University of Warwick
Beyond disease counts: multimorbidity patterns and self-rated health in South African adults–a network analysis of the 2016 demographic and health survey
By Olalekan Abdulrahman Uthman, Matthew Hazell, Muhammed Mubashir B Uthman and 4 others.
Abstract
Background
Multimorbidity is rising rapidly in sub-Saharan Africa, where infectious and non-communicable disease burdens overlap. Whether the pattern of co-occurring conditions carries information beyond a simple disease count is unclear.
Objective
To map patterns of co-occurring chronic conditions in South African adults, test for additive interactions between condition pairs, and compare network-derived measures with the disease count as correlates of poor self-rated health.
Methods
Cross-sectional analysis of the nationally representative 2016 South Africa Demographic and Health Survey. The analytic sample comprised 5,650 adults aged 18 years and older with complete data on 12 chronic conditions ascertained by self-report and biomarker measurement. The outcome was self-rated health, dichotomised as poor vs. average, good or excellent. Disease networks were constructed from phi coefficients with Louvain community detection; cluster stability used 1,000 design-consistent bootstrap replicates. Survey-weighted logistic regression adjusted for age, sex and residence compared the disease count with network-based measures (per 1-SD increase), using the area under the receiver operating characteristic curve (AUC), DeLong tests and cross-validation.