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Int J Equity Health. 2013 Aug 20;12:63. doi: 10.1186/1475-9276-12-63.

The social determinants of multimorbidity in South Africa.

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Health Systems and Services Research Unit, Division of Community Health, Stellenbosch University, Cape Town, South Africa.



Multimorbidity is a growing concern worldwide, with approximately 1 in 4 adults affected. Most of the evidence on multimorbidity, its prevalence and effects, comes from high income countries. Not much is known about multimorbidity in low income countries, particularly in sub-Saharan Africa. The aim of this study was to determine the prevalence of multimorbidity and examine its association with various social determinants of health in South Africa.


The data used in this study are taken from the South Africa National Income Dynamic Survey (SA-NIDS) of 2008. Multimorbidity was defined as the coexistence of two or more chronic diseases in an individual. Multinomial logistic regression models were constructed to analyse the relationship between multimorbidity and several indicators including socioeconomic status, area of residence and obesity.


The prevalence of multimorbidity in South Africa was 4% in the adult population. Over 70% of adults with multimorbidity were females. Factors associated with multimorbidity were social assistance (Odds ratio (OR) 2.35; Confidence Interval (CI) 1.59-3.49), residence (0.65; 0.46-0.93), smoking (0.61; 0.38-0.96); obesity (2.33; 1.60-3.39), depression (1.07; 1.02-1.11) and health facility visits (5.14; 3.75-7.05). Additionally, income was strongly positively associated with multimorbidity. The findings are similar to observations made in studies conducted in developed countries.


The findings point to a potential difference in the factors associated with single chronic disease and multimorbidity. Income was consistently significantly associated with multimorbidity, but not single chronic diseases. This should be investigated further in future research on the factors affecting multimorbidity.

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