Cardiometabolic multimorbidity prevalence and its socio-demographic determinants among Iranian adults: insights from the nationwide STEPS 2021

Abstract Cardiometabolic multimorbidity—typically defined as the presence of two or more cardiometabolic morbidities simultaneously—has emerged as a critical public health challenge both globally and in Iran. We analyzed data from the 2021 WHO STEPwise approach to NCD risk factor surveillance (STEPS) to determine its national prevalence and associated socio-demographic factors. Cardiometabolic multimorbidity was defined as having ≥ 2 of: hypertension (HTN), type 2 diabetes (T2DM), or history of MI/stroke. Multivariable stepwise logistic regression was employed to identify the potential socio-demographic associated factors. Of total 16,453 participants aged 25–75 years (75.43% from urban areas, 54.67% women), 58.01% (confidence interval (CI): 56.92–59.09) had no morbidity, 27.56% (26.59–28.55) had only one morbidity (HTN: 19.78%, T2DM: 6.02%, MI/Stroke: 1.76%), 11.73% (11.07–12.45) had two morbidities, and 2.68% (2.31–3.11) had all three morbidities. In total, the prevalence of cardiometabolic multimorbidity was 14.43% (13.67–15.22); and while being employed, wealthy, and having high educational level were negatively associated with the prevalent cardiometabolic multimorbidity, aging, urban residency, physical inactivity, central and general obesity, positive family history of MI/Stroke, positive family history of diabetes, and history of COVID-19 hospitalization had positive associations (all p-values < 0.05). Moreover, sex-stratified analyses showed similar results. As a limitation, history of MI/stroke was based on self-reported data. In conclusion, 14.43% of Iranian adults experience cardiometabolic multimorbidity with comparable prevalence between men and women, posing a considerable burden on public health and underscoring the necessity for pragmatic and multicomponent preventive strategies in both sexes.