from two or more long-term health conditions at the same time this is known as multimorbidity.
The World Health Organization says multimorbidity puts patients at greater risk and complicates primary care. It also drives up healthcare costs.
People with more than one condition face a higher risk of early death and poorer quality of life. They may also have to take multiple medications. Polypharmacy increases the risk of harmful drug interactions and side effects, and patients find it harder to stick to treatment.
In African countries the situation is further complicated by several disease burdens converging. Individuals may suffer non-communicable diseases like hypertension and diabetes, as well as from infectious diseases like HIV and tuberculosis.
Poverty and unequal access to healthcare add to the impact of multimorbidity.
Most research on multimorbidity has focused on populations of European ancestry. When people of African descent are included, the focus is often on African-Americans. This group does not represent the diversity or health challenges faced in Africa.
As specialists in genetic epidemiology and chronic diseases management, we set out to research the gaps in understanding multimorbidity among people with African ancestry.
Identifying gaps
We examined 232 medical research publications (published from 2010 to June 2022), and included those published in English and French. That’s not a lot if one considers all the different health challenges that people of African descent suffer globally.
Of these studies, 113 focused on continental African populations and 100 on the diaspora. Nineteen included both groups.
Our review spanned five major academic databases. We used search terms such as “multimorbidity”, “comorbidity” and “African population”. Restricting searches to titles and abstracts and relying on texts that our institutions could access may have excluded some studies.
Heart diseases dominate
Cardiometabolic diseases, including hypertension, heart disease and diabetes, were the most studied conditions in both populations (those in Africa and those elsewhere).
But notable differences emerged.
In populations on the continent, cardiometabolic diseases tended to occur along with chronic infectious diseases such as HIV and tuberculosis.
In diaspora populations, cardiometabolic diseases more commonly occurred along with other non-communicable diseases and psychiatric conditions such as depression and post-traumatic stress disorder.
Age, sex, poverty
As with all populations worldwide, older people in the studies we reviewed were the group most likely to have more than one health condition.
But on the continent, the burden of infectious diseases meant younger adults were also at risk of having more than one illness.
Women were more likely than men to have multiple conditions, particularly in relation to conditions such as hypertension and diabetes. This likely reflects both biological factors, such as hormonal differences, and social influences like income inequalities and differences in working environments.
Individuals with lower socioeconomic status (which often means women) would be more likely to be exposed to unhealthy lifestyles, and to have less access to preventive care.
What can be done?
Our review found that the way health conditions combine differs between people of African descent outside Africa and those on the continent. This means medical research should include a greater diversity of participants.
Expanded data collection should include genetic and metabolomic data.
It is also essential to study a wider range of chronic conditions.
The increasing co-existence of conditions means that treatment for cardiovascular, metabolic and infectious diseases should be integrated.
Some African countries, including South Africa and Kenya, have already introduced integrated care, with encouraging results. A patient with two or more diseases is offered treatment for the conditions at the same facility during the same visit.
Michele Ramsay receives funding from the National Research Foundation (RSA), National Institutes of Health (USA) and Wellcome (UK). She serves on the WHO TAG-G committee.
Isaac Kisiangani and Michelle Kamp do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.
: The Conversation – Articles (AFRICA)
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