Critical review of multimorbidity outcome measures suitable for low-income and middle-income country settings: perspectives from the Global Alliance for Chronic Diseases (GACD) researchers
Najma Siddiqi,
Meena Daivadanam,
J Jaime Miranda,
Trishul Siddharthan,
John R Hurst,
Rajesh Vedanthan,
Gary Parker,
Gina Agarwal,
Shabbar Jaffar,
Naomi Levitt,
Niels H Chavannes,
Pallab K Maulik,
Patricio Lopez-Jaramillo,
Kamran Siddiqi,
Muralidhar M Kulkarni,
Gillian Sandra Gould,
Job F M van Boven,
Kirsten Bobrow,
M O Owolabi,
Joan B Soriano,
Erick Wan-Chun Huang,
Shahirose Sadrudin Premji,
Lijing Yan,
Ricardo Araya,
F Xavier Gómez-Olivé,
Bruce J Kirenga,
Rianne M J J van der Kleij,
Laura Loli-Dano,
Shane Norris,
Josefien van Olmen,
Antigona C Trofor
Affiliations
Najma Siddiqi
1 University of York, York, UK
Meena Daivadanam
Global Health and Migration Unit, Department of Women`s and Children`s Health, Uppsala University, Uppsala, Sweden
J Jaime Miranda
8 CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
Trishul Siddharthan
Division of Pulmonary, Critical care and Sleep medicine, University of Miami School of Medicine, Miami, Florida, USA
John R Hurst
UCL Respiratory, University College London, London, UK
Rajesh Vedanthan
Population Health, New York University Grossman School of Medicine, New York, New York, USA
Gary Parker
Gina Agarwal
Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
Shabbar Jaffar
Institute for Global Health, University College London, London, UK
Naomi Levitt
6 Division of Endocrinology, Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
Niels H Chavannes
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
Pallab K Maulik
Research, The George Institute for Global Health, New Delhi, India
Patricio Lopez-Jaramillo
Masira Research Institute, Universidad de Santander, Bucaramanga, Colombia
Kamran Siddiqi
1 University of York, York, UK
Muralidhar M Kulkarni
Community Medicine, Kasturba Medical College, Manipal Acadamy of Higher Education, Manipal, Karnataka, India
Gillian Sandra Gould
Faculty of Health, Southern Cross University, Lismore, New South Wales, Australia
Job F M van Boven
Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, Groningen, The Netherlands
Kirsten Bobrow
Division of Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
M O Owolabi
Medicine, University of Ibadan College of Medicine, Ibadan, Nigeria
Joan B Soriano
Universidad Autónoma de Madrid, Madrid, Spain
Erick Wan-Chun Huang
Respiratory and Environmental Epidemiology, Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
Shahirose Sadrudin Premji
Faculty of Health, School of Nursing, York University, Toronto, Ontario, Canada
Lijing Yan
The George Institute for Global Health at Peking University Health Science Center, Beijing, China
Ricardo Araya
1 Health Services and Population Research, King`s College London, London, UK
Objectives There is growing recognition around the importance of multimorbidity in low-income and middle-income country (LMIC) settings, and specifically the need for pragmatic intervention studies to reduce the risk of developing multimorbidity, and of mitigating the complications and progression of multimorbidity in LMICs. One of many challenges in completing such research has been the selection of appropriate outcomes measures. A 2018 Delphi exercise to develop a core-outcome set for multimorbidity research did not specifically address the challenges of multimorbidity in LMICs where the global burden is greatest, patterns of disease often differ and health systems are frequently fragmented. We, therefore, aimed to summarise and critically review outcome measures suitable for studies investigating mitigation of multimorbidity in LMIC settings.Setting LMIC.Participants People with multimorbidity.Outcome measures Identification of all outcome measures.Results We present a critical review of outcome measures across eight domains: mortality, quality of life, function, health economics, healthcare access and utilisation, treatment burden, measures of ‘Healthy Living’ and self-efficacy and social functioning.Conclusions Studies in multimorbidity are necessarily diverse and thus different outcome measures will be appropriate for different study designs. Presenting the diversity of outcome measures across domains should provide a useful summary for researchers, encourage the use of multiple domains in multimorbidity research, and provoke debate and progress in the field.
