The Institute for Global Health and Development
Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/9
Browse
65 results
Search Results
Item Multimorbidity latent classes in relation to 11-year mortality, risk factors and health-related quality of life in Malaysia: a prospective health and demographic surveillance system study(BioMed Central, 2025-01-06) Tan, Michelle M. C.; Hanlon, Charlotte; Muniz-Terrera, Graciela; Benaglia, Tatiana; Ismail, Roshidi; Mohan, Devi; Konkoth, Ann Breeze Joseph; Reidpath, Daniel; Pinho, Pedro José M. Rebello; Allotey, Pascale; Kassim, Zaid; Prina, Matthew; Su, Tin TinBackground: We aimed to identify specific multimorbidity latent classes among multi-ethnic community-dwelling adults aged ≥ 18 years in Malaysia. We further explored the risk factors associated with these patterns and examined the relationships between the multimorbidity patterns and 11-year all-cause mortality risk, as well as health-related quality of life (HRQoL). Methods: Using data from 18,101 individuals (aged 18–97 years) from the baseline Census 2012, Health Round 2013, and Verbal Autopsies 2012–2023 of the South East Asia Community Observatory (SEACO) health and demographic surveillance system, latent class analysis was performed on 13 chronic health conditions to identify statistically and clinically meaningful groups. Multinomial logistic regression and Cox proportional hazards regression models were conducted to investigate the adjusted association of multimorbidity patterns with the risk factors and mortality, respectively. HRQoL was analyzed by linear contrasts in conjunction with ANCOVA adjusted for baseline confounders. Results: Four distinct multimorbidity latent classes were identified: (1) relatively healthy (n = 10,640); (2) cardiometabolic diseases (n = 2428); (3) musculoskeletal, mobility and sensory disorders (n = 2391); and (4) complex multimorbidity (a group with more severe multimorbidity with combined profiles of classes 2 and 3) (n = 699). Significant variations in associations between socio-demographic characteristics and multimorbidity patterns were discovered, including age, sex, ethnicity, education level, marital status, household monthly income and employment status. The complex multimorbidity group had the lowest HRQoL across all domains compared to other groups (p < 0.001), including physical health, psychological, social relationships and environment. This group also exhibited the highest mortality risk over 11 years even after adjustment of confounders (age, sex, ethnicity, education and employment status), with a hazard of death of 1.83 (95% CI 1.44–2.33), followed by the cardiometabolic group (HR 1.42, 95% CI 1.18–1.70) and the musculoskeletal, mobility and sensory disorders group (HR 1.29, 95% CI 1.04–1.59). Conclusions: Our study advances the understanding of the complexity of multimorbidity and its implications for health outcomes and healthcare delivery. The findings suggest the need for integrated healthcare approaches that account for the clusters of multiple conditions and prioritize the complex multimorbidity cohort. Further longitudinal studies are warranted to explore the underlying mechanisms and evolution of multimorbidity patterns.Item Equity in decline: illustrating fairness in a worse-off world. [Commentary](2023-10-30) Reidpath, Daniel; Khosla, Rajat; Gruskin, Sofia; Dakessian, Arek; Allotey, PascaleItem Social, cultural and environmental contexts and the measurement of burden of disease : an exploratory comparison of the developed and developing world(University of Melbourne, 2001) Reidpath, Daniel; Allotey, Pascale; Kouamé, Aka; Cummins, RobertThe Disability Adjusted Life Year (DALY) is a measure of population health that was developed, as part of a World Bank initiated study, to inform health strategy development, priority setting, resource allocation and research, and to measure the global burden of disease. The innovative feature of the DALY was the combination of information on morbidity and mortality within a single index. Since its development in 1992, the rate at which it has been adopted by governments, multilateral agencies and researchers has been staggering. The enthusiasm with which the measure has been taken-up perhaps reflects a desire on the part of health policy makers to embrace an “evidence-based” approach to health policy. Although the DALY has been heavily criticised in some quarters, it has survived. There are a number of reasons why this may be: • It is a good measure of population health; • The enormous political will to see it succeed; and • The lack of empirical data to challenge the validity of the DALY; • In addition, many of the criticisms of the DALY have been about the implicit and explicit social values, which are hard to argue on technical grounds. This report details the findings of an empirical investigation of some of the technical and social assumptions on which the DALY is based.Item Structure, (governance) and health: an unsolicited response(BMC, 2006-09-05) Reidpath, Daniel; Allotey, PascaleBackground In a recently published article, it was suggested that governance was the significant structural factor affecting the epidemiology of HIV. This suggestion was made notwithstanding the observed weak correlation between governance and HIV prevalence (r = .2). Unfortunately, the paper raised but left unexamined the potentially more important questions about the relationship between the broader health of populations and structural factors such as the national economy and physical infrastructure. Methods Utilizing substantially the same data sources as the original article, the relationship between population health (healthy life expectancy) and three structural factors (access to improved water, GDP per capita, and governance) were examined in each of 176 countries. Results Governance was found to be significantly correlated with population health, as were GDP per capita, and access to improved water. They were also found to be significantly correlated with each other. Conclusion The findings are discussed with reference to the growing interest in structural factors as an explanation for population health outcomes, and the relatively weak relationship between governance and HIV prevalence.Item Measuring global health inequity(BMC, 2007-10-30) Reidpath, Daniel; Allotey, PascaleBackground Notions of equity are fundamental to, and drive much of the current thinking about global health. Health inequity, however, is usually measured using health inequality as a proxy – implicitly conflating equity and equality. Unfortunately measures of global health inequality do not take account of the health inequity associated with the additional, and unfair, encumbrances that poor health status confers on economically deprived populations. Method Using global health data from the World Health Organization's 14 mortality sub-regions, a measure of global health inequality (based on a decomposition of the Pietra Ratio) is contrasted with a new measure of global health inequity. The inequity measure weights the inequality data by regional economic capacity (GNP per capita). Results The least healthy global sub-region is shown to be around four times worse off under a health inequity analysis than would be revealed under a straight health inequality analysis. In contrast the healthiest sub-region is shown to be about four times better off. The inequity of poor health experienced by poorer regions around the world is significantly worse than a simple analysis of health inequality reveals. Conclusion By measuring the inequity and not simply the inequality, the magnitude of the disparity can be factored into future economic and health policy decision making.Item Ethnicity, discrimination and health outcomes: a secondary analysis of hospital data from Victoria, Australia(Prime Scholars Library, 2006-12-12) Sundararajan, Vijaya; Reidpath, Daniel; Allotey, PascaleDiscrimination is difficult to measure objectively in clinical settings, although it has been identified as a significant cause of ethnic health disparities. Proxy quantitative indicators relating to differential outcomes based on quality of care can begin to shed some light on the possible discrimination, but current data are largely from countries where there is differential access to healthcare as a result of health insurance schemes, and this is a major confounder in the findings. Using data from Victoria, Australia, where there is currently universal healthcare coverage, we explored a number of quality of care-relatedclinical outcomes across ethnic groups. The aim was to explore the relationship between ethnicity and clinical outcomes for postpartum haemorrhage, sepsis and cardiac rehabilitation in Victoria, Australia, as the first step to developing methods for research into discrimination in quality of care. We drew on the Victorian Admitted Episodes Dataset and undertook a secondary data analysis based on recategorisation of country of birth data. A multivariate logistic regression was used to examine the relationship between ethnicity and specified clinical outcomes. Results showed that the risk for postpartum haemorrhage was higher in ethnic minority groups, and access to intensive care for sepsis lower; however, there was no association with access to cardiac care. Our analyses did not support any strong or consistent barriers to access or pooroutcomes of care for particular ethnic groups. This may be an indication of the protection provided by universal health coverage. However, research in this area in Australia is in its infancy and there is a lack of systematically collected administrative data on ethnicity. Growing ethnic minority populations, not just in Australia but also in many other high-income countries, highlight a critical need for the development of data collection systems that are conceptually sound and useful for the monitoring of ethnic minority health in gene.Item Efficacious, effective, and embedded interventions: Implementation research in infectious disease control(BMC, 2008-10-01) Allotey, Pascale; Reidpath, Daniel; Ghalib, Hashim; Pagnoni, Franco; Skelly, William CBackground Research in infectious disease control is heavily skewed towards high end technology; development of new drugs, vaccines and clinical interventions. Oft ignored, is the evidence to inform the best strategies that ensure the embedding of interventions into health systems and amongst populations. In this paper we undertake an analysis of the challenge in the development of research for the sustainable implementation of disease control interventions. Results We highlight the fundamental differences between the research paradigms associated with the development of technologies and interventions for disease control on the one hand and the research paradigms required for enhancing the sustainable uptake of those very same interventions within the communities on the other. We provide a definition for implementation research in an attempt to underscore its critical role and explore the multidisciplinary science needed to address the challenges in disease control. Conclusion The greatest value for money in health research lies in the sustainable and effective implementation of already proven, efficacious solutions. The development of implementation research that can help provide some solutions on how this can be achieved is sorely needed.Item The Millennium Development Goals Fail Poor Children: The Case for Equity-Adjusted Measures(Public Library of Science, 2009-04-28) Reidpath, Daniel; Morel, Chantal M.; Mecaskey, Jeffrey W.; Allotey, PascaleItem Social sciences research in neglected tropical diseases 3: Investment in social science research in neglected diseases of poverty: a case study of Bill and Melinda Gates Foundation(BMC, 2011-01-06) Pokhrel, Subhash; Reidpath, Daniel; Allotey, PascaleBackground The level of funding provides a good proxy for the level of commitment or prioritisation given to a particular issue. While the need for research relevant to social, economic, cultural and behavioural aspects of neglected tropical diseases (NTD) control has been acknowledged, there is limited data on the level of funding that supports NTD social science research. Method A case study was carried out in which the spending of a major independent funder, the Bill and Melinda Gates Foundation (BMGF) - was analysed. A total of 67 projects funded between October 1998 and November 2008 were identified from the BMGF database. With the help of keywords within the titles of 67 grantees, they were categorised as social science or non-social science research based on available definition of social science. A descriptive analysis was conducted. Results Of 67 projects analysed, 26 projects (39%) were social science related while 41 projects (61%) were basic science or other translational research including drug development. A total of US$ 697 million was spent to fund the projects, of which 35% ((US$ 241 million) went to social science research. Although the level of funding for social science research has generally been lower than that for non-social science research over 10 year period, social science research attracted more funding in 2004 and 2008. Conclusion The evidence presented in this case study indicates that funding on NTD social science research compared to basic and translational research is not as low as it is perceived to be. However, as there is the acute need for improved delivery and utilisation of current NTD drugs/technologies, informed by research from social science approaches, funding priorities need to reflect the need to invest significantly more in NTD social science research.Item Social sciences research in neglected tropical diseases 2: A bibliographic analysis(BMC, 2011-01-06) Reidpath, Daniel; Allotey, Pascale; Pokhrel, SubhashBackground There are strong arguments for social science and interdisciplinary research in the neglected tropical diseases. These diseases represent a rich and dynamic interplay between vector, host, and pathogen which occurs within social, physical and biological contexts. The overwhelming sense, however, is that neglected tropical diseases research is a biomedical endeavour largely excluding the social sciences. The purpose of this review is to provide a baseline for discussing the quantum and nature of the science that is being conducted, and the extent to which the social sciences are a part of that. Methods A bibliographic analysis was conducted of neglected tropical diseases related research papers published over the past 10 years in biomedical and social sciences. The analysis had textual and bibliometric facets, and focussed on chikungunya, dengue, visceral leishmaniasis, and onchocerciasis. Results There is substantial variation in the number of publications associated with each disease. The proportion of the research that is social science based appears remarkably consistent (<4%). A textual analysis, however, reveals a degree of misclassification by the abstracting service where a surprising proportion of the "social sciences" research was pure clinical research. Much of the social sciences research also tends to be "hand maiden" research focused on the implementation of biomedical solutions. Conclusion There is little evidence that scientists pay any attention to the complex social, cultural, biological, and environmental dynamic involved in human pathogenesis. There is little investigator driven social science and a poor presence of interdisciplinary science. The research needs more sophisticated funders and priority setters who are not beguiled by uncritical biomedical promises.