Multimorbidity Patterns and Functioning Associations Among Adults in a Local South African Setting: A Cross-Sectional Study
2025
Karina Berner | Diribsa Tsegaye Bedada | Hans Strijdom | Ingrid Webster | Quinette Louw
Multimorbidity poses significant challenges for resource-constrained healthcare systems, particularly in low and middle income countries where specific combinations of chronic conditions may differentially impact function. This cross-sectional study examined multimorbidity patterns and associations with functioning among 165 adults attending semi-rural primary healthcare facilities in South Africa. Participants completed performance-based measures (handgrip strength, five-times sit-to-stand test, step test and exercise prescription tool [STEP] maximum oxygen consumption) and self-reported function (12-item WHODAS 2.0). Exploratory factor analysis identified three multimorbidity patterns: HIV-hypercholesterolaemia-obesity (Pattern 1), hypertension-anaemia-lung disease (Pattern 2), and stroke-heart disease-hypercholesterolaemia (Pattern 3). Pattern 1 was associated with reduced aerobic capacity (&beta: = &minus:6.41, 95% CI: &minus:9.45, &minus:3.36) and grip strength (&beta: = &minus:0.11, 95% CI: &minus:0.14, &minus:0.07). Pattern 2 showed associations with mild (&beta: = 1.12, 95% CI: 0.28, 1.97) and moderate (&beta: = 1.48, 95% CI: 0.53, 2.43) self-reported functional problems and reduced grip strength (&beta: = &minus:0.05, 95% CI: &minus:0.09, &minus:0.003). Pattern 3 was associated with all self-reported impairment levels, with the strongest association for severe impairment (&beta: = 2.16, 95% CI: 0.32, 4.01). These findings highlight the convergence of infectious and non-communicable diseases in this setting. Simple clinical measures like grip strength and self-reported function may hold potential as screening or monitoring tools in the presence of disease patterns, warranting further research.
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