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Title: At risk population for COVID-19 : multimorbidity characteristics of a European small island state
Authors: Cuschieri, Sarah
Grech, Stephan
Keywords: Chronic diseases -- Malta
Chronic diseases -- Complications
COVID-19 (Disease) -- Transmission -- Malta -- Prevention
Chronic diseases -- Social aspects -- Malta -- Gozo
States, Small -- Europe
Issue Date: 2021
Publisher: Elsevier
Citation: Cuschieri, S., & Grech, S. (2021). At risk population for COVID-19: multimorbidity characteristics of a European small island state. Public Health, doi:
Abstract: Objectives: Multimorbidity, defined as the co-occurrence of at least two chronic diseases, is a common occurrence with ageing and a recognised public health concern, especially during the COVID-19 pandemic. The multimorbidity population is more susceptible to the virus, its complications and death. The study aimed to explore the multimorbidity characteristics and their associations at a population level for the first time in Malta. Such data enables adequate priority and policy planning due to COVID-19’s predilection for this population. Study Design and Methods: Baseline data was collected from 3,947 adults recruited between 2014-2016. A single-stage sampling strategy was implemented and stratified by age (18 – 70 years), sex and locality. Participants were invited to attend a health examination survey consisting of a questionnaire, anthropometric and biological measurements. Descriptive (chi-square) and analytic (regression modelling) statistics were used to determine the characteristics and associations of the multimorbidity population. The chronic diseases considered for multimorbidity were type 2 diabetes, obesity, hypertension, myocardial infraction, coronary heart disease and dyslipidaemia.Results:Multimorbidity was present in 33% (CI 95%: 31.54 – 34.47) of the study population, with a male predominance. Hypertension and myocardial infarction were the commonest multimorbidity combination from a young age group (20 – 30 years). Low socioeconomic status and residing on the island of Gozo were positively associated with multimorbidity. Conclusion: Multimorbidity in Malta was evident from a young age, with the highest occurrence among the low socioeconomic status and residents of Gozo, bringing forward the need for preventive action. An adoptive healthcare system and policies are recommended to prevent, support and manage multimorbidity non-communicable diseases while bracing for the current COVID-19 pandemic.
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