MPIDR Working Paper

Multimorbid life expectancy across race, socioeconomic status, and gender in South Africa

Lam, A., Keenan, K., Myrskylä, M., Kulu, H.
MPIDR Working Paper WP-2022-024, 90 pages.
Rostock, Max Planck Institute for Demographic Research (October 2022)
Open Access


The burden of multimorbidity is increasing globally as populations age. However, it is unclear how many years someone is expected to live with multimorbidity, and how it varies by social and economic factors particularly in low- and middle-income countries. We investigate this in South Africa, where its apartheid history further complicates the roles of race, socioeconomic, and gender inequalities in society. This underlines the importance of taking an intersectional perspective when trying to understand the interplay of these factors and how they influence health and mortality. We introduce the term ‘multimorbid life expectancy’ to describe the years lived with multimorbidity. Using an incidence-based multistate Markov modeling approach, we find that females had higher multimorbid life expectancy than males (17.7 years vs 9.9 years), and this disparity was consistent across all race and education groups. Asian/Indians and the post-secondary educated had the highest multimorbid life expectancy relative to other groups. White males seemed to benefit the most from having more education, while African males and females seemed to benefit the least. This suggests associations between structural inequalities and multimorbid life expectancy, highlighting the need for health system and educational policy changes that are proportionate to each group’s level of need.

Keywords: South Africa, adult mortality, apartheid, chronic diseases, education, gender, infectious diseases, life expectancy, morbidity, races, socio-economic status
The Max Planck Institute for Demographic Research (MPIDR) in Rostock is one of the leading demographic research centers in the world. It's part of the Max Planck Society, the internationally renowned German research society.