Prevalence and determinants of comorbidity amongst hypertensive adults (20+ years) in South Africa

Abstract

Introduction; Comorbidity has several definitions based on different conceptualisations of a single core concept: the presence of more than one distinct condition in an individual. The prevalence of comorbidity is high, as the vast majority of the South African population on average have between two and three co-existing conditions. Comorbidity is associated with a decline in many health outcomes and increases in mortality and the use of health care resources. Hypertension is one of the leading causes of mortality, with an estimated 1.2 billion sufferers globally. South Africa has the highest Hypertension prevalence in Southern Africa. In the year 2017, an estimated 42% to 54% of people were suffering from Hypertension in South Africa and this figure is expected to increase. With this in mind, this study looked at the four most prevalent comorbidities in South Africa and the areas in which their prevalence is highest. DATA & METHODS: Data were drawn from the 2017 General Household Survey. The analysis compromised of a total of three phases: the first stage, descriptive statistics were used to show the overall distribution of the four most prevalent comorbidities amongst hypertensive adults, ArcGIS was used to perform a GIS analysis to visualize the prevalence of comorbidities of hypertension across South Africa and lastly, a multinomial regression model was used to finally examine the socioeconomic factors associated with comorbidities amongst hypertensive adults. The data were analyzed using STATA software version 14. All model diagnostics showed that the model fits reasonably for the data. The interpretation of results was made using relative risk ratios (RRRs), and 95% confidence intervals. RESULTS: Diabetes and Hypertension had the highest prevalence rate with 21% of Hypertensive adults suffering from both chronic illnesses. The second was Hypertension and Hyperlipidemia (5.63%), followed by Hypertension and Heart Attacks (3.77%) and lastly Hypertension and HIV/AIDS (2.92%). For all four comorbidities, Females had an overall higher rate than their male counterparts as their relative risk increases by a factor of 2.2. CONCLUSION & RECOMMENDATIONS: Comorbidity and multimorbidity have been shown to be associated with adverse health outcomes, such as poor quality of life, disability, psychological problems, and increased mortality. They also associated with increased frequency of health-service use involving emergency hospital admission, adverse drug events, poly-pharmacy, duplicate testing, and poor care coordination. A large proportion of women and individuals from the Black/African racial group experience several comorbidities, highlighting the need to address the chronic non-communicable disease epidemic in South Africa and to co-ordinate multidisciplinary primary-, secondary-and tertiary-level care in the country’s complex healthcare system for a better outcome