Multimorbidity and perceived stress: a population-based cross-sectional study among older adults across six low- and middle-income countries

Background: Stress in chronic conditions or multimorbidity (>=2 chronic conditions) has been reported to affectclinical outcomes but there are no studies on the association between stress and chronic conditions/multi-morbidity among older adults in low- and middle-income countries (LMICs). Thus, we investigated this asso-ciation among adults aged >=50 years across six LMICs.Methods: A cross-sectional analysis using data from the World Health Organization's Study on Global Ageing andAdult Health (China, Ghana, India, Mexico, Russia, South Africa) was conducted. A perceived stress score [range0 (lowest stress) -100 (highest stress)] was computed based on two questions from the Perceived Stress Scale.Thirteen chronic conditions were assessed. Multivariable linear regression analyses were conducted.Results: 34,129 adults with a mean age of 62.4 (SD = 16.0) years (52.1% females) were included. Overall,56.6% (95% CI = 55.0%-58.2%) had multimorbidity. In the adjusted model including all countries, comparedwith those with no chronic conditions, higher numbers of chronic conditions were significantly associated withhigher stress levels, dose dependently. In a countrywide meta-analysis, multimorbidity was associated withsignificantly higher stress levels in all countries (especially India and Ghana) although characterized by mod-erate heterogeneity (I2= 54.6%). For single chronic conditions, notably high stress scores were observed fordepression, stroke, and hearing problems.Conclusion: Chronic conditions and multimorbidity are associated with higher levels of stress in older adults inLMICs. Given that perceived stress and chronic conditions are collectively associated with worse health out-comes, low-cost, population-level integrated interventions to address stress among those with chronic conditionsare urgently needed.