{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T20:14:03Z","timestamp":1791576843658,"version":"4.3.4"},"reference-count":43,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,12,17]],"date-time":"2023-12-17T00:00:00Z","timestamp":1702771200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/T037423\/1"],"award-info":[{"award-number":["MR\/T037423\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Obesity Reviews"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p>Multimorbidity\u2014the coexistence of at least two chronic health conditions within the same individual\u2014is an important global health challenge. In high\u2010income countries (HICs), multimorbidity is dominated by non\u2010communicable diseases (NCDs); whereas, the situation may be different in low\u2010 and middle\u2010income countries (LMICs), where chronic communicable diseases remain prominent. The aim of this systematic review was to identify determinants (including risk and protective factors) and potential mechanisms underlying multimorbidity from published longitudinal studies across diverse population\u2010based or community\u2010dwelling populations in LMICs. We systematically searched three electronic databases (Medline, Embase, and Global Health) using pre\u2010defined search terms and selection criteria, complemented by hand\u2010searching. All titles, abstracts, and full texts were independently screened by two reviewers from a pool of four researchers. Data extraction and reporting were according to Preferred Reporting Items for Systematic Reviews and Meta\u2010Analyses (PRISMA) guidelines. Methodological quality and risk of bias assessment was performed using the Newcastle\u2010Ottawa Scale for cohort studies. Data were summarized using narrative synthesis. The search yielded 1782 records. Of the 52 full\u2010text articles included for review, 8 longitudinal population\u2010based studies were included for final data synthesis. Almost all studies were conducted in Asia, with only one from South America and none from Africa. All studies were published in the last decade, with half published in the year 2021. The definitions used for multimorbidity were heterogeneous, including 3\u201316 chronic conditions per study. The leading chronic conditions were heart disease, stroke, and diabetes, and there was a lack of consideration of mental health conditions (MHCs), infectious diseases, and undernutrition. Prospectively evaluated determinants included socio\u2010economic status, markers of social inequities, childhood adversity, lifestyle behaviors, obesity, dyslipidemia, and disability. This review revealed a paucity of evidence from LMICs and a geographical bias in the distribution of multimorbidity research. Longitudinal research into epidemiological aspects of multimorbidity is warranted to build up scientific evidence in regions beyond Asia. Such evidence can provide a detailed picture of disease development, with important implications for community, clinical, and interventions in LMICs. The heterogeneity in study designs, exposures, outcomes, and statistical methods observed in the present review calls for greater methodological standardisation while conducting epidemiological studies on multimorbidity. The limited evidence for MHCs, infectious diseases, and undernutrition as components of multimorbidity calls for a more comprehensive definition of multimorbidity globally.<\/jats:p>","DOI":"10.1111\/obr.13661","type":"journal-article","created":{"date-parts":[[2023,12,18]],"date-time":"2023-12-18T07:04:51Z","timestamp":1702883091000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Determinants of multimorbidity in low\u2010 and middle\u2010income countries: A systematic review of longitudinal studies and discovery of evidence gaps"],"prefix":"10.1111","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4806-7939","authenticated-orcid":false,"given":"Michelle M. 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M.","family":"Keinert","sequence":"additional","affiliation":[{"name":"Psychogeriatric Unit, Department of Psychiatry, Medical School Universidade Federal de S\u00e3o Paulo (UNIFESP)  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7937-3226","authenticated-orcid":false,"given":"Charlotte","family":"Hanlon","sequence":"additional","affiliation":[{"name":"Department of Health Service and Population Research, Institute of Psychiatry, Psychology &amp; Neuroscience King's College London  London UK"},{"name":"Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT\u2010Africa) Addis Ababa University  Addis Ababa Ethiopia"},{"name":"Global Mental Health, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neurosciences King's College London  London UK"},{"name":"Department of Psychiatry, School of Medicine, College of Health Sciences Addis Ababa University  Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0270-6256","authenticated-orcid":false,"given":"Barbara","family":"Barrett","sequence":"additional","affiliation":[{"name":"Department of Health Service and Population Research, Institute of Psychiatry, Psychology &amp; Neuroscience King's College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandru","family":"Dregan","sequence":"additional","affiliation":[{"name":"Department of Health Service and Population Research, Institute of Psychiatry, Psychology &amp; Neuroscience King's College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0387-6406","authenticated-orcid":false,"given":"Tin Tin","family":"Su","sequence":"additional","affiliation":[{"name":"Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences Monash University Malaysia  Sunway City Selangor Malaysia"},{"name":"South East Asia Community Observatory (SEACO) Monash University Malaysia  Sunway City Selangor Malaysia"},{"name":"Victorian Heart Institute Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton Campus  Clayton Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0898-2729","authenticated-orcid":false,"given":"Devi","family":"Mohan","sequence":"additional","affiliation":[{"name":"Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences Monash University Malaysia  Sunway City Selangor Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cleusa","family":"Ferri","sequence":"additional","affiliation":[{"name":"Psychogeriatric Unit, Department of Psychiatry, Medical School Universidade Federal de S\u00e3o Paulo (UNIFESP)  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4516-0337","authenticated-orcid":false,"given":"Graciela","family":"Muniz\u2010Terrera","sequence":"additional","affiliation":[{"name":"Edinburgh Dementia Prevention University of Edinburgh and Western General Hospital  Edinburgh UK"},{"name":"Department of Social Medicine, Heritage College of Osteopathic Medicine Ohio University  Athens Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6698-3263","authenticated-orcid":false,"given":"Matthew","family":"Prina","sequence":"additional","affiliation":[{"name":"Department of Health Service and Population Research, Institute of Psychiatry, Psychology &amp; 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