ArticleBMJ open2021
Multimorbidity and mortality in an older, rural black South African population cohort with high prevalence of HIV findings from the HAALSI Study.
Article in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed, 27 citations in OpenAlex.
- HIV testing and linkage to ART following secondary distribution of HIV self-test kits to male partners of women living with HIV: a pilot randomized control trial in Mpumalanga, South Africa.Journal of the International AIDS Society · 2022Trial
- Correlates of Poor Quality of Life Among Older People Living With HIV: A Cross-Sectional Analysis of the Tanzania HIV and Aging Cohort Study.Journal of the International AIDS Society · 2026Article
- Article
- Multimorbid life expectancy across race, socio-economic status, and sex in South Africa.Population studies · 2025Article
- In-Person Social Interactions and Anxiety During the COVID-19 Pandemic: Exploring the Role of Household Size and Virtual Social Contact Among Midlife and Older Black South African Adults.The journals of gerontology. Series B, Psychological sciences and social sciences · 2024Article
- Social support receipt as a predictor of mortality: A cohort study in rural South Africa.PLOS global public health · 2024Article
- Article
- Multimorbidity in African ancestry populations: a scoping review.BMJ global health · 2023Article
- Association of alcohol use and multimorbidity among adults aged 40 years and above in rural South Africa.Scientific reports · 2023Article
- Article
- Impact of diabetes on longevity and disability-free life expectancy among older South African adults: A prospective longitudinal analysis.Diabetes research and clinical practice · 2023Article
- Multimorbidity and adverse longitudinal outcomes among patients attending chronic outpatient medical care in Bahir Dar, Northwest Ethiopia.Frontiers in medicine · 2023Article
- Associations between cognitive function and marital status in the United States, South Africa, Mexico, and China.SSM - population health · 2022Article
- Marital experiences and depressive symptoms among older adults in rural South Africa.SSM. Mental health · 2022Article
- Understanding older peoples' chronic disease self-management practices and challenges in the context of grandchildren caregiving: A qualitative study in rural KwaZulu-Natal, South Africa.PLOS global public health · 2022Article
- Multimorbidity matters in low and middle-income countries.Journal of multimorbidity and comorbidityReview
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Authors and funding
11 authors at 5 institutions in 7 countries.
Funding
Abstract
objectivesMultimorbidity is associated with mortality in high-income countries. Our objective was to investigate the relationship between multimorbidity (≥2 of the following chronic medical conditions: hypertension, diabetes, dyslipidaemia, anaemia, HIV, angina, depression, post-traumatic stress disorder, alcohol dependence) and all-cause mortality in an older, rural black South African population. We further investigated the relationship between HIV multimorbidity (HIV as part of the multimorbidity cluster) and mortality, while testing for the effect of frailty in all models.
designPopulation cohort study.
settingAgincourt subdistrict of Mpumalanga province, South Africa.
participants4455 individuals (54.7% female), aged ≥40 years (median age 61 years, IQR 52-71) and resident in the study area. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was time to death and the secondary outcome measure was likelihood of death within 2 years of the initial study visit. Mortality was determined during annual population surveillance updates.
results3157 individuals (70.9%) had multimorbidity; 29% of these had HIV. In models adjusted for age and sociodemographic factors, multimorbidity was associated with greater risk of death (women: HR 1.72; 95% CI: 1.18 to 2.50; men: HR 1.46; 95% CI: 1.09 to 1.95) and greater odds of dying within 2 years (women: OR 2.34; 95% CI: 1.32 to 4.16; men: OR 1.51; 95% CI: 1.02 to 2.24). HIV multimorbidity was associated with increased risk of death compared with non-HIV multimorbidity in men (HR 1.93; 95% CI: 1.05 to 3.54), but was not statistically significant in women (HR 1.85; 95% CI: 0.85 to 4.04); when detectable, HIV viral loads were higher in men (p=0.021). Further adjustment for frailty slightly attenuated the associations between multimorbidity and mortality risk (women: HR 1.55; 95% CI: 1.06 to 2.26; men: HR 1.36; 95% CI: 1.01 to 1.82), but slightly increased associations between HIV multimorbidity and mortality risk.
conclusionsMultimorbidity is associated with mortality in this older black South African population. Health systems which currently focus on HIV should be reorganised to optimise identification and management of other prevalent chronic diseases.
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