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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Public Health 1/2015

Multimorbidity and the inequalities of global ageing: a cross-sectional study of 28 countries using the World Health Surveys

BMC Public Health > Ausgabe 1/2015
Sara Afshar, Paul J. Roderick, Paul Kowal, Borislav D. Dimitrov, Allan G. Hill
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12889-015-2008-7) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they do not have competing interests.

Authors’ contributions

SA has made significant contributions through the conception, data analysis, interpretation and drafting of the manuscript. PR, BDD and AH have made contributions to the conception, analysis and interpretation of results; as well as the re-drafting of the manuscript. PK has made contributions to the accuracy of information, revising of the manuscript and final approval before submission.

Authors’ information

This work is part of an ongoing doctoral research programme. SA is a PhD student and PR, BDD and AH are academic supervisors at the Academic Unit of Primary Care and Population Sciences and Co-Chairs and members of the Strategic Research group (USRG) for Population Health at the University of Southampton (www.​southampton.​ac.​uk/​populationhealth​); PK is the WHO co-PI of WHO’s SAGE (www.​who.​int/​healthinfo/​sage/​en/​), Senior Research Fellow at the University of Newcastle’s Priority Research Centre for Gender, Health and Ageing, and is an external advisor to the doctoral study.



Multimorbidity defined as the “the coexistence of two or more chronic diseases” in one individual, is increasing in prevalence globally. The aim of this study is to compare the prevalence of multimorbidity across low and middle-income countries (LMICs), and to investigate patterns by age and education, as a proxy for socio-economic status (SES).


Chronic disease data from 28 countries of the World Health Survey (2003) were extracted and inter-country socio-economic differences were examined by gross domestic product (GDP). Regression analyses were applied to examine associations of education with multimorbidity by region adjusted for age and sex distributions.


The mean world standardized multimorbidity prevalence for LMICs was 7.8 % (95 % CI, 7.79 % - 7.83 %). In all countries, multimorbidity increased significantly with age. A positive but non–linear relationship was found between country GDP and multimorbidity prevalence. Trend analyses of multimorbidity by education suggest that there are intergenerational differences, with a more inverse education gradient for younger adults compared to older adults. Higher education was significantly associated with a decreased risk of multimorbidity in the all-region analyses.


Multimorbidity is a global phenomenon, not just affecting older adults in HICs. Policy makers worldwide need to address these health inequalities, and support the complex service needs of a growing multimorbid population.
Additional file 1: Shows the crude morbidity prevalence of chronic disease by country and region.
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