Cardiovascular disease Multimorbidity is Associated with Decreased Health-Related Quality of Life in Haiti: Findings from a Population-based Cohort

BackgroundMultimorbidity is increasingly prevalent in lower-and middle-income countries (LMICs). Health-related quality of life (HRQOL) has been inversely associated with multimorbidity but is understudied in LMICs. We report cardiovascular disease (CVD) multimorbidity in Haiti and its association with HRQOL. MethodsWe used data from the Haiti CVD Cohort, a population-based longitudinal cohort of adults. CVD multimorbidity was 2+ CVD risk factors/diseases at enrollment. HRQOL was measured using the Short Form-12, yielding physical (PCS)/mental (MCS) component summary scores between 0-100, with higher scores indicating better HRQOL. We used linear regressions to assess the association between CVD multimorbidity and HRQOL and between individual CVD comorbidities and HRQOL. Additionally, we examined how gender and education modified the main effect. ResultsAmong 2,996 participants, the median age was 40 (IQR: 27-55), 58.0% were female, and 70.3% earned <1 USD/day. CVD multimorbidity prevalence was 24.1%; compared to those without CVD multimorbidity, those with CVD multimorbidity were older (median 56.0 [IQR: 47.0, 53.0]) and female (70.5%). Adjusted models revealed CVD multimorbidity was inversely related to PCS (-2.7 [95% CI: -3.8, -1.6]) and MCS (-1.0 [95% CI: -1.8, -0.2]). Heart failure and hypertension showed the strongest CVD morbidities associated with poor HRQOL. In the interaction analysis, among men, CVD multimorbidity was associated with a 4.3-point lower PCS score, and among those with less education, CVD multimorbidity was associated with a 4.6-point lower PCS score than no CVD multimorbidity. ConclusionsOur data are among the first to describe HRQOL data with high CVD multimorbidity in a young population in urban Haiti, and CVD multimorbidity was associated with decreased HRQOL. (https://www.clinicaltrials.gov/ct2/show/NCT03892265, #NCT03892265) Research Perspective- This research raises the question of whether people with CVD multimorbidity in LMICs need specific interventions that are tailored to their high levels of comorbidity and if women and those with low socioeconomic status are at extra risk for experiencing the adverse effects of multimorbidity. - Future research should investigate cut-off points for describing a population average relevant to an LMIC.