Prevalence and patterns of multi-morbidity in the productive age group of 30-69 years: A cross-sectional study in Pathanamthitta District, Kerala.

Abstract

Background: Multi-morbidity is the coexistence of multiple chronic conditions in individuals and families. With advancing epidemiological and demographic transitions, the burden of multi-morbidity is expected to increase India. Methods: A cross-sectional representative survey was conducted among 410 participants aged 30-69 years in Pathanamthitta District, Kerala. A multi-stage cluster sampling method was employed to identify households for the survey. We interviewed all eligible participants in the selected households. A structured interview schedule was used to assess socio-demographic variables, behavioral risk factors and prevailing clinical conditions. We used the PHQ-9 questionnaire for depression screening. Further, we conducted active measurements of both blood sugar and blood pressure. Multiple logistic regression was used to identify variables associated with multi-morbidity. Results: Overall, the prevalence of multi-morbidity was 45.4% (95% CI: 40.5-50.3%). Nearly a quarter of the study participants (25.4%) reported only one chronic condition (21.3-29.9%). Further, 30.7% (26.3-35.5), 10.7% (7.9-14.2), 3.7% (2.1-6.0) and 0.2% reported two, three, four and five chronic conditions, respectively. At least one person with multi-morbidity was present in around seven out of ten households (72%, 95% CI: 65-78%). Further, one in five households (22%, 95% CI: 16.7-28.9%) reported more than one person with multi-morbidity. Diabetes and hypertension was the most frequent dyad (30.9%, 95% CI: 26.5-35.7%), followed by hypertension and depression (7.8%, 95% CI: 5.5-10.9%). Diabetes, hypertension and ischemic heart disease was the common triad in males (8.5%, 95% CI: 4.8-14.1%), while it was diabetes, hypertension and depression (6.9%, 95% CI: 4.2-11.1%) in females. Age, sex, and employment status were associated with multi-morbidity. Conclusion: Multi-morbidity is prevalent in one of two participants in the productive age group of 30-69 years. Further, seven of ten households have at least one person with multi-morbidity. The high burden of multi-morbidity calls for integrated preventive and management strategies for multiple chronic conditions.

Sex differences in non-communicable disease multimorbidity among adults aged 45 years or older in India

“…Our study also suggests that in many states, there was no significant difference in NCD-MM prevalence by sex. While there are many studies exploring NCDs morbidity and interventions in Kerala,72 89 Karnataka and Punjab,32 90 91 we found less discussion of NCDs in Jammu and Kashmir and West Bengal. State specific or regional analyses may also shed more light on patterns of multimorbidity, which in some cases should also include other determinants like nutritional status, substance use, presence of conflict, economic security, etc, which may have bearing on prevalence as well as coping with chronic disease.…”

Patterns of multimorbidity among a community-based cohort in rural India

“…The prevalence of multimorbidity in the population we studied was higher than those reported from rural populations with similar age profiles (39% to 55%). 20,28,29 A nationally representative study (Longitudinal Aging Study from India) reported a multimorbidity prevalence of 24.1% amongst those above the age of 60 years. 18 Similar estimates of multimorbidity have been reported from LMICs such as Ghana 30 and Brazil.…”

“…Various authors have documented the compounding of multimorbidity with advancing age, with the burden rising after the age of 45 years. 1,20,33–35,45,46 The long-standing accumulation of risk factors due to environmental exposure, sedentary lifestyle, poor dietary or behavioural practices, and gradual functional and physiological decline make the aging population susceptible to a constellation of morbidities. 47,48…”

“…13–22 The wide gap in prevalence is due to inconsistencies in defining multimorbidity, different permutations of included morbidities, or an overestimation of prevalence due to the inclusion of self-reported morbidities. Most studies have focused on the elderly population, 15–18 were conducted in health facilities, 19,20 studied urban populations, 21 or explored multimorbidity amongst patients with non-communicable diseases. 15,22 Few studies have explored the prevalence and correlation of multimorbidity amongst the rural population.…”

Patients', carers' and healthcare providers' views of patient‐held health records in Kerala, India: A qualitative exploratory study

“…Multiple PHRs posed difficulty in informational continuity for providers, as they may not have up‐to‐date information on all medications/diagnostic tests or other pertinent medical information that aid in preventing medication errors/duplication of tests. Therefore, our findings suggest an increasing risk for patient safety, especially for patients with multiple morbidities who are increasing in prevalence in Kerala 51 and similar LMIC settings 52 …”