Prevalence, Correlates, and Outcomes of Multimorbidity Among Patients Attending Primary Care in Odisha, India

Abstract

PURPOSE Little information is available on multimorbidity in primary care in India. Because primary care is the first contact of health care for most of the population and important for coordinating chronic care, we wanted to examine the prevalence and correlates of multimorbidity in India and its association with health care utilization.METHODS Using a structured multimorbidity assessment protocol, we conducted a cross-sectional study, collecting information on 22 self-reported chronic conditions in a representative sample of 1,649 adult primary care patients in Odisha, India. RESULTSThe overall age-and sex-adjusted prevalence of multimorbidity was 28.3% (95% CI, 24.3-28.6) ranging from 5.8% in patients aged 18 to 29 years to 45% in those aged older than 70 years. Older age, female sex, higher education, and high income were associated with significantly higher odds of multimorbidity. After adjusting for age, sex, socioeconomic status (SES), education, and ethnicity, the addition of each chronic condition, as well as consultation at private hospitals, was associated with significant increase in the number of medicines intake per person per day. Increasing age and higher education status significantly raised the number of hospital visits per person per year for patients with multiple chronic conditions. CONCLUSION Our findings of higher prevalence of multimorbidity and hospitalizations in higher SES individuals contrast with findings in Western countries, where lower SES is associated with a greater morbidity burden. INTRODUCTIONM ultimorbidity, the co-occurrence of 2 or more (chronic) conditions within the same individual, is linked to higher health care use, higher expenditure, and impaired quality of life. [1][2][3] In the developing countries, little information on multimorbidity is available and is based on secondary data and limited to a only a few chronic conditions and geriatric groups. [4][5][6] With our previous study, for which data were based on the World Health Organization (WHO) Study on Global Aging and Adult Health (SAGE), we reported a 8.9% prevalence of multimorbidity in Indian adults. 7 Our systematic review on multimorbidity in South Asia found a lack of uniformity in the definition and assessment of multimorbidity, and no information from primary care in India.8 Given the importance of primary care for delivering coordinated chronic care, and that primary care being the first contact for most populations in India, it is important that we understand the magnitude of multimorbidity in these settings. We therefore undertook this first study to estimate the prevalence of multimorbidity among adult patients attending public and private primary care and to examine the socioeconomic correlates and health care use. The study was exploratory; we restricted it to Odisha, an Indian state (approximate population share of 4% of the total population of India) with average health indicators and comparable health system characteristics. 447 METHODSWe conducted a cross-sectional study from October ...

Trends in the use of health services and their relationship with multimorbidity in Brazil, 1998–2013

“…The use of secondary services, measured as utilizing hospitalisations, had a prevalence twice as high among individuals classi ed as having multimorbidity and had a different pattern with regard to sex. In general, our results are in line with the ndings of other studies, which point to a twice as high probability of hospitalisations among individuals with multimorbidity [13,[31][32][33].…”

Healthcare utilisation and out-of-pocket expenditure of type 2 diabetes patients with and without comorbidity: A study in primary care in Bhubaneswar, India.

“…The other nding of our study that diabetes patients above poverty line had a higher prevalence of comorbid conditions in comparison to diabetes patients from below poverty line is divergent from study ndings from developed countries but similar to ndings from studies conducted in India. [17,18] Wang et al in their study have also concluded that the number of visits to health facilities increased with increase in number of complications associated with diabetes. [3] Likewise, Grunier et al concluded that rise in the number of comorbid conditions raised the healthcare utilisation among diabetes patients.…”

Healthcare utilisation and out-of-pocket expenditure of type 2 diabetes patients with and without comorbidity: A study in primary care in Bhubaneswar, India.

“…The other finding is the higher prevalence of diabetes comorbidities among the above poverty line participants, which is contrary to finding from studies in developed countries but similar to findings of studies conducted in India. [17,18] Wang et al found a linear increase in outpatient hospital visits for each successive diabetic complication. [3] Similarly, Gruneir et al inferred that there is increased utilization of all health services with an increase in the number of comorbid conditions.…”