{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T10:04:20Z","timestamp":1793095460724,"version":"4.5.0"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,1,11]],"date-time":"2023-01-11T00:00:00Z","timestamp":1673395200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001322","name":"South African Medical Research Council","doi-asserted-by":"publisher","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"10.13039\/501100001322","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>South Africa has the largest burden of HIV worldwide and has a growing burden of non-communicable diseases; the combination of which may lead to diseases clustering in ways that are not seen in other regions. This study sought to identify common disease classes and sociodemographic and lifestyle factors associated with each disease class.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were analyzed from the South African Demographic and Health Survey 2016. A latent class analysis (LCA) was conducted using nine disease conditions. Sociodemographic and behavioral factors associated with each disease cluster were explored. All analysis was conducted in Stata 15 and the LCA Stata plugin was used to conduct the latent class and regression analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Multimorbid participants were included (\n                      <jats:italic>n<\/jats:italic>\n                      = 2 368). Four disease classes were identified: (1) HIV, Hypertension and Anemia (comprising 39.4% of the multimorbid population), (2) Anemia and Hypertension (23.7%), (3) Cardiovascular-related (19.9%) and (4) Diabetes and Hypertension (17.0%). Age, sex, and lifestyle risk factors were associated with class membership. In terms of age, with older adults were less likely to belong to the first class (HIV, Hypertension and Anemia). Males were more likely to belong to Class 2 (Anemia and Hypertension) and Class 4 (Diabetes and Hypertension). In terms of alcohol consumption, those that consumed alcohol were less likely to belong to Class 4 (Diabetes and Hypertension). Current smokers were more likely to belong to Class 3 (Cardiovascular-related). People with a higher body mass index tended to belong to Class 3 (Cardiovascular-related) or the Class 4 (Diabetes and Hypertension).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study affirmed that integrated care is urgently needed, evidenced by the largest disease class being an overlap of chronic infectious diseases and non-communicable diseases. This study also highlighted the need for hypertension to be addressed. Tackling the risk factors associated with hypertension could avert an epidemic of multimorbidity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2022.1082587","type":"journal-article","created":{"date-parts":[[2023,1,11]],"date-time":"2023-01-11T01:15:41Z","timestamp":1673399741000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":30,"title":["Multimorbidity patterns in South Africa: A latent class analysis"],"prefix":"10.3389","volume":"10","author":[{"given":"Rifqah Abeeda","family":"Roomaney","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"van Wyk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annibale","family":"Cois","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Pillay van-Wyk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,1,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1093\/aje\/kwx198","article-title":"Multimorbidity, mortality, and long-term physical functioning in 3 prospective cohorts of community-dwelling adults","volume":"187","author":"Wei","year":"2018","journal-title":"Am J Epidemiol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1186\/s12875-014-0185-6","article-title":"Association of self-rated health with multimorbidity, chronic disease and psychosocial factors in a large middle-aged and older cohort from general practice: a cross-sectional study","volume":"15","author":"Mavaddat","year":"2014","journal-title":"BMC Fam Pract."},{"key":"B3","doi-asserted-by":"publisher","first-page":"e0214183","DOI":"10.1371\/journal.pone.0214183","article-title":"Multimorbidity, healthcare utilization and socioeconomic status: a register-based study in Denmark","volume":"14","author":"Fr\u00f8lich","year":"2019","journal-title":"PLoS ONE."},{"key":"B4","unstructured":"LondonThe Academy of Medical Sciences.Multimorbidity: A Priority for Global Health Research2018"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/2235042X19870934","article-title":"Prevalence of multimorbidity in community settings: a systematic review and meta-analysis of observational studies","volume":"9","author":"Nguyen","year":"2019","journal-title":"J Comorb."},{"key":"B6","doi-asserted-by":"publisher","first-page":"010414","DOI":"10.7189\/jogh.07.010414","article-title":"Mapping the global research landscape and knowledge gaps on multimorbidity: a bibliometric study","volume":"7","author":"Xu","year":"2017","journal-title":"J Glob Health."},{"key":"B7","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1097\/COH.0000000000000595","article-title":"Multimorbidity patterns in people with HIV","volume":"15","author":"De Francesco","year":"2020","journal-title":"Curr Opin HIV AIDS."},{"key":"B8","doi-asserted-by":"publisher","first-page":"S5","DOI":"10.1097\/QAD.0000000000001888","article-title":"Noncommunicable diseases among hiv-infected persons in low-income and middle-income countries: a systematic review and meta-analysis","volume":"32","author":"Patel","year":"2018","journal-title":"AIDS."},{"key":"B9","unstructured":"SimbayiL\n            ZumaK\n            MoyoS\n            MarindaE\n            MabasoM\n            RamlaganS\n          South African National HIV Prevalence, Incidence, Behaviour Communication Survey, 20172019"},{"key":"B10","unstructured":"GenevaUNAIDSCountry Factsheets: South Africa 20202022"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e642","DOI":"10.1016\/S2214-109X(16)30113-9","article-title":"Mortality trends and differentials in South Africa from 1997 to 2012: second national burden of disease study","volume":"4","author":"Pillay-van Wyk","year":"2016","journal-title":"Lancet Glob Health"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e048676","DOI":"10.1136\/bmjopen-2021-048676","article-title":"Multimorbidity in South Africa: a systematic review of prevalence studies","volume":"11","author":"Roomaney","year":"2021","journal-title":"BMJ Open."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1214","DOI":"10.3389\/fpsyg.2019.01214","article-title":"The application of latent class analysis for investigating population child mental health: a systematic review","volume":"10","author":"Petersen","year":"2019","journal-title":"Front Psychol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"e041604","DOI":"10.1136\/bmjopen-2020-041604","article-title":"Identifying co-occurrence and clustering of chronic diseases using latent class analysis: cross-sectional findings from sage South Africa Wave 2","volume":"11","author":"Chidumwa","year":"2021","journal-title":"BMJ Open."},{"key":"B15","unstructured":"South Africa Demographic and Health Survey 20162019"},{"key":"B16","unstructured":"Definition, Diagnosis and Classification of Diabetes Mellitus and Its Complications: Report of a Who Consultation1999"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1327","DOI":"10.2337\/dc09-9033","article-title":"International expert committee report on the role of the A1c assay in the diagnosis of diabetes","volume":"32","year":"2009","journal-title":"Diabetes Care."},{"key":"B18","unstructured":"Demographic and Health Surveys Standard Recode Manual for Dhs72018"},{"key":"B19","doi-asserted-by":"publisher","first-page":"571","DOI":"10.7196\/SAMJ.2022.v112i8b.16542","article-title":"Estimating the changing burden of disease attributable to high blood pressure in South Africa for 2000, 2006 and 2012","volume":"112","author":"Nojilana","year":"2022","journal-title":"S Afr Med J."},{"key":"B20","doi-asserted-by":"publisher","first-page":"2560","DOI":"10.1001\/jama.289.19.2560","article-title":"The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the Jnc 7 report","volume":"289","author":"Chobanian","year":"2003","journal-title":"JAMA."},{"key":"B21","volume-title":"Lca Stata Plugin (Version 1.2) [Software]","author":"Lanza","year":"2015"},{"key":"B22","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1177\/0095798420930932","article-title":"Latent class analysis: a guide to best practice","volume":"46","author":"Weller","year":"2020","journal-title":"J Black Psychol."},{"key":"B23","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1214\/aos\/1176344136","article-title":"Estimating the dimension of a model","volume":"6","author":"Schwarz","year":"1978","journal-title":"Ann Stat."},{"key":"B24","first-page":"276","article-title":"Information theory as an extension of the maximum likelihood principle","volume-title":"Second International Symposium on Information Theory Akademiai Kiado, Budapest","author":"Akaike","year":"1973"},{"key":"B25","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1007\/BF02294360","article-title":"Application of model-selection criteria to some problems in multivariate analysis","volume":"52","author":"Sclove","year":"1987","journal-title":"Psychometrika."},{"key":"B26","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/j.arr.2017.05.003","article-title":"Evidence on multimorbidity from definition to intervention: an overview of systematic reviews","volume":"37","author":"Xu","year":"2017","journal-title":"Ageing Res Rev."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1031","DOI":"10.1097\/QAD.0000000000002171","article-title":"Age-related comorbidities and mortality in people living with HIV in rural Tanzania","volume":"33","author":"Albrecht","year":"2019","journal-title":"AIDS."},{"key":"B28","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1093\/inthealth\/ihaa036","article-title":"Anemia and thrombocytopenia in people living with HIV\/aids: a narrative literature review","volume":"13","author":"Marchionatti","year":"2020","journal-title":"Int Health."},{"key":"B29","doi-asserted-by":"publisher","first-page":"530","DOI":"10.1016\/j.jash.2017.06.004","article-title":"Global prevalence of hypertension among people living with HIV: a systematic review and meta-analysis","volume":"11","author":"Xu","year":"2017","journal-title":"J Am Soc Hypertens."},{"key":"B30","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1161\/HYPERTENSIONAHA.118.10893","article-title":"Hypertension in HIV-infected adults: novel pathophysiologic mechanisms","volume":"72","author":"Fahme","year":"2018","journal-title":"Hypertension."},{"key":"B31","doi-asserted-by":"publisher","first-page":"e001386","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":"B32","doi-asserted-by":"publisher","first-page":"650","DOI":"10.1080\/10641963.2017.1416123","article-title":"The relationship between anemia and pulse pressure and hypertension: the Korea national health and nutrition examination survey 2010\u20132012","volume":"40","author":"Yoon","year":"2018","journal-title":"Clin Exp Hypertens."},{"key":"B33","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1007\/s11883-012-0227-2","article-title":"Diabetes and hypertension: is there a common metabolic pathway?","volume":"14","author":"Cheung","year":"2012","journal-title":"Curr Atheroscl Rep."},{"key":"B34","doi-asserted-by":"publisher","first-page":"e034441","DOI":"10.1136\/bmjopen-2019-034441","article-title":"Multimorbidity patterns in low-middle and high income regions: a multiregion latent class analysis using athlos harmonised cohorts","volume":"10","author":"Bayes-Marin","year":"2020","journal-title":"BMJ Open."},{"key":"B35","doi-asserted-by":"publisher","first-page":"956","DOI":"10.1186\/s12889-018-5832-8","article-title":"The evolution of non-communicable diseases policies in post-apartheid South Africa","volume":"18","author":"Ndinda","year":"2018","journal-title":"BMC Public Health."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2022.1082587\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,11]],"date-time":"2023-01-11T01:15:53Z","timestamp":1673399753000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2022.1082587\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,11]]},"references-count":35,"alternative-id":["10.3389\/fpubh.2022.1082587"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2022.1082587","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,11]]},"article-number":"1082587"}}