{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T22:30:16Z","timestamp":1784673016683,"version":"3.55.0"},"reference-count":44,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2021,11,1]],"date-time":"2021-11-01T00:00:00Z","timestamp":1635724800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2021,11,1]],"date-time":"2021-11-01T00:00:00Z","timestamp":1635724800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2021,9,29]],"date-time":"2021-09-29T00:00:00Z","timestamp":1632873600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Public Health in Practice"],"published-print":{"date-parts":[[2021,11]]},"DOI":"10.1016\/j.puhip.2021.100193","type":"journal-article","created":{"date-parts":[[2021,9,30]],"date-time":"2021-09-30T09:08:32Z","timestamp":1632992912000},"page":"100193","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":20,"special_numbering":"C","title":["Prevalence of multimorbidity of cardiometabolic conditions and associated risk factors in a population-based sample of South Africans: A cross-sectional study"],"prefix":"10.1016","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2523-1222","authenticated-orcid":false,"given":"Ronel","family":"Sewpaul","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony David","family":"Mbewu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adeniyi Francis","family":"Fagbamigbe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ngianga-Bakwin","family":"Kandala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sasiragha Priscilla","family":"Reddy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.puhip.2021.100193_bib1","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/j.arr.2011.03.003","article-title":"Aging with multimorbidity: a systematic review of the literature","volume":"10","author":"Marengoni","year":"2011","journal-title":"Ageing Res. Rev."},{"key":"10.1016\/j.puhip.2021.100193_bib2","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1370\/afm.983","article-title":"Defining comorbidity: implications for understanding health and health services","volume":"7","author":"Valderas","year":"2009","journal-title":"Ann. Fam. Med."},{"key":"10.1016\/j.puhip.2021.100193_bib3","doi-asserted-by":"crossref","first-page":"2269","DOI":"10.1001\/archinte.162.20.2269","article-title":"Prevalence, expenditures, and complications of multiple chronic conditions in the elderly","volume":"162","author":"Wolff","year":"2002","journal-title":"Arch. Intern. Med."},{"key":"10.1016\/j.puhip.2021.100193_bib4","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1016\/S0140-6736(09)61863-8","article-title":"Multimorbidity: another key issue for cardiovascular medicine","volume":"374","author":"Glynn","year":"2009","journal-title":"Lancet"},{"key":"10.1016\/j.puhip.2021.100193_bib5","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1001\/jama.298.10.1160-b","article-title":"Patterns of prevalent major chronic disease among older adults in the United States","volume":"298","author":"Weiss","year":"2007","journal-title":"J. Am. Med. Assoc."},{"key":"10.1016\/j.puhip.2021.100193_bib6","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1001\/jama.2015.7008","article-title":"Association of cardiometabolic multimorbidity with mortality","volume":"314","author":"Di Angelantonio","year":"2015","journal-title":"Jama"},{"key":"10.1016\/j.puhip.2021.100193_bib7","doi-asserted-by":"crossref","first-page":"3554","DOI":"10.1161\/CIRCULATIONAHA.105.563452","article-title":"Risk factors associated with myocardial infarction in Africa: the INTERHEART Africa study","volume":"112","author":"Steyn","year":"2005","journal-title":"Circulation"},{"key":"10.1016\/j.puhip.2021.100193_bib8","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.ijcard.2007.11.067","article-title":"A time bomb of cardiovascular risk factors in South Africa: results from the Heart of Soweto Study \u201cHeart Awareness Days","volume":"132","author":"Tibazarwa","year":"2009","journal-title":"Int. J. Cardiol."},{"key":"10.1016\/j.puhip.2021.100193_bib9","series-title":"Statistics South Africa (Stats SA), South African Medical Research Council (SAMRC), ICF. South Africa Demographic and Health Survey 2016","year":"2019"},{"key":"10.1016\/j.puhip.2021.100193_bib10","series-title":"Persistent Burden from Non-communicable Diseases in South Africa Needs Strong Action","author":"Nojilana","year":"2016"},{"key":"10.1016\/j.puhip.2021.100193_bib11","series-title":"National Strategic Plan for the Prevention and Control of Non-communicable Diseases 2020-25. Pretoria","year":"2019"},{"key":"10.1016\/j.puhip.2021.100193_bib12","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1038\/35007508","article-title":"Obesity as a medical problem","volume":"404","author":"Kopelman","year":"2000","journal-title":"Nature"},{"key":"10.1016\/j.puhip.2021.100193_bib13","series-title":"The Health Consequences of Smoking\u201450 Years of Progress: A Report of the Surgeon General","year":"2014"},{"key":"10.1016\/j.puhip.2021.100193_bib14","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1186\/s12889-019-7682-4","article-title":"The prevalence of cardiometabolic multimorbidity and its association with physical activity, diet, and stress in Canada: evidence from a population-based cross-sectional study","volume":"19","author":"Sakakibara","year":"2019","journal-title":"BMC Publ. Health"},{"key":"10.1016\/j.puhip.2021.100193_bib15","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1002571","article-title":"Clinical, socioeconomic, and behavioural factors at age 50 years and risk of cardiometabolic multimorbidity and mortality: a cohort study","volume":"15","author":"Singh-Manoux","year":"2018","journal-title":"PLoS Med."},{"key":"10.1016\/j.puhip.2021.100193_bib16","doi-asserted-by":"crossref","first-page":"22","DOI":"10.15256\/joc.2017.7.89","article-title":"Multimorbidity of four cardiometabolic and chronic pulmonary disease groups: prevalence and attributable fraction in US adults, 2007-2012","volume":"7","author":"Staimez","year":"2017","journal-title":"J. Comorbidity"},{"key":"10.1016\/j.puhip.2021.100193_bib17","doi-asserted-by":"crossref","first-page":"e277","DOI":"10.1016\/S2468-2667(17)30074-9","article-title":"Overweight, obesity, and risk of cardiometabolic multimorbidity: pooled analysis of individual-level data for 120 813 adults from 16 cohort studies from the USA and Europe","volume":"2","author":"Kivimaki","year":"2017","journal-title":"Lancet Publ Health"},{"key":"10.1016\/j.puhip.2021.100193_bib18","article-title":"Prevalence and correlates of cardiometabolic multimorbidity among hypertensive individuals: a cross-sectional study in rural South Asia-Bangladesh, Pakistan and Sri Lanka","volume":"9","author":"Feng","year":"2019"},{"key":"10.1016\/j.puhip.2021.100193_bib19","article-title":"Multimorbidity of cardiometabolic diseases: prevalence and risk for mortality from one million Chinese adults in a longitudinal cohort study","volume":"9","author":"Zhang","year":"2019","journal-title":"BMJ open"},{"key":"10.1016\/j.puhip.2021.100193_bib20","series-title":"South African National Health and Nutrition Examination Survey (SANHANES-1)","author":"Shisana","year":"2014"},{"key":"10.1016\/j.puhip.2021.100193_bib22","article-title":"Diagnosis and classification of diabetes mellitus","volume":"35","year":"2012","journal-title":"Diabetes Care"},{"key":"10.1016\/j.puhip.2021.100193_bib23","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0185114","article-title":"The impact of cardiovascular risk factors on cardiac structure and function: insights from the UK Biobank imaging enhancement study","volume":"12","author":"Petersen","year":"2017","journal-title":"PloS One"},{"key":"10.1016\/j.puhip.2021.100193_bib24","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1186\/s13643-018-0801-y","article-title":"Modifiable and emerging risk factors for type 2 diabetes in Africa: a systematic review and meta-analysis protocol","volume":"7","author":"Issaka","year":"2018","journal-title":"Syst. Rev."},{"key":"10.1016\/j.puhip.2021.100193_bib25","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1186\/s12889-020-8368-7","article-title":"Socio-economic inequalities in the multiple dimensions of access to healthcare: the case of South Africa","volume":"20","author":"Gordon","year":"2020","journal-title":"BMC Publ. Health"},{"key":"10.1016\/j.puhip.2021.100193_bib26","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1001\/archinte.158.16.1789","article-title":"The Audit alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test","volume":"158","author":"Bush","year":"1998","journal-title":"Arch. Intern. Med."},{"key":"10.1016\/j.puhip.2021.100193_bib28","series-title":"Measuring Health and Disability: Manual for WHO Disability Assessment Schedule (WHODAS 2.0)","author":"World Health Organization","year":"2010"},{"key":"10.1016\/j.puhip.2021.100193_bib29","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2017-000348","article-title":"Quantifying unmet need for hypertension care in South Africa through a care cascade: evidence from the SANHANES, 2011-2012","volume":"2","author":"Berry","year":"2017","journal-title":"BMJ Glob. Health"},{"key":"10.1016\/j.puhip.2021.100193_bib30","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0184264","article-title":"Prevalence and unmet need for diabetes care across the care continuum in a national sample of South African adults: evidence from the SANHANES-1, 2011-2012","volume":"12","author":"Stokes","year":"2017","journal-title":"PloS One"},{"key":"10.1016\/j.puhip.2021.100193_bib31","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1186\/s12889-018-5653-9","article-title":"Cardiovascular disease (CVD) and associated risk factors among older adults in six low-and middle-income countries: results from SAGE Wave 1","volume":"18","author":"Ruan","year":"2018","journal-title":"BMC Publ. Health"},{"key":"10.1016\/j.puhip.2021.100193_bib32","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1161\/CIRCRESAHA.111.246876","article-title":"The intersection between aging and cardiovascular disease","volume":"110","author":"North","year":"2012","journal-title":"Circ. Res."},{"key":"10.1016\/j.puhip.2021.100193_bib33","series-title":"Mid - year population estimates. Pretoria","author":"Statistics South Africa","year":"2019"},{"key":"10.1016\/j.puhip.2021.100193_bib34","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0202899","article-title":"Differential associations of cardio-metabolic diseases by population group, gender and adiposity in South Africa","volume":"13","author":"Peer","year":"2018","journal-title":"PloS One"},{"key":"10.1016\/j.puhip.2021.100193_bib35","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1038\/ijo.2010.135","article-title":"Obesity-related non-communicable diseases: South Asians vs white Caucasians","volume":"35","author":"Misra","year":"2011","journal-title":"Int. J. Obes."},{"key":"10.1016\/j.puhip.2021.100193_bib36","first-page":"491","article-title":"The genetics of non-insulin dependent diabetes mellitus in South India. An overview","volume":"24","author":"Graham","year":"1992","journal-title":"Annu. Mediaev."},{"key":"10.1016\/j.puhip.2021.100193_bib37","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0207649","article-title":"Lifestyle factors and high body mass index are associated with different multimorbidity clusters in the Brazilian population","volume":"13","author":"de Carvalho","year":"2018","journal-title":"PloS One"},{"key":"10.1016\/j.puhip.2021.100193_bib38","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.socscimed.2016.06.055","article-title":"A cross-sectional and spatial analysis of the prevalence of multimorbidity and its association with socioeconomic disadvantage in South Africa: a comparison between 2008 and 2012","volume":"163","author":"Weimann","year":"2016","journal-title":"Soc. Sci. Med."},{"key":"10.1016\/j.puhip.2021.100193_bib39","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1038\/nature05487","article-title":"Mechanisms linking obesity with cardiovascular disease","volume":"444","author":"Van Gaal","year":"2006","journal-title":"Nature"},{"key":"10.1016\/j.puhip.2021.100193_bib40","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1186\/s12889-015-2227-y","article-title":"Socioeconomic inequalities in non-communicable diseases and their risk factors: an overview of systematic reviews","volume":"15","author":"Sommer","year":"2015","journal-title":"BMC Publ. Health"},{"key":"10.1016\/j.puhip.2021.100193_bib41","doi-asserted-by":"crossref","DOI":"10.7189\/jogh.08.020405","article-title":"Association between life-course socio-economic status and prevalence of cardio-metabolic risk ractors in five middle-income countries","volume":"8","author":"Ogunsina","year":"2018","journal-title":"J. Glob. Health"},{"key":"10.1016\/j.puhip.2021.100193_bib42","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2018-001386","article-title":"Chronic multimorbidity among older adults in rural South Africa","volume":"4","author":"Chang","year":"2019","journal-title":"BMJ Glob. Health"},{"key":"10.1016\/j.puhip.2021.100193_bib43","doi-asserted-by":"crossref","first-page":"20936","DOI":"10.3402\/gha.v6i0.20936","article-title":"Self-reported prevalence of chronic non-communicable diseases and associated factors among older adults in South Africa","volume":"6","author":"Phaswana-Mafuya","year":"2013","journal-title":"Glob. Health Action"},{"key":"10.1016\/j.puhip.2021.100193_bib44","doi-asserted-by":"crossref","first-page":"1449924","DOI":"10.1080\/16549716.2018.1449924","article-title":"Diabetes in South African older adults: prevalence and impact on quality of life and functional disability - as assessed using SAGE Wave 1 data","volume":"11","author":"Werfalli","year":"2018","journal-title":"Glob. Health Action"},{"key":"10.1016\/j.puhip.2021.100193_bib45","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1002\/(SICI)1520-7560(199905\/06)15:3<205::AID-DMRR29>3.0.CO;2-O","article-title":"Quality of life and diabetes","volume":"15","author":"Rubin","year":"1999","journal-title":"Diabetes Metab. Res. Rev."},{"key":"10.1016\/j.puhip.2021.100193_bib46","doi-asserted-by":"crossref","first-page":"10","DOI":"10.2471\/BLT.18.217000","article-title":"Multimorbidity and care for hypertension, diabetes and HIV among older adults in rural South Africa","volume":"97","author":"Chang","year":"2019","journal-title":"Bull. World Health Organ."}],"container-title":["Public Health in Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S266653522100118X?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S266653522100118X?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T01:21:02Z","timestamp":1762996862000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S266653522100118X"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11]]},"references-count":44,"alternative-id":["S266653522100118X"],"URL":"https:\/\/doi.org\/10.1016\/j.puhip.2021.100193","relation":{},"ISSN":["2666-5352"],"issn-type":[{"value":"2666-5352","type":"print"}],"subject":[],"published":{"date-parts":[[2021,11]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Prevalence of multimorbidity of cardiometabolic conditions and associated risk factors in a population-based sample of South Africans: A cross-sectional study","name":"articletitle","label":"Article Title"},{"value":"Public Health in Practice","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.puhip.2021.100193","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2021 The Authors. Published by Elsevier Ltd on behalf of The Royal Society for Public Health.","name":"copyright","label":"Copyright"}],"article-number":"100193"}}