Global study identifies key health challenge in China

Multimorbidity, defined as two or more chronic noncommunicable diseases, or NCDs such as stroke and cancer, has become a major challenge for the health system in China, which faces unprecedented aging of its population.

Multimorbidity increases the complexity of diagnosis and treatment of NCDs, reduces a patient's quality of life, and is associated with an increase in risk of death, says a new study published in the June issue of the medical journal The Lancet Global Health.

The study, led by Zhao Yang, a research fellow at The George Institute for Global Health in Beijing and the University of Melbourne's Nossal Institute for Global Health, examined socioeconomic group differences in the prevalence of physical multimorbidity, and the association between physical multimorbidity, healthcare use, and catastrophic health expenditure in China.

Some Chinese academics took part in the research, along with the Nossal Institute for Global Health in Australia and the World Health Organization Collaborating Centre on Implementation Research for Prevention and Control of Noncommunicable Diseases. Others contributing to it included Harvard University, Duke University, the University of Edinburgh, the London School of Hygiene and Tropical Medicine, the National University of Singapore, and Imperial College London.

Several innovative findings from this study suggest options for better health policies for China and low-income and middle-income countries.

In an interview, Zhao said one finding was that the prevalence of physical multimorbidity was higher in poorer regions than in more affluent ones, and that physical multimorbidity is strongly linked to increased health service use and the occurrence of catastrophic health expenditure.

The study used data from the three waves of the China Health and Retirement Longitudinal Study conducted in 2011, 2013 and 2015 with Chinese residents aged 45 years and older. Researchers analyzed data from 11,817 respondents.

Overall, 62 percent of participants had physical multimorbidity in 2015. The study concluded that concerted efforts were needed to reduce health inequalities due to multimorbidity and its adverse economic impact.

Zhao said the research showed that patients with multimorbidity incur substantial health expenditures due to their conditions, and are more likely to be absent from work and less productive.

COVID-19 complicated the research, he said.

"Some evidence suggests those with multimorbidity are more susceptible to COVID-19 and more likely to be at risk of severe cases and poor outcomes. But the situation is temporary.

"The Chinese government has made unprecedented efforts and invested enormous resources, and these efforts have stemmed the spread of the disease," he said.

Much work to be done

There is much work to be done on public health in China generally.

John Tayu Lee, senior author and Nossal Institute for Global Health senior lecturer, said chronic conditions were a major contributor to China's health burden, outcome inequalities and economic burden.

"Disease-specific guidelines are inadequate for the effective management of individuals with multimorbidity, and new clinical guidelines for multimorbidity are needed in China," he said.

Photo caption:   Medics from Beijing medical institutes assisted local counterparts with surgeries and other medical tasks at Tibet's People's Hospital, as part of the Aid Tibet medical program. [Photo provided to

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John Tayu Lee

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