This scoping review aimed to map the scope of available evidence on relationships between multimorbidity patterns and functioning among adults in LMICs, and describe methods used. Secondary objectives included identifying multimorbidity patterns, associated functional problems, and evidence gaps.
A systematic search of PubMed/MEDLINE, Scopus, EBSCOhost (CINAHL), and Cochrane databases was conducted from January 1976 to March 2023. Peer-reviewed studies of any design involving adults with multimorbidity in LMICs that referred to associations between multimorbid patterns and functioning were included. Two reviewers independently screened studies and extracted data. The World Health Organisation's International Classification of Functioning, Disability and Health framework was used to classify functional problems. Findings were synthesised narratively.
Nine studies (total sample size: 62,003) were included, mainly from upper-middle-income Asian countries. Key methodological inconsistencies were identified in defining and operationalising multimorbidity, conditions included in determining patterns, statistical methods for pattern determination, and functioning outcome measures. Commonly used methods for pattern identification included exploratory factor analysis and latent class analysis. Five main multimorbidity pattern domains emerged: Cardio-Metabolic and Coronary Atherosclerotic, Musculoskeletal, Respiratory and Digestive/Visceral, Degenerative, and Mental Health-Related. The Cardio-Metabolic/Coronary Atherosclerotic and Respiratory/Digestive patterns were associated with the most functional problems. Mobility limitations, instrumental activities of daily living, self-care, and bowel/bladder problems were consistently linked to all pattern domains.
The limited and geographically skewed body of literature, along with methodological inconsistencies, hampers a comprehensive understanding of multimorbidity patterns and associations with functioning in LMICs. Future research should explore context-specific multimorbidity definitions, employ transparent methodologies, use standardised measures, and incorporate diverse samples to inform tailored interventions and policies.
Future research should prioritise studies in diverse LMIC settings, particularly in Africa and low-income countries, to capture a broader range of multimorbidity patterns and functional associations. Longitudinal study designs are needed to investigate causal relationships between multimorbidity patterns and functional decline. The inclusion of chronic infectious diseases in multimorbidity definitions for LMICs should be explored. Developing and validating standardised, culturally-appropriate functional assessment tools for multimorbid populations in LMICs is crucial. Healthcare providers, particularly in primary care, should be aware of potential impacts of specific multimorbidity patterns on functional outcomes. Such outcomes may be valuable to monitor and may inform personalised care of young-to-middle-aged adults to optimise function in resource-constrained settings.
developing countries
Multimorbidity
