Epidemiology of chronic multimorbidity and temporary migration in a rural South African community in health transition: A cross-sectional population-based analysis
Date
2023-04-21
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Abstract
Introduction: In sub-Saharan African settings, the increasing non-communicable
disease mortality is linked to migration, which disproportionately exposes subpopulations
to risk factors for co-occurring HIV and NCDs.
Methods: We examined the prevalence, patterns, and factors associated with two or
more concurrent diagnoses of chronic diseases (i.e., multimorbidity) among temporary
within-country migrants. Employing a cross-sectional design, our study sample
comprised 2144 residents and non-residents 18–40 years interviewed and with
measured biomarkers in 2018 in Wave 1 of the Migrant Health Follow-up Study
(MHFUS), drawn from the Agincourt Health and Demographic Surveillance System
(AHDSS) in rural north-eastern South Africa. We used modified Poisson regression
models to estimate the association between migration status and prevalent chronic
multimorbidity conditional on age, sex, education, and healthcare utilisation.
Results: Overall, 301 participants (14%; 95% CI 12.6–15.6), median age 31 years had
chronic multimorbidity. Multimorbidity was more prevalent among non-migrants
(14.6%; 95% CI 12.8–16.4) compared to migrants (12.8%; 95% CI 10.3–15.7). Nonmigrants
also had the greatest burden of dual-overlapping chronic morbidities, such
as HIV-obesity 5.7%. Multimorbidity was 2.6 times as prevalent (PR 2.65. 95% CI 2.07–
3.39) among women compared to men. Among migrants, men, and individuals with
secondary or tertiary education manifested lower prevalence of two or more conditions.
Discussion: In a rural community with colliding epidemics, we found low but significant
multimorbidity driven by a trio of conditions: HIV, hypertension, and obesity. Understanding the
multimorbidity burden associated with early adulthood exposures, including potential
protective factors (i.e., migration coupled with education), is a critical first step towards
improving secondary and tertiary prevention for chronic disease among highly mobile
marginalised sub-populations.
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Keywords
human migration, epidemics, infectious diseases, non-communicable diseases, LMIC