Chronic Disease Comorbidities Among Injured Patients in Cameroon: A Retrospective Cohort Study

Kevin J Blair; Fanny N Dissak-Delon; Rasheedat Oke; Melissa Carvalho; Alan Hubbard; Mbiarikai Mbianyor; Georges Alain Etoundi-Mballa; Thompson Kinge; Louis Richard Njock; Daniel N Nkusu; Jean-Gustave Tsiagadigui; Rochelle A Dicker; Alain Chichom-Mefire; Catherine Juillard; S Ariane Christie

doi:10.1016/j.jss.2022.06.045

Chronic Disease Comorbidities Among Injured Patients in Cameroon: A Retrospective Cohort Study

J Surg Res. 2022 Dec:280:74-84. doi: 10.1016/j.jss.2022.06.045. Epub 2022 Aug 11.

Authors

Kevin J Blair¹, Fanny N Dissak-Delon², Rasheedat Oke³, Melissa Carvalho³, Alan Hubbard⁴, Mbiarikai Mbianyor³, Georges Alain Etoundi-Mballa⁵, Thompson Kinge⁶, Louis Richard Njock⁷, Daniel N Nkusu⁸, Jean-Gustave Tsiagadigui⁹, Rochelle A Dicker³, Alain Chichom-Mefire¹⁰, Catherine Juillard³, S Ariane Christie¹¹

Affiliations

¹ Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, California. Electronic address: kevin.james.blair@gmail.com.
² Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, California; Littoral Regional Delegation, Ministry of Public Health, Douala, Cameroon.
³ Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, California.
⁴ Division of Biostatistics, School of Public Health, University of California Berkeley, Berkeley, California.
⁵ Department of Disease Epidemic and Pandemic Control, Ministry of Public Health, Yaoundé, Cameroon.
⁶ Hospital Administration, The Limbe Regional Hospital, Limbe, Cameroon.
⁷ Hospital Administration, The Laquintinie Hospital of Douala, Douala, Cameroon.
⁸ Hospital Administration, The Catholic Hospital of Pouma, Pouma, Cameroon.
⁹ Hospital Administration, The Edea Regional Hospital, Edea, Cameroon.
¹⁰ Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, California; Faculty of Health Sciences, University of Buea, Buea, Cameroon.
¹¹ Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, California; Division of General and Trauma Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburg, Pennsylvania.

PMID: 35964485
DOI: 10.1016/j.jss.2022.06.045

Abstract

Introduction: Chronic diseases are increasing but underdiagnosed in low-income and middle-income countries (LMICs), where injury mortality is already disproportionately high. We estimated prevalence of known chronic disease comorbidities and their association with outcomes among injured patients in Cameroon.

Materials and methods: Injured patients aged ≥15 y presenting to four Cameroonian hospitals between October 2017 and January 2020 were included. Our explanatory variable was known chronic disease; prevalence was age-standardized. Outcomes were overall in-hospital mortality and admission or transfer from the emergency department (ED). Associations between known chronic disease and outcomes were evaluated using logistic regression adjusted for age, gender, estimated injury severity score (eISS), hospital, and household socioeconomic status. Unadjusted eISS-stratified and age-stratified outcomes were also compared via chi-squared tests.

Results: Of 7509 injured patients, 370 (4.9%) reported at least one known chronic disease; age-standardized prevalence was 8.4% (95% confidence interval [CI] 7.5%-9.2%). Patients with known chronic disease had higher mortality (4.6% versus 1.5%, adjusted odds ratio [aOR]: 2.61 [95% CI: 1.25-5.47], P = 0.011) and were more likely to be admitted or transferred from the ED (38.7% versus 19.8%, aOR: 1.40 [95% CI: 1.02-1.92], P = 0.038) compared to those without known comorbidities. Crude differences in mortality (11.3% versus 3.3%, P = 0.002) and hospital admission or transfer (63.8% versus 46.6%, P = 0.011) were most notable for patients with eISS 16-24.

Conclusions: Despite underdiagnosis among Cameroonians, we demonstrated worse injury outcomes among those with known chronic diseases. Integrating chronic disease screening with injury care may help address underdiagnosis in Cameroon. Future work should assess whether chronic disease prevention in LMICs could improve injury outcomes.

Keywords: Cameroon; Chronic disease; Comorbidity; Injury; Sub-Saharan Africa; Trauma.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cameroon / epidemiology
Chronic Disease
Humans
Injury Severity Score
Retrospective Studies
Trauma Centers*