Chronic physical conditions, physical multimorbidity, and quality of life among adults aged ≥ 50 years from six low- and middle-income countries

Olawale Olanrewaju, Mike Trott, Lee Smith*, Guillermo F. López Sánchez, Christina Carmichael, Hans Oh, Felipe Schuch, Louis Jacob, Nicola Veronese, Pinar Soysal, Jae Il Shin, Laurie Butler, Yvonne Barnett, Ai Koyanagi

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Purpose: Multimorbidity (i.e., ≥ 2 chronic conditions) poses a challenge for health systems and governments, globally. Several studies have found inverse associations between multimorbidity and quality of life (QoL). However, there is a paucity of studies from low- and middle-income countries (LMICs), especially among the older population, as well as studies examining mediating factors in this association. Thus, the present study aimed to explore the associations, and mediating factors, between multimorbidity and QoL among older adults in LMICs. 

Methods: Cross-sectional nationally representative data from the Study on Global Ageing and Adult Health were analyzed. A total of 11 chronic conditions were assessed. QoL was assessed with the 8-item WHO QoL instrument (range 0–100) with higher scores representing better QoL. Multivariable linear regression and mediation analyses were conducted to assess associations.

 Results: The final sample consisted of 34,129 adults aged ≥ 50 years [mean (SD) age 62.4 (16.0) years; age range 50–114 years; 52.0% females]. Compared to no chronic conditions, 2 (b-coefficient − 5.89; 95% CI − 6.83, − 4.95), 3 (− 8.35; − 9.63, − 7.06), 4 (− 10.87; − 12.37, − 9.36), and ≥ 5 (− 13.48; − 15.91, − 11.06) chronic conditions were significantly associated with lower QoL, dose-dependently. The mediation analysis showed that mobility (47.9%) explained the largest proportion of the association between multimorbidity and QoL, followed by pain/discomfort (43.5%), sleep/energy (35.0%), negative affect (31.9%), cognition (20.2%), self-care (17.0%), and interpersonal activities (12.0%).

 Conclusion: A greater number of chronic conditions was associated with lower QoL dose-dependently among older adults in LMICs. Public health and medical practitioners should aim to address the identified mediators to improve QoL in patients with multimorbidity.

Original languageEnglish
Pages (from-to)1031-1041
Number of pages11
JournalQuality of Life Research
Issue number4
Early online date26 Dec 2022
Publication statusPublished - Apr 2023

Bibliographical note

Funding Information:
Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. Dr. Guillermo F. López Sánchez is funded by the European Union—Next Generation EU.

Funding Information:
This paper uses data from WHO’s Study on Global Ageing and Adult Health (SAGE). SAGE is supported by the U.S. National Institute on Aging through Interagency Agreements OGHA 04034785, YA1323–08-CN-0020, Y1-AG-1005–01 and through research grants R01-AG034479 and R21-AG034263.

Publisher Copyright:
© 2022, The Author(s).


  • Low- and middle-income countries
  • Multimorbidity
  • Older adults
  • Quality of life

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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