Clustering of non-communicable disease risk factors and multimorbidity in Ethiopia: A latent class analysis

Abstract Background Non-communicable disease (NCD) mortality dominates the cause of death globally, with low and middle-income countries (LMICs) contributing 85% of NCD deaths, which are avoidable. While NCDs accounted for almost 50% of the burden of illness in Ethiopia at the time of the survey, very little research has been conducted on multimorbidity at the national level. This study aimed to look into the detailed clustering of NCD risk factors and multimorbidity in Ethiopia. Methods The data analyzed were obtained from the nationally representative Ethiopian WHO STEPS 2015 cross-sectional household survey with cross-sectionally sampled 9,800 adults (15–69 years) with weights applied. Latent class analysis (LCA) was used to analyze clustering of eight risk factors. Multimorbidity was defined as having 2 or more self-reported diagnosed NCDs. Factors associated with clustering and multimorbidity were identified using multivariable logistic regression. Results More than half of adults (55.4%) had three or more risk factors. Three classes were identified in LCA: cardio-metabolic risk (24.2% of adults), behavioral risk (44.6%) and low risk (31.2%). The prevalence of multimorbidity (2 + NCDs) at the population level was 8.2%. The burden was higher by sex (women), residential status (urban), income (higher) and age (older). Significant associations were seen between overweight/obesity and hypertension (adjusted odds ratio (AOR) = 2.1), ≥ 3 risk factors (AOR = 2.5), and multimorbidity (AOR = 2.7). Conclusions Ethiopia experienced a relatively high prevalence of multimorbidity and clustering of NCD risk factors in 2015. There is a need for a shift in the health system towards integrated prevention and management.