Epidemiology of chronic Multimorbidity and Migration in a Rural South African Community undergoing Health Transition

Armstrong Dzomba, University of the Witwatersrand, Johannesburg
Carren Ginsburg, University of the Witwatersrand, Johannesburg
Chodziwadziwa Kabudula, University of the Witwatersrand
Steve Asiimwe, University of California
Pedzisai Ndagurwa, University of the Witwatersrand, Johannesburg
Mark Collinson, University of the Witwatersrand
Michael J. White, Brown University
Francesc Gomez-Olive, Harvard University

We examined prevalence, patterns and determinants of the multimorbidity burden that occurs with migration among adults (n=3093) 18-40-years in a rural community in north-eastern South Africa. Ordered logistic regressions were used to calculate the final estimates of multimorbidity (>=2 co-occurring conditions) risk, adjusting for age, sex, education, HIV|viral load status, healthcare utilisation and migration. Overall, 315 (13%; 95% CI 11.6 – 14.0) had prevalent chronic multimorbidity. Non-migrants contributed a higher proportion among those with multimorbidity, (12.9%) (95% CI 11.4 – 14.5) compared to migrants 6.6% (95% CI 5.3 –8.1). The largest correlation for pairwise comorbidities conditions was between hypertension and obesity (tetrachoric rho=0.34). Migrants compared to non-migrants had the greatest burden of dual overlapping cardio-metabolic morbidities, such as BP+obesity 53.4% vs 39.1% p=0.02. Multimorbidity risk was higher (aOR=3.74, 95% CI:2.46-5.66) among those aged (=35-years) compared to 18-24 years, (aOR=2.50, 95% CI:1.86-3.38) among women compared men and (aOR=6.30, 95 CI:4.57-8.67) HIV+ virally suppressed individuals compared to HIV-negative. In models stratified by migration status, multimorbidity risk was consistently higher among migrants compared to non-migrants. Understanding the excess multimorbidity burden conferred in early life is critical for improving chronic disease preventive interventions and spatial optimisation of access to HIV care for those mobile.

Keywords: Health and morbidity, Internal migration, Migrant populations, Urbanization and urban populations

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  Presented in Session 140. Profiles and Patterns of Chronic Multimorbidity