India's escalating burden of non-communicable diseases

Trends in adult mortality rates in India, 1970 to 2018: age-period-cohort analysis

High premature adult deaths in developing countries are gaining attention, as recent studies show their increasing impact on overall mortality rates. This paper has twofold objectives: firstly, it investigates the long-term trends and patterns of adult mortality between 1970 and 2018 in India. Secondly, it attempts to detect age, period, and cohort (APC) effects on adult mortality decline over time. Data on age-specific mortality rates and disease-adjusted life years for adult age groups (15-59 years) were collected from the Sample Registration System and the Global Burden of Disease study, respectively. The trends in age-standardized mortality rates were presented graphically, and critical change points were highlighted using a change-point analysis. The intrinsic estimator model was applied to estimate the independent effects of APC on adult mortality. The findings revealed that adult mortality declined between 1970 and 2018 with multiple critical change points. The APC effects showed a notable decline in adult mortality during 2005-2018 and for the recent birth cohorts, 1980-2004. However, the rate of mortality declined slowly over time. Results also indicated that mortality started increasing from mid-adult ages and peaked in older adult ages due to the age effects and provided evidence of a rise in adult life loss due to non-communicable diseases in recent years. Overall, the study underscores the importance of implementing health policies aimed at reducing life loss in the most economically active ages that can have long-term negative implications for the country's economic growth.

The Burden of Chronic Diseases with the Status of Family Medical History Among Older Adults in India

This study aims to assess and compare the prevalence of chronic diseases by the first-degree Family Medical History (FMH) and also explores the relationship between FMH and selected Non-communicable diseases (NCDs) among older adults in India. The present study collated secondary data from the Longitudinal Ageing Study in India (LASI, 2017-18). The eligible respondents for the analysis of this study were aged 45 years and above, where the final study sample consisted of 65,562 older adults across all Indian states and union territories. The LASI dataset collected responses on self-reported diseases: Hypertension, Stroke, Heart disease, Cancer, and Diabetes. These diseases have a high prevalence among the population and are considered in the present study. Along with disease status, respondents' first-degree relatives FMH were used to fulfil the objective. Descriptive statistical analysis and multiple logistic regression techniques were used to accomplish the objectives analysis. This approach was chosen due to the binary nature of our primary dependent variables. The study found that the prevalence of selected NCDs was considerably higher among older adults with FMH than those without FMH. It revealed that NCDs and the status of FMH of parents and siblings were significantly associated. Based on the multivariate-adjusted model, we found significantly higher odds for developing the NCDs when the respondents have FMH among at least one of the first-degree relative. The likelihood among those with FMH of having hypertension (AOR: 2.058), diabetes (AOR: 2.94), heart diseases (AOR: 2.39), stroke (AOR: 1.62) and cancer (AOR: 2.32) was higher compared to no FMH of respective diseases. Similarly, significant associations were observed according to the different stratification of the number of first-degree relatives FMH. The present study demonstrated that first-degree relatives FMH is indeed a dominant associated risk factor for chronic disease among the older adults of India. This study supports the promotion of a disease history tool for chronic disease prevention and early detection approaches as a valuable measure of NCD risk. Public health practitioners can take several steps to access FMH and incorporate FMH into public health programs for the screening of the risk population.

Consanguineous marriage and associated diseases among their children and grandchildren in India: evidence from large-scale data

Worldwide, more than 130 million infants are born each year and a considerable number of 13.5 million of these children have inbred parents. The present study aimed to investigate the association between parents' consanguinity and chronic illness among their children and grandchildren in India. The nationally representative data, Longitudinal Aging Study in India, 2017-2018, Wave 1 was used for the present study. Bivariate analysis, a probit model, and propensity score estimation were employed to conduct the study. The study observed the highest prevalence of consanguinity marriage in the state of Andhra Pradesh (28%) and the lowest in Kerala (5%) among the south Indian States. People who lived in rural areas, belonged to the richer wealth quintile and Hindu religion were the significant predictors of consanguinity marriage in India. For individuals who were in consanguineous marriages, there was 0.85%, 0.84%, 1.57% 0.43%, 0.34%, and 0.14% chances of their children and grandchildren developing psychotic disorders, heart disease, hypertension stroke, cancer, and diabetes, respectively. Moreover, around 4.55% of the individuals have a history of birth defects or congenital disorders. To address the risk of complicated illnesses due to the consanguinity of marriage, medical, genetic, and social counselling services are required.

Morbidity transition at the national and sub-national level and their determinants over the past and contemporary period in India

The study delves into the epidemiological transition, examining the intricate changes in health status patterns and their connection to morbidities. Specifically, it assesses morbidity transition at both national and subnational levels in India and their determinants from 1995 to 2018. This study examines self-reported morbidities in India by utilising four rounds of National Sample Survey Organisation (NSSO) data (52nd, 60th, 71st, and 75th) from 1995-2018. We estimated prevalence by conducting descriptive analysis on socio-demographic determinants and morbidities such as: Infectious and Communicable Diseases (In&CDs), Non-communicable diseases (NCDs), Disability and other diseases. Moreover, we employed pooled regression analysis to explore morbidity risk transitions over the past decades. The study revealed a steady upsurge in morbidity prevalence in India, doubling from 56 (per thousand) in 1995 to 106 in 2014. However, a considerable decline was observed in the most recent round in 2018 (79 per thousand). From 1995 to 2018, NCDs gained a prominent share in morbidity trends. Kerala in the southern region reported the highest rates, followed by states like Lakshadweep, Andhra Pradesh, Karnataka, West Bengal, Punjab, and others. Age, sex, residence, education, caste, religion, and wealth are pivotal factors in determining the severity of different disease burdens in different sections of the population in India. Over the study period (1995, 2004, 2014, and 2018), the odds of reported morbidities risk transition significantly increased over successive decades: 1.81 times in 2004 (95% CI: 1.78-1.84), 2.16 times in 2014 (95% CI: 2.12-2.2), and 1.44 times in 2018 (95% CI: 1.41-1.46), compared to 1995 (52nd round). The study reveals significant disparities in morbidity reporting across Indian states from 1995 to 2018, attributed to distinct demographic, social, and economic determinants. India continues to grapple with the dual burden of diseases, but the NCDs burden is mounting at a faster pace than CDs.

A longitudinal qualitative study on physician experience in managing multimorbidity across the COVID-19 pandemic in Odisha, India

While many studies have documented adverse impact of multiple chronic conditions or multimorbidity on COVID-19 outcomes in patients, there is scarcity of report on how physicians managed these patients. We investigated the experiences and challenges of clinicians in managing patients with multimorbidity throughout the COVID-19 pandemic in Odisha state, India. To understand the factors influencing illness management and the adaptive responses of physicians alongside the evolving pandemic, we followed a longitudinal qualitative study design. Twenty-three physicians comprising general practitioners, specialists, and intensivists, were telephonically interviewed in-depth. Saldana's longitudinal qualitative data analysis method was employed for data analysis. COVID-19 pandemic initially diverted the attention of health systems, resulting in reduced care. With time, the physicians overcame fear, anxiety, and feelings of vulnerability to COVID-19 and started prioritising patients with multimorbidity for treatment and vaccination. All physicians recommended teleconsultation and digital health records to benefit chronic illness care during future public health crises. The findings underscore the transformative potential of physician resilience and adaptation during the COVID-19 pandemic, emphasizing the importance of prioritizing patients with multimorbidity, incorporating teleconsultation, and implementing digital health records in healthcare systems to enhance chronic illness care and preparedness for future public health crises.

Non-communicable disease risk reduction training for medical graduates in India: context, challenges and opportunities

Physicians' hold pivotal roles in improving non-communicable diseases (NCDs). Studies conducted in India revealed that physicians' feel unprepared to address NCDs risk reduction and provide counseling. We conducted a gap analysis using desk reviews to identify inclusion of NCD risk reduction in medical curricula, and a scoping review to assess knowledge, attitude, perception, and practice related to NCD risk reduction among the undergraduate medical students in India. We also conducted key-informant interviews to understand perceptions among medical students and physicians. We found a lack of knowledge about NCDs and strong interest and perceived need for NCD risk reduction training among both medical students and their teachers. Our findings suggest promoting NCD prevention by physicians and allied health workers in clinical settings can enable the learning environment for medical students to adopt these practices.

Comparative study of cancer profiles between 2020 and 2022 using global cancer statistics (GLOBOCAN)

Background

The International Agency for Research on Cancer (IARC) released the latest estimates of the global burden of cancer. We present a comparison of cancer profiles between 2020 and 2022, leveraging data from the Global Cancer Statistics (GLOBOCAN).

Methods

Cancer incidence and mortality data were sourced from two different years, 2020 and 2022, in the GLOBOCAN database. We tracked changes in age-standardized incidence and mortality rates, as well as estimated numbers of new cancer cases and deaths of the 15 most common cancer types globally and in China between 2020 and 2022. Additionally, we conducted comparisons to assess alterations in the cancer burden and variations in mortality-to-incidence ratio (MIR) across different regions and countries for both 2020 and 2022.

Results

Lung cancer remained the most common cancer and the leading cause of cancer death worldwide. The new cases of thyroid cancer witnessed a sharp increase in 2022. Conversely, the numbers of new cancer cases and deaths from stomach and esophageal cancer decreased significantly in 2022. The geographic distribution of cancer incidence and mortality across six continents in 2022 largely mirrored that of 2020. Higher Human Development Index (HDI) levels in countries corresponded with elevated rates of cancer incidence and mortality, consistent with the previous year. Among 185 countries or territories, China's age-standardized incidence rate (ASIR) ranked 64th and its age-standardized mortality rate (ASMR) ranked 68th, aligning with global averages. Lung cancer continued to impose the greatest burden of incidence and mortality. Stomach, breast, and esophageal cancers showed declines in both case counts and ASIR. Noteworthy reductions in both ASMR and absolute mortality numbers were observed in liver, stomach, and esophageal cancers. The global MIR decreased from 0.516 in 2020 to 0.488 in 2022. MIR trends indicated an upward trajectory with decreasing HDI levels in both 2022 and 2020. While Canada, Germany, India, Italy, Japan, and the United Kingdom demonstrated increasing MIRs, China exhibited the most significant decrease, followed by Russia and the United States.

Conclusions

The global landscape of cancer incidence and mortality in 2022 reflects ongoing trends observed in 2020. Cancer burdens vary notably across countries with differing socioeconomic statuses. Decreases in stomach, liver, and esophageal cancer cases and deaths signify progress in cancer control efforts. The decrease in the global MIRs highlights potential improvements in cancer management.

Palliative care needs of stroke patients at a tertiary care center in South India

Objectives

Stroke survivors have palliative care needs in multiple domains, which are overlooked. Accurate estimation of these is pivotal in ensuring proper rehabilitation and planning interventions to improve quality of life (QoL). We aimed to assess the palliative care needs of stroke patients in various domains in a structured manner at the neurology service of a tertiary care center in South India.

Materials and Methods

Seventy-five consecutive stroke patients presenting to the neurology service were recruited over six months with assessment across various domains including symptom burden, physical domain, activities of daily living (ADL), psychiatric/psychological domain, and QoL at baseline and with follow-up at one month and three months.

Results

Despite improvement in the conventional stroke impairment measures among stroke survivors, there were significant unmet needs across various domains; 98% were severely or entirely dependent on ADL at three-month follow-up; and pain and insomnia were the most frequent (33% incidence) troubling symptoms encountered. There were substantial mental health related issues. The QoL measurement tools employed were the stroke impact assessment questionnaire (SIAQ), a novel tool and the World Health Organization Quality Of Life Brief Version (WHO-QOL-BREF). SIAQ scores at one month showed that 19 patients (42.22%) had their QoL severely affected, and 36 patients (80%) showed the same trend at the three-month follow-up. WHO-BREF scores showed that 27 (62%) did not report good QoL, and 32 (73%) were found not to be satisfied with their health at a one-month follow-up.

Conclusion

There is a significant burden of unmet palliative care needs among stroke survivors in India across various domains.

Third Agers in India: Empirical Evidence From Longitudinal Aging Study in India (LASI), 2017-2018

Given that the ontological origins of the Third Age lie in the cultural logics of social class, consumer society and "habitus," a majority of its gerontological examination is qualitative in nature. We utilize the recently released Longitudinal Aging Study in India (2017-2018) and harness the time-use module to offer an empirical portrait of Third Agers in India. Considering that the aging scholarship in India has been often articulated in the empirical language of dependency, care regimes, and (economic) insecurity, we believe this examination allows us to shift the gerontological gaze from a risk perspective to one that is positive and affirmative. Following an exploratory factor analysis and nested linear regression, we corroborate the emergence of a "silver market" where educated, urban, affluent, and professionally qualified older Indians are the ones who are more likely to engage in active leisure pursuits. Noteworthy is the combined effects of wealth and professional education in determining who is ultimately able to "purchase" leisure in a highly segmented emerging senior market. In all, we conclude by discussing how these findings upend our cultural imagination around growing old in contemporary India.

Examining the factors contributing to a reduction in hardship financing among inpatient households in India

In India, the rising double burden of diseases and the low fiscal capacity of the government forces people to resort to hardship financing. This study aimed to examine the factors contributing to the reduction in hardship financing among inpatient households in India. The study relies on two rounds of National Sample Surveys with a sample of 34,478 households from the 71st round (2014) and 56,681 households from the 75th round (2018). We employed multivariable logistic regression and multivariate decomposition analyses to explore the factors associated with hardship financing in Indian households with hospitalized member(s) and assess the contributing factors to the reduction in hardship financing between 2014 and 2018. Notably, though hardship financing for inpatient households has decreased between 2014 and 2018, households with catastrophic health expenditure (CHE) had higher odds of hardship financing than those without CHE. While factors such as CHE, prolonged hospitalization, and private hospitals had impoverishing effects on hardship financing in 2014 and 2018, the decomposition model showed the potential of CHE (32%), length of hospitalization (32%), and private hospitals (24%) to slow down this negative impact over time. The findings showed the potential for further improvements in financial health protection for inpatient care over time, and underscore the need for continuing efforts to strengthen the implementation of public programs and schemes in India such as Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY).

Association between Multimorbidity and Psychological Distress among Older Adults in India: The Moderating Role of Elder Abuse

OBJECTIVES

In this study, we examine the association between multimorbidity and psychological distress and to what extent elder abuse mediates the association.

METHODS

We analyzed cross-sectional nationally representative data from the "Building Knowledge Base on Population Ageing in India (BKPAI)." Multivariate logistic regression was used to understand the association between multimorbidity and psychological distress. We used Karlson-Holm- Breen (KHB) method to understand the role of elder abuse in mediating the association between multimorbidity and psychological distress.

RESULTS

Older adults who ever experienced abuse (OR = 1.92 95%CI = 1.62, 2.26, p < .001) or in last one month (OR = 2.09 95%CI = 1.65, 2.64, p < .001) reported higher odds of psychological distress. Further, older adults with four or more chronic diseases are thrice more likely to report psychological distress (OR = 3.03 95%CI = 2.38, 3.82, p < .001). The results further suggest the mediating role of abuse on the association between multimorbidity and psychological distress.

CONCLUSIONS

The results suggest the role of elder abuse on the association between multimorbidity and psychological distress among older population in India.

CLINICAL IMPLICATIONS

Creating an environment to reduce the abuse among older adults who have multimorbidity will be essential to reducing the psychological distress among older adults in India.

Protocol of systematic reviews on implementation research on cardiovascular diseases, diabetes mellitus and mental ailments in India

Introduction

The burden of non-communicable diseases (NCDs) is a major public health concern across the world. Various initiatives have tried to address these with varying degrees of success.

Objective

The objective is to assess and collate existing evidence in implementation research done in India on three broad domains of NCDs namely, cardiovascular diseases (CVD), diabetes mellitus (DM), and mental health (MH) in India.

Materials and methods

Three systematic review protocols have been drafted to explore and collate extant evidence of implementation research on cardiovascular diseases, diabetes mellitus, and mental health in India, in accordance with the PRISMA-P statement. Academic databases including PubMed, Embase and Science Direct will be searched. Search strategies will be formulated in iterative processes and in accordance with the formats that are specific to the databases that will be searched. In addition, grey literature and non-academic databases will also be explored. Data extracted from the selected studies will be analysed and a narrative summary of the selected articles, using the SWiM (Synthesis without meta-analysis) guidelines will be produced.

Intended Outcomes

The outputs of these systematic reviews could help in a better understanding of implementation research gaps and also how to address them. Apart from giving insights into how healthcare initiatives for CVDs, diabetes and mental health could be implemented in a better way, the study could also advocate the need to build and consolidate capacity for implementation research in the country.

The moderating effect of mental health and health insurance ownership on the relationships between physical multimorbidity and healthcare utilisation and catastrophic health expenditure in India

BACKGROUND

The current demographic transition has resulted in the growth of the older population in India, a population group which has a higher chance of being affected by multimorbidity and its subsequent healthcare and economic consequences. However, little attention has been paid to the dual effect of mental health conditions and physical multimorbidity in India. The present study, therefore, aimed to analyse the moderating effects of mental health and health insurance ownership in the association between physical multimorbidity and healthcare utilisation and catastrophic health expenditure (CHE).

METHODS

We analysed the Longitudinal Aging Study in India, wave 1 (2017-2018). We determined physical multimorbidity by assessing the number of physical conditions. We built multivariable logistic regression models to determine the moderating effect of mental health and health insurance ownership in the association between the number of physical conditions and healthcare utilisation and CHE. Wald tests were used to evaluate if the estimated effects differ across groups defined by the moderating variables.

RESULTS

Overall, around one-quarter of adults aged 45 and above had physical multimorbidity, one-third had a mental health condition and 20.5% owned health insurance. Irrespective of having a mental condition and health insurance, physical multimorbidity was associated with increased utilisation of healthcare and CHE. Having an additional mental condition strengthened the adverse effect of physical multimorbidity on increased inpatient service use and experience of CHE. Having health insurance, on the other hand, attenuated the effect of experiencing CHE, indicating a protective effect.

CONCLUSIONS

The coexistence of mental health conditions in people with physical multimorbidity increases the demands of healthcare service utilisation and can lead to CHE. The findings point to the need for multidisciplinary interventions for individuals with physical multimorbidity, ensuring their mental health needs are also addressed. Our results urge enhancing health insurance schemes for individuals with mental and physical multimorbidity.

Treatment challenges in the management of difficult-to-treat gram-positive infections: A consensus view apropos therapeutic role of novel anti-MRSA antibiotics, levonadifloxacin (IV) and alalevonadifloxacin (oral)

PURPOSE

Treatment of antibiotic-resistant Gram-positive infections (GPIs), including methicillin-resistant Staphylococcus aureus (MRSA) is becoming increasingly difficult, particularly in patients with multiple co-morbidities who require antibiotics with greater safety and a consistent pharmacokinetic/pharmacodynamic (PK/PD) profile. Such difficult-to-treat GPIs are often associated with poor outcomes, extended hospital stay and increased expenditure. This can be partly attributed to the limited safety and aberrant PK/PD profile of existing anti-MRSA antibiotics. In this context, intravenous levonadifloxacin and its oral prodrug alalevonadifloxacin are novel anti-MRSA antibiotics that have significant advantages over conventional anti-Gram-positive antibiotics. The purpose of this paper was to generate a consensus on the optimal use of levonadifloxacin and alalevonadifloxacin for tackling resistant Gram-positive infections in patients with multiple co-morbidities.

METHOD

Using a modified Delphi approach that combines critical appraisal of evidence and expert opinion, therapeutic use of levonadifloxacin and alalevonadifloxacin in various clinical scenarios and specific unmet conditions was deliberated. Fifteen expert members from medicine, critical-care, emergency, microbiology, and intensive-care disciplines participated and voted on 11 pre-conceived statements. When there was at least 70 % agreement, a consensus was reached.

RESULTS

Following the voting, agreements were reached on 10 out of the 11 statements. Broadly, a consensus was reached in defining the therapeutic role of levonadifloxacin and alalevonadifloxacin in the treatment of various clinical indications involving resistant Gram-positive pathogens, including MRSA, in patients with co-morbidities, such as co-existing or increased risk for kidney dysfunction or hepatic disease and/or immunosuppression; also, in therapeutically challenging conditions caused by Gram-positive bacteria such as bacteraemia, bone and joint infection, diabetic foot infection, febrile neutropenia, and hospital-acquired pneumonia.

CONCLUSIONS

This consensus supports the therapeutic use of levonadifloxacin and alalevonadifloxacin in the treatment of antibiotic-resistant GPIs, including those caused by MRSA and certain polymicrobial infections, in patients with multiple co-morbidities requiring drug with adequate safety and consistent efficacy.

Prevalence and correlates of multimorbidity among patients attending AYUSH primary care settings in Delhi-National Capital Region, India

INTRODUCTION

India has a multifaceted healthcare system and recognizes complementary and alternative systems of medicine (AYUSH) that cater to the healthcare needs of people. Multimorbidity requires frequent visits to physicians and long-term use of medications, due to which people tend to prefer AYUSH systems as they provide holistic patient-centered treatment. Hence, we aimed to estimate the prevalence of multimorbidity and assess its correlates among patients attending AYUSH primary care clinics in Delhi.

METHODS

A cross-sectional study was conducted among 943 patients aged ≥ 18 years attending various AYUSH primary care clinics in Delhi from September 2021 to February 2022, employing a stratified random sampling technique. Descriptive statistics such as frequency and proportion were used to report the prevalence of multimorbidity (two or more chronic conditions in an individual out of the 33 conditions listed as per the Multimorbidity Assessment Questionnaire for Primary Care). A multivariable logistic regression assessed the association between various socio-demographic characteristics and multimorbidity, presented as an adjusted odds ratio (AOR) with a 95% confidence interval (CI).

RESULTS

The prevalence of diabetes (14.7%) was found to be the highest (out of all included chronic conditions) among the patients attending various AYUSH primary care settings. The overall prevalence of multimorbidity was observed to be around 39.4%. We observed a higher likelihood of having multimorbidity among participants aged ≥ 70 years [AOR: 9.19 (95% CI: 3.75-22.54)], females [AOR: 1.57 (95% CI: 1.04-2.37)], and middle class [AOR: 2.23 (95% CI: 1.45-3.43)].

CONCLUSION

Multimorbidity was evidently prevalent across AYUSH primary care settings, which cannot be overlooked. The results suggest behavioral change communication may be aimed at older individuals, females, and the middle class.

Medication Adherence among Primary Care Patients with Common Mental Disorders and Chronic Medical Conditions in Rural India

Background

Only a few studies have explored the relationship between psychosocial factors and medication adherence in Indian patients with noncommunicable diseases (NCDs). We aimed to examine the association of psychosocial variables with medication adherence in people with NCDs and comorbid common mental disorders (CMDs) from primary care in rural southern India.

Methods

We performed a secondary analysis using baseline data from a randomized controlled trial in 49 primary care health centers in rural southern India (HOPE study). Participants were adults (≥30 years) with NCDs that included hypertension, diabetes, and/or ischemic heart disease, and comorbid depression or anxiety disorders. Medication adherence was assessed by asking participants if they had missed any prescribed NCD medication in the past month. Data were collected between May 2015 and November 2018. The association between psychosocial and demographic variables and medication nonadherence were assessed via logistic regression analyses.

Results

Of the 2486 participants enrolled, almost one-fifth (18.06%) reported missing medication. Male sex (OR = 1.74, 95% CI 1.37-2.22) and higher internalized mental illness stigma (OR = 1.46, 95% CI 1.07-2.00) were associated with higher odds of missing medication. Older age (OR = 0.40, 95% CI 0.26-0.60, for participants aged 64-75 years vs 30-44 years), reporting more social support (OR = 0.65, 95% CI 0.49-0.86), and higher satisfaction with health (OR = 0.74, 95% CI 0.61-0.89) were associated with lower odds of missing medication.

Conclusions

Greater internalized mental illness stigma and less social support are significantly associated with lower rates of medication adherence in patients with NCDs and comorbid CMDs in rural India.

Essential medicines for cardiovascular diseases in India: Rapid appraisal of policies and processes at the subnational level

Background The burden of cardiovascular diseases (CVDs) and response to health systems vary widely at the subnational level in India. Our study aimed to assess the variation in state-level access to medicines for CVDs by comparing the essential medicines lists (EMLs) at the national and subnational levels in India and by rapid appraisal of the existing policies and processes of drug procurement. Methods We assessed the inclusion of six classes of medicines for CVDs in the recent and publicly available national and subnational EMLs from July to September 2018 in the states of Telangana and Madhya Pradesh. We examined the drug procurement and distribution policies and processes using documentary review and five key informant interviews between March and June 2018. Results The WHO's EML, India's national EML, and 21 of 28 publicly available (75%) Indian state and Union Territory EMLs included all six classes of essential medicines for CVDs. However, some medicines were not included in the policy packages of essential medicines meant for primary health centres. Both the states used centralized tendering and decentralized distribution as part of the public sector drug procurement process. The requirement was based on the previous year's consumption. The approximate time between procurement planning and distribution was 7-8 months in both the states. Conclusion Substantial variation exists in the selection of drugs for CVDs in EMLs at the subnational level in India. Improving forecasting techniques for requirement of medicines and reducing time lags between forecasting and distribution to health facilities may allow for better access to essential medicines.

Qualitative Insights on the Importance of Sociocultural Contexts on Asian Indian Migrant Participation in Physical Activity and Sedentary Behavior

BACKGROUND

Influences on physical activity and sedentary behavior may differ for migrants moving from their country of origin to a new country. This study aimed to explore the range of contextual factors that influence physical activity and sedentary behavior among Indian migrants, making comparisons with India.

METHODS

Semistructured interviews were conducted with 21 Indian migrants (10 men and 11 women) aged between 18 and 65 years living in Melbourne, Australia. Data were analyzed thematically, coded inductively, and managed with NVivo.

RESULTS

Participants perceived a lack of social connection as a key barrier to physical activity participation. Group-based physical activity fostered social connections. Cultural associations were sites to engage in cultural physical activity and integrate with other Indians. Australia's physical contexts (eg, availability of facilities and built environment) facilitated physical activity behavior. Workplace environments (eg, the nature of the job) prompted sedentary behavior. Other contextual shifts with migration related to activities of daily living (eg, shifts in transport [walking] behavior in India to a greater reliance on cars in Australia) and migrant-friendly health communication (messaging from Australian health/allied health practitioners).

CONCLUSIONS

Sociocultural contexts remain key influences on migrant physical activity participation. Prioritizing integrated approaches and engaging insider codesign are important in tailoring and promoting migrant physical activity and limiting sedentary behavior.

Factors influencing adherence to non-communicable disease medication in India: secondary analysis of cross-sectional data from WHO - SAGE2

Background: Non-communicable diseases (NCDs) are a leading cause of death globally and disproportionately affect those in low- and middle-income countries lower-middle-income countries. Poor medication adherence among patients with NCDs is prevalent in India due to lack of initiation, missed dosing or cessation of treatment, and represents a growing healthcare and financial burden. Objective: This study aimed to identify factors influencing medication adherence in adults with NCDs in India. Methods: We performed a cross-sectional study, conducting secondary data analysis on the second wave of the World Health Organisation's 'Study on global AGEing and adult health (SAGE)', a survey that collected data from predominantly older adults across India. Bivariate analysis and multivariate logistic regression modelling were conducted to specifically interrogate the reasons for lack of initiation and cessation of treatment. Reporting of this study was informed by the STROBE guidelines. Results: The average medication adherence rate was 51% across 2,840 patients with one or more NCDs, reflecting non-initiation and lack of persistence of treatment. The strongest factor significantly predicting non-adherence to medication across these components was multimorbidity (odds ratio 0.47, 95% CI 0.40-0.56). Tobacco use (OR = 0.76, CI 0.59-0.98) and never having attended school (OR = 0.75, CI 0.62-0.92) were significantly associated with poor medication adherence (p < 0.05) while rural living (OR = 0.70, CI 0.48-1.02), feelings of anxiety (OR = 0.84, CI 0.66-1.08) and feelings of depression (OR = 0.90, CI 0.70-1.16) were factors lacking statistically significant association with medication adherence on multivariate analysis. Older age (OR = 2.02, CI 1.51-2.71) was significantly associated with improved medication adherence whilst there was a weak association between increased wealth and improved medication use. Limitations: The SAGE2 survey did not capture whether patients were taking their medication doses according to prescribed instructions-as a result our findings may under-estimate the true prevalence of medication non-adherence. Conclusion: Our analysis provides evidence that poor medication adherence in India is multifactorial, with distinct socioeconomic and health-system factors interacting to influence patient decision making. Future large-scale surveys interrogating adherence should assess all components of adherence specifically, whilst public health interventions to improve medication adherence should focus on barriers that may exist due to multimorbidity, comorbid depression and anxiety, and low educational status.

Transitioning diets: a mixed methods study on factors affecting inclusion of millets in the urban population

BACKGROUND

The increasing health challenge in urban India has led to consumers to change their diet preferences by shifting away from staple cereals and making way for healthier foods such as nutri-cereals like millets and other diverse food groups. Taking the case of millets, this study seeks to uncover the exact drivers for this shift of consumers away from a traditional cereal dense diet to a nutritionally more diverse diet that includes nutri-cereal. We also look at deterrents that dissuade consumers from shifting to millets.

METHOD

We use primary data by surveying respondents through interviews and focused group discussions and online questionnaires. A total of 20 personal consumer interviews and 4 focus group discussions having 8-12 members each were conducted to arrive at the measures for the study. We use logistic regression and Structural Equation Modeling for data analysis. Responses were obtained across major metropolitan cities and tier 2 cities of India thus ensuring representation of geographical, cultural and diet diversity. 875 participants' responses were analysed for results.

RESULTS

Health reasons and social networks are the major drivers for shift to millets while lack of awareness, lack of easy availability, high prices, lack of branded products, family being averse to switching to millets and lack of attractive promotional cashbacks and discounts are major deterrents to trying out millets.

CONCLUSIONS

Diet focussed interventions are urgently needed to curb rising diet related non communicable diseases. Government policies aimed at greater production of millets, running awareness campaigns on mass media and private sector initiatives aimed at generating better value added market offerings could lead the way.

Palliative Care Need in India: A Systematic Review and Meta-analysis

Background

To achieve sustainable development goal 3.8, countries must prioritise the provision of palliative care. We aimed to estimate the prevalence of palliative care needs in India.

Methods

A systematic literature search was conducted in databases of PubMed, Cochrane, Embase, Web of Science, and EBSCO Host. We included community-based studies published in English between inception and April 30, 2023. We excluded hospital-based studies that were conducted solely including diseased patients. Data were extracted independently, and a quality assessment was performed. To estimate the pooled prevalence and 95% confidence intervals (CI), we used the random-effects model. Heterogeneity was assessed using the Q statistic and I2 test. Subgroup analyses were conducted based on the study site, urban-rural distribution, gender, and age groups. Publication bias was evaluated using a funnel plot and Egger test. STATA software was used for data analysis.

Results

Out of the 2632 articles identified, 8 cross-sectional studies were included. Using the random-effects model, the pooled estimate of palliative care needs was found to be 6.21/1000 population (95% CI: 2.42-11.64). The southern region showed a prevalence of 10.83/1000 compared to 2.24/1000 in the northern region. Urban areas had a prevalence of 3.34/1000, while rural areas had a prevalence of 7.69/1000. Among females, the prevalence was 9.64/1000, compared to 6.77/1000 among males. Notably, individuals aged over 60 years had a higher prevalence of palliative care needs, with a rate of 37.86/1000 population.

Conclusion

This systematic review and meta-analysis highlight a substantial need for palliative care in India, with a prevalence of 6.21 individuals/1000 population.

Clinico-Epidemiological Profile of Patients Presenting With Acute Chest Discomfort in Emergency Medicine Department of a Tertiary Care Hospital in Uttarakhand, India: A Prospective Observational Study

Background Acute chest discomfort is a common presenting complaint in the emergency department. There is a paucity of studies related to clinico-epidemiological profile of patients with acute chest discomfort in the emergency department (ED). Hence, we intended to conduct the study to address the dearth of research in this field. Aims and objectives The primary objective of this study was to study the clinico-epidemiological profile of patients with acute chest discomfort presenting to the ED. The secondary objectives were to assess the prevalence of premature acute coronary syndrome (ACS), to study the ED disposition and final hospital discharge diagnosis, and to assess the predictors of 24-hour mortality in such patients. Methods A prospective observational study of patients presenting with acute chest discomfort was conducted in the emergency medicine department of a tertiary care hospital. We included adults above the age of 18 years from December 2021 to December 2022 and excluded trauma patients. A standardized form was used to document patient demographic patterns, comorbidities, chest discomfort description, physical findings, investigations, consultations, ED management, and disposition. Variables having p-value ≤ 0.05 were considered to be significant. Results A total of 200 patients were included. The most common cause of chest discomfort in the ED was cardiac, accounting for 48.5% (n = 97) of patients. The most common cardiac cause of acute chest discomfort was ST-elevation myocardial infarction (STEMI) ~ 21% (n = 42). Cardiac diagnosis was associated with the maximum number of admissions (≈80%; n = 78). The prevalence of premature ACS was 13.9% (n = 10). A 24-hour mortality was significantly associated with male gender, ambulance transport, history of coronary artery disease, and hypoxia and hypotension at the initial presentation. Conclusions ACS followed by respiratory causes are the predominant etiologies of acute chest discomfort in the ED. Knowledge of the differential diagnosis of acute chest discomfort in the ED can aid in prompt diagnosis and delivery of lifesaving treatment to these patients.

Dietary and Physical Exercise Facilitation for Cardiovascular Health in Indian Subcontinent

The advent of industrialization and outburst of urbanization significantly influences the lifestyle of people. Further, the incidence of noncommunicable diseases, such as chronic lung conditions, cancer, cardiovascular diseases (including conditions affecting the heart and blood vessels), diabetes, hypertension, and obesity, has increased. The prevalence of cardiovascular diseases in India in 2016 was reported to be 54.5 million. One out of four deaths was associated with cardiovascular diseases. With time, the prevalence of cardiovascular diseases is exerting more impact on the younger Indian population aged 20-29 years. The foremost risk factors for disability-adjusted life-years include poor dietary habits, tobacco use, and low physical activity. A healthy diet and an optimum physical activity level should be projected as primary interventions for noncommunicable diseases in the Indian subcontinent. Government health organizations and associations should concentrate and prioritize the current situation and scale up cost-effective policies and innovative techniques with interventional research and funding, especially on diet and exercise facilitation, as comprehensive management toward minimizing cardiovascular diseases to safeguard Indian economy's future.

Non-communicable disease multimorbidity among tribal older adults in India: evidence from Study on Global AGEing and adult health, 2015

Introduction

Multimorbidity defined as the simultaneous presence of two or more chronic conditions in an individual is on the rise in low- and middle-income countries such as India. With India aiming to achieve universal health coverage, it is imperative to address the inequalities in accessing healthcare, especially among vulnerable groups such as tribal. Moreover, changing lifestyle has led to the emergence of multimorbidity among tribals in India. We aimed to estimate the prevalence and assess the correlates of multimorbidity among tribal older adults in India.

Methods

We employed nationally representative data from the World Health Organization's Study on Global AGEing and Adult Health conducted in 2015. We included 522 participants aged ≥50 years who reported their caste to be 'Scheduled Tribe' in the survey. A multivariable regression model assessed the association between multimorbidity and various attributes.

Results

Arthritis, cataract, and hypertension were the most common chronic conditions. The overall prevalence of multimorbidity was ~22.61%. We observed a higher likelihood of having multimorbidity among respondents aged ≥80 years [AOR: 4.08 (1.17-14.18)] than the younger age groups, and among the most affluent group [AOR: 2.64 (1.06-6.56)] than the most deprived class.

Conclusion

The prevalence of multimorbidity among tribal older adults is emerging which cannot be overlooked. Health and wellness centers may be a window of opportunity to provide egalitarian and quality preventive and curative services to achieve universal health coverage. Future studies should explore the outcomes of multimorbidity in terms of healthcare utilization, expenditure, and quality of life in this group.

Metabolic risk factors and psychosocial problems independently explain poor sleep quality and obstructive sleep apnea symptoms among adults in urban India

STUDY OBJECTIVES

To determine if metabolic risk factors are associated with poor sleep quality and obstructive sleep apnea-like symptoms (OSA symptoms) independent of psychosocial problems and demographic and lifestyle factors in older Indian adults.

METHODOLOGY

We analyzed baseline data from adults (≥ 50 years) from a population-based cohort, the LoCARPoN study, in India. Variables were grouped as (a) demographic and lifestyle factors such as smoking, alcohol use, and physical activity; (b) psychosocial problems including symptoms of depression, anxiety, and perceived stress; and (c) metabolic risk factors including glycated hemoglobin, high-density lipoprotein, low-density lipoprotein, total cholesterol, body mass index, and hypertension. Variables were examined as predictors of poor sleep quality and OSA symptoms. Groups of variables were added stepwise to a logistic regression. Variance explained by nested models was quantified using McFadden's pseudo R2, and change was formally tested with the log-likelihood ratio test.

RESULTS

Among 7505 adults, the prevalence of poor sleep quality was 16.9% (95% CI: 16.0, 17.7), and OSA symptoms were present in 7.0% (95% CI: 6.4, 7.6). Psychosocial problems had a strong independent association with both poor sleep quality (pseudo R2 increased from 0.10 to 0.15, p < 0.001) and more OSA symptoms (pseudo R2 increased from 0.08 to 0.10, p < 0.001). Metabolic risk factors had a modest independent association with sleep quality (pseudo R2 increased from 0.14 to 0.15, p < 0.01), but a strong association with OSA symptoms (pseudo R2 increased from 0.08 to 0.10, p < 0.001).

CONCLUSION

Psychosocial and metabolic risk factors were independently associated with sleep quality and OSA symptoms. This fact implied that OSA symptoms may affect both mental health and physical health. Our findings have public health implications because the number and proportion of the elderly in India is increasing, while the prevalence of metabolic risk factors and psychosocial problems is high already. These facts have the potential to exacerbate not only the burden of sleep disorders and OSA symptoms but also associated cardiovascular and neurologic sequelae, further stretching the Indian health-care system.

Frailty among middle-aged and older women and men in India: findings from wave 1 of the longitudinal Ageing study in India

OBJECTIVES

Few studies have examined frailty in Indian adults, despite an increasing population of older adults and an escalating burden of chronic diseases. We aimed to study the prevalence and correlates of frailty in middle-aged and older Indian adults.

SETTING

Cross-sectional data from Wave 1 of Longitudinal Ageing Study in India, conducted in 2017-2018 across all states and union territories, were used.

PARTICIPANTS

The final analytical sample included 57 649 participants aged 45 years and above who had information on frailty status.

PRIMARY OUTCOME MEASURE

The deficits accumulation approach to measuring frailty was employed, creating a frailty index between 0 and 1, based on 40 deficits. Individuals with a frailty index of 0.25 or more were defined as 'frail'.

RESULTS

Prevalence of frailty among 45+ adults was 30%. 60+ women were two times as likely to be frail compared with 60+ men, after adjusting for a wide range of sociodemographic, economic and lifestyle factors. The sex difference was more pronounced in adults aged 45-59 years. Odds of hospitalisation in the last 12 months, and having falls in the past 2 years, were two times as high in frail adults compared with non-frail adults. Frail middle-aged and older adults had 33% and 39% higher odds, respectively, of having poor cognition than non-frail adults. The relative increase was higher in women for all three outcomes, although not statistically significant.

CONCLUSIONS

There needs to be careful consideration of sex differences when addressing frailty, particularly for optimising frailty interventions. Frailty, although typically assessed in older adults, was shown in this study to be also prevalent and associated with adverse outcomes in middle-aged Indian adults. More research into assessment of frailty in younger populations, its trajectory and correlates may help develop public health measures for prevention of frailty.

Prevalence and correlates of metabolic syndrome among women living in urban slums, Mysore, India

Metabolic Syndrome (MetSyn) is a predictor of cardiovascular disease (CVD). About a third of urban Indians suffer from MetSyn. This study examined the prevalence of MetSyn among women living in urban slums. A cross-sectional survey was carried out between October 2017 and May 2018 among a non-probability sample of slum-dwelling women, 40-64 years of age, in six government-designated slums in Mysore, India. Data were collected on demographics, diet, behavioral risks, anthropometry, blood pressure, serum glucose, hemoglobin A1c, and serum lipids. The study used a definition of MetSyn from the International Diabetes Federation Task Force on Epidemiology and Prevention with an HbA1c measure for average blood glucose. About two-fifths of the 607 participants had MetSyn (41.5%; 95% CI: 37.7-45.5). Of those, 40.9% met three criteria, 38.1% four, and 25.0%, all five criteria. Elevated BP was the most prevalent MetSyn factor (79.6%), followed by increased waist circumference (54.5%), low HDL (50.1%), elevated Hb A1c (37.1%), and elevated triglycerides (36.1%). Odds for MetSyn were 1.52 times greater for those who were 50-59 years of age compared with those 40-49 years of age (adjusted odds ratio[AOR]:1.52; 95% CI:0.96-2.40). Women with mobility issues had 1.29 times higher odds of MetSyn than those without it (AOR: 0.76, 95% CI: 0.96, 1.75). Housewives had 1.29 times greater odds of MetSyn (AOR: 1.29, 95% CI: 1.00, 1.67). There is a high prevalence of MetSyn among urban slum-dwelling women in Mysore. There is a need for interventions aimed at reducing CVD risk factors in this population.

Food insecurity and its association with health and well-being in middle-aged and older adults in India

AIM

Food insecurity is a global public health concern; however, there is limited knowledge about its health impacts in India. We examined the associations of food insecurity with socioeconomic conditions, chronic disease and various domains of health and well-being in a community sample of middle-aged and older adults (45+ years) in India.

METHODS

Cross-sectional nationally representative data were collected in wave 1 (2017-2018) of the Longitudinal Ageing Study in India. Food insecurity was measured by questions of access and availability of food. We used logistic regression analyses to examine associations of food insecurity with poor self-rated health, limitations in activities of daily living (ADLs), instrumental ADLs, low life satisfaction, depression, sleep problems and low body mass.

RESULTS

Food insecurity related to all seven indicators of poor health and well-being, even after controlling for material wealth and the presence of multimorbidity (which food insecurity also predicted). Associations with mental health were stronger for those for physical health. For instance, food insecurity related to a threefold increase in probable depression (OR=2.9, 95% CI=2.4 to 3.4) and low life satisfaction (OR=3.4, 95% CI=2.9 to 3.8).

CONCLUSIONS

Food insecurity is a powerful social determinant of poor health among older adults in India. Policy measures to improve population health and well-being should closely follow trends in food insecurity, particularly among those living in poverty and with multiple health conditions.

Prevalence of pain and its treatment among older adults in India: a nationally representative population-based study

ABSTRACT

There were no estimates of the prevalence of pain and its treatment in the older population of India obtained from face-to-face interviews with a nationally representative sample. We addressed this evidence gap by using data on 63,931 individuals aged 45 years and older from the 2017/2018 Longitudinal Ageing Study in India. We identified pain from an affirmative response to the question: Are you often troubled by pain? We also identified those who reported pain that limited usual activities and who received treatment for pain. We estimated age- and sex-adjusted prevalence of pain, pain limiting usual activity and treatment, and compared these estimates across states and sociodemographic groups. We used a multivariable probit model to estimate full adjusted differences in the probability of each outcome across states and sociodemographic groups. We estimated that 36.6% (95% confidence interval [CI]: 35.3-37.8) of older adults in India were often troubled by pain and 25.2% (95% CI: 24.2-26.1) experienced pain limiting usual activity. We estimated that 73.3% (95% CI: 71.9-74.6) of those often troubled by pain and 76.4% (95% CI: 74.9-78.0) of those with pain that limited usual activity received treatment. There was large variation in each outcome across states. Fully adjusted prevalence of pain and pain limiting usual activity were higher among individuals who were female, older, less educated, rural residents, and poorer. Prevalence of treatment among those troubled by pain was lower among socially disadvantaged groups.

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

Background

Multimorbidity estimates are expected to increase in India primarily due to the population aging. However, there is a lack of research estimating the burden of multimorbidity in the Indian context using a validated tool. We estimated the prevalence and determinants of multimorbidity amongst the adult population of the rural Uddanam region, Andhra Pradesh.

Methods

This community-based cross-sectional study was conducted as a part of an ongoing research program. Multistage cluster sampling technique was used to select 2419 adult participants from 40 clusters. Multimorbidity was assessed using Multimorbidity Assessment Questionnaire for Primary Care (MAQ-PC) tool, collecting information on 13 chronic diseases. Patient Health Questionnaire (PHQ-12) was used to screen for depression. Multiple logistic regression was conducted to identify the strongest determinants of multimorbidity.

Results

Of the 2419 participants, 2289 completed the MAQ-PC tool. Mean age (standard deviation) of participants was 48.1 (13.1) years. The overall prevalence of multimorbidity was 58.5% (95% CI 56.5-60.6); with 30.7%, 15.6%, and 12.2% reporting two, three, and four chronic conditions, respectively. Acid peptic disease-musculoskeletal disease (44%) and acid peptic disease-musculoskeletal disease-hypertension (14.9%) were the most common dyad and triad. Among metabolic diseases, diabetes-hypertension (28.3%) and diabetes-hypertension-chronic kidney disease (7.6%) were the most common dyad and triad, respectively. Advancing age, female gender, and being obese were the strongest determinates of the presence of multimorbidity. Depression was highly prevalent among the study population, and participants with higher PHQ-12 score had 3.7 (2.5-5.4) greater odds of having multimorbidity.

Conclusions

Our findings suggest that six of 10 adults in rural India are affected with multimorbidity. We report a higher prevalence of multimorbidity as compared with other studies conducted in India. We also identified vulnerable groups which would guide policy makers in developing holistic care packages for individuals with multimorbidity.

Socioeconomic Inequalities in the Prevalence of Non-Communicable Diseases among Older Adults in India

Understanding socioeconomic inequalities in non-communicable disease prevalence and preventive care usage can help design effective action plans for health equality programs among India's aging population. Hypertension (HTN) and diabetes mellitus (DM) are frequently used as model non-communicable diseases for research and policy purposes as these two are the most prevalent NCDs in India and are the leading causes of mortality. For this investigation, data on 31,464 older persons (aged 60 years and above) who took part in the Longitudinal Ageing Survey of India (LASI: 2017-2018) were analyzed. The concentration index was used to assess socioeconomic inequality whereas relative inequalities indices were used to compare HTN, DM, and preventive care usage between the different groups of individuals based on socioeconomic status. The study reveals that wealthy older adults in India had a higher frequency of HTN and DM than the poor elderly. Significant differences in the usage of preventive care, such as blood pressure/blood glucose monitoring, were found among people with HTN or DM. Furthermore, economic position, education, type of work, and residential status were identified as important factors for monitoring inequalities in access to preventive care for HTN and DM. Disparities in non-communicable diseases can be both a cause and an effect of inequality across social strata in India.

The need for vaccination in adults with chronic (noncommunicable) diseases in India - lessons from around the world

Worldwide, chronic diseases (noncommunicable diseases [NCDs]) cause 41 million (71%) deaths annually. They are the leading cause of mortality in India, contributing to 60% of total deaths each year. Individuals with these diseases are more susceptible to vaccine-preventable diseases (VPDs) and have an increased risk of associated disease severity and complications. This poses a substantial burden on healthcare systems and economies, exemplified by the COVID-19 pandemic. Vaccines are an effective strategy to combat these challenges; however, utilization rates are inadequate. With India running one of the world’s largest COVID-19 vaccination programs, this presents an opportunity to improve vaccination coverage for all VPDs. Here we discuss the burden of VPDs in those with NCDs, the benefit of vaccinations, current challenges and possible strategies that may facilitate implementation and accessibility of vaccination programs. Effective vaccination will have a significant impact on the disease burden of both VPDs and NCDs and beyond.

What is already known on this topic?

Annually, chronic or noncommunicable diseases (NCDs) cause >40 million deaths worldwide and 60% of all deaths in India

Adults with these diseases are more susceptible to vaccine-preventable diseases (VPDs); however, vaccine utilization is inadequate in this population

What is added by this report?

We highlight the benefits of vaccination in adults with NCDs that extend beyond disease prevention

We discuss key challenges in implementing adult vaccination programs and provide practical solutions

What are the implications for public health practice?

Raising awareness about the benefits of vaccinations, particularly for those with NCDs, and providing national guidelines with recommendations from medical societies, will increase vaccine acceptance

Adequate vaccine acceptance will reduce the VPD burden in this vulnerable population

Burden of communicable and non-communicable diseases-related inequalities among older adults in India: a study based on LASI survey

Background

A rising proportion of elderly in India has infused notable challenges to the healthcare system, which is already underdeveloped. On one side, NCDs are increasing among the elderly in India; however, on the other side, CDs are also a cause of concern among the elderly in India. While controlling the outbreak of communicable diseases (CDs) remained a priority, non-communicable diseases (NCDs) are placing an unavoidable burden on the health and social security system. India, a developing nation in South Asia, has seen an unprecedented economic growth in the past few years; however, it struggled to fight the burden of communicable and non-communicable diseases. Therefore, this study aimed at examining the burden of CDs and NCDs among elderly in India.

Methods

Data from Longitudinal Ageing Study in India (LASI Wave-I, 2017–18) were drawn to conduct this study. The LASI is a large-scale nationwide scientific study of the health, economics, and social determinants and implications of India's aged population. The LASI is a nationally representative survey of 72,250 aged 45 and over from all Indian states and union territories. Response variables were the occurrence of CDs and NCDs. The bi-variate and binary logistic regression were used to predict the association between communicable and non-communicable diseases by various socio-demographic and health parameters. Furthermore, to understand the inequalities of communicable and non-communicable diseases in urban and rural areas, the Fairlie decomposition technique was used to predict the contribution toward rural–urban inequalities in CDs and NCDs.

Results

Prevalence of communicable diseases was higher among uneducated elderly than those with higher education (31.9% vs. 17.3%); however, the prevalence of non-communicable diseases was higher among those with higher education (67.4% vs. 47.1%) than uneducated elderly. The odds of NCDs were higher among female elderly (OR = 1.13; C.I. = 1–1.27) than their male counterparts. Similarly, the odds of CDs were lower among urban elderly (OR = 0.70; C.I. = 0.62–0.81) than rural elderly, and odds of NCDs were higher among urban elderly (OR = 1.85; C.I. = 1.62–2.10) than their rural counterparts. Results found that education (50%) contributes nearly half of the rural–urban inequality in the prevalence of CDs among the elderly. Education status and current working status were the two significant predictors of widening rural–urban inequality in the prevalence of NCDs among the elderly.

Conclusion

The burden of both CD and NCD among the elderly population requires immediate intervention. The needs of men and women and urban and rural elderly must be addressed through appropriate efforts. In a developing country like India, preventive measures, rather than curative measures of communicable diseases, will be cost-effective and helpful. Further, focusing on educational interventions among older adults might bring some required changes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03481-x.

Estimating the Need for Palliative Care in an Urban Resettlement Colony of New Delhi, North India

Objectives:

This study was aimed to estimate the need for palliative care in an urban resettlement colony of Dakshinpuri Extension, New Delhi.

Material and Methods:

This was a community-based cross-sectional study conducted in New Delhi. We trained four multipurpose workers to screen the households during their routine household-to-household visits. The screening for the need for palliative care was done using three questions – that is, (1) presence of a bedridden patient or (2) person in need for help in activities of daily living or (3) not able to go for work due to any physical chronic illness. If the answer to any of the three screening questions was yes for any member in a household, then these households were visited by a community physician trained in palliative care and a medical social service officer to confirm the need for palliative care. Patients were administered a semi-structured questionnaire containing the sociodemographic details and an assessment of disease status and review of health records was done. The patient and his/her caregiver were also assessed for awareness regarding palliative care.

Results:

A total of 2028 households were screened and the need for palliative care was found to be 1.5/1000 population (95% CI: 0.9–2.1). The mean age (SD) of patients who need palliative care was 60 years (SD–12.9). The common diseases which required palliative care were stroke with a focal neurological deficit (45.8%), osteoarthritis with marked dependence (20.8%) and cancer (12.5%). None of the patients was receiving palliative care as patients and their caregivers were not aware of the term palliative care/end of life care/home care for bedridden people/community-based care.

Conclusion:

The need for palliative care in an urban resettlement colony of North India was found to be 1.1/1000 population. Further studies are required to estimate the need for palliative care in North India.

Family-Level Multimorbidity among Older Adults in India: Looking through a Syndemic Lens

Most evidence on multimorbidity is drawn from an individual level assessment despite the fact that multimorbidity is modulated by shared risk factors prevailing within the household environment. Our study reports the magnitude of family-level multimorbidity, its correlates, and healthcare expenditure among older adults using data from the Longitudinal Ageing Study in India (LASI), wave-1. LASI is a nationwide survey amongst older adults aged ≥45 years conducted in 2017-2018. We included (n = 22,526) families defined as two or more members coresiding in the same household. We propose a new term, "family-level multimorbidity", defined as two or more members of a family having multimorbidity. Multivariable logistic regression was used to assess correlates, expressed as adjusted odds ratios with a 95% confidence interval. Family-level multimorbidity was prevalent among 44.46% families, whereas 41.8% had conjugal multimorbidity. Amongst siblings, 42.86% reported multimorbidity and intergenerational (three generations) was 46.07%. Family-level multimorbidity was predominantly associated with the urban and affluent class. Healthcare expenditure increased with more multimorbid individuals in a family. Our findings depict family-centred interventions that may be considered to mitigate multimorbidity. Future studies should explore family-level multimorbidity to help inform programs and policies in strategising preventive as well as curative services with the family as a unit.

Multimorbidity and Complex Multimorbidity in India: Findings from the 2017-2018 Longitudinal Ageing Study in India (LASI)

Complex multimorbidity refers to the co-occurrence of three or more chronic illnesses across >2 body systems, which may identify persons in need of additional medical support and treatment. There is a scarcity of evidence on the differences in patient outcomes between non-complex (≥2 conditions) and complex multimorbidity groups. We evaluated the prevalence and patient outcomes of complex multimorbidity and compared them to non-complex multimorbidity. We included 30,489 multimorbid individuals aged ≥45 years from the Longitudinal Ageing Study in India (LASI) from wave-1 conducted in 2017−2018. We employed a log link in generalised linear models (GLM) to identify possible risk factors presenting the adjusted prevalence−risk ratio (APRR) and adjusted prevalence−risk difference (APRD) with 95% confidence interval. The prevalence of complex multimorbidity was 34.5% among multimorbid individuals. Participants residing in urban areas [APRR: 1.10 (1.02, 1.20)], [APRD: 0.04 (0.006, 0.07)] were more likely to report complex multimorbidity. Participants with complex multimorbidity availed significantly higher inpatient department services and had higher expenditure as compared to the non-complex multimorbidity group. Our findings have major implications for healthcare systems in terms of meeting the requirements of people with complicated multimorbidity, as they have significantly higher inpatient health service utilisation, higher medical costs, and poorer self-rated health.

Decomposing the rural-urban gap in the prevalence of undiagnosed, untreated and under-treated hypertension among older adults in India

Background

Although awareness and treatment rates of hypertension have significantly improved in recent years, the prevalence of undiagnosed and untreated hypertension remains a major public health concern for Indian policymakers. While the urban–rural variation in the prevalence, diagnosis, control, and treatment of hypertension is reasonably well-documented, the explanation behind such variation remains poorly understood given the dearth of studies conducted on exploring the determinants of the rural–urban gap in the prevalence of undiagnosed, untreated, and uncontrolled hypertension in India. In view of this research gap, our paper aims to decompose the inter-group differences between rural and urban areas in undiagnosed, untreated, and undertreated hypertension among older adults in India into the major contributing factors.

Methods

Nationally representative data collected in the Longitudinal Ageing Study of India, Wave-1 (2017–18), was utilized for this study. Maximum-likelihood binary logistic-regression models were employed to capture the crude and adjusted associations between the place of residence and prevalence of undiagnosed, untreated, and undertreated hypertension. Fairlie’s decomposition technique was used to decompose the inter-group differences between rural and urban residents in the prevalence of undiagnosed, untreated, and undertreated hypertension among the older population in India, into the major contributing factors, in order to explore the pathways through which these differences manifest.

Results

The overall prevalence rates of undiagnosed, untreated, and undertreated hypertension among older adults were 42.3%, 6%, and 18.7%, respectively. However, the prevalence of undiagnosed and untreated hypertension was higher in rural areas, by 12.4 and 1.7 percentage-points, respectively, while undertreated hypertension was more prevalent in the urban areas (by 7.2 percentage-points). The decomposition analysis explained roughly 41% and 34% of the urban advantage over rural areas in the case of undiagnosed and untreated hypertension, while it explained 51% of the urban disadvantage in respect of undertreated hypertension. The rural–urban differentials in education and comorbidities accounted for the majority of the explained rural disadvantage in the prevalence of undiagnosed hypertension, explaining 13.51% and 13.27% of the gap, respectively. The regional factor was found to be the major driver behind urban advantage in the prevalence of untreated hypertension, contributing 37.47% to the overall gap. In the case of undertreated hypertension, education, comorbidities, and tobacco consumption were the major contributors to the urban–rural inequality, which accounted for 12.3%, 10.6%, and 9.8% of the gap, respectively.

Conclusion

Socio-economic and lifestyle factors seemed to contribute significantly to the urban–rural gap in undiagnosed, untreated and undertreated hypertension in India among older adults. There is an urgent need of creating awareness programmes for the early identification of hypertensive cases and regular treatment, particularly in under-serviced rural India. Interventions should be made targeting specific population groups to tackle inequality in healthcare utilization.

Multimorbidity as a Risk Factor of Elder Abuse/Mistreatment in India: A Cross-Sectional Study

Globally, elder abuse/mistreatment is a common form of violence against the elderly. This study examines the association between multimorbidity and abuse/mistreatment among the elderly population (60+) in India. Cross-sectional data from the United Nations Population Fund (UNFPA)'s "Building Knowledge Base on Population Aging in India" (BKPAI, 2011) was analyzed. We generated a multimorbidity variable by combining 20 self-reported diagnosed chronic diseases. Bivariate analysis was used to understand the sample distribution and prevalence estimation of elder abuse/mistreatment by multimorbidity and state. Furthermore, multilevel mixed-effect logistic regression was used to examine the association between multimorbidity and elder abuse/mistreatment. The overall prevalence of elder abuse/mistreatment in the study population is 11.4%. The prevalence of elder abuse/mistreatment among elderly with no chronic diseases is 6.01% which increases to 22.7% among elderly with four or more chronic diseases. Furthermore, the result from the multilevel mixed-effect logistic regression showed a close association between multimorbidity and elder abuse. Elderly with two, three, and four or more chronic diseases are 3.02 (CI = 2.33, 3.91, p < .000), 4.16 (CI = 3.02, 5.74, p < .000), and 5.06 (CI = 3.50, 7.31, p <.000) times more likely to experience abuse/mistreatment than elderly with no chronic diseases, respectively. In specific, this association is stronger for the elderly population residing in the urban areas. Furthermore, economic status and educational attainment have a protective role in determining elder abuse/mistreatment in India. In conclusion, multimorbidity has emerged as a significant risk factor of elder abuse/mistreatment in India. Measures to prevent elder abuse should consider the role of multimorbidity.

Rural-urban and gender differences in metabolic syndrome in the aging population from southern India: Two parallel, prospective cohort studies

BACKGROUND

Despite the growing evidence of metabolic syndrome as a major risk factor for cardiovascular and cerebrovascular disease, there are limited studies from India on its prevalence, especially in the aging population. We aimed to estimate the prevalence of metabolic syndrome and associated comorbidities in two prospective, aging cohorts from rural and urban India.

METHODS

In these two parallel, prospective, aging (≥ 45 years) cohorts, the samples included 2171 people from rural India (Srinivaspura Aging, Neuro Senescence and COGnition, SANSCOG cohort; April 23, 2018 to Sept 25, 2021) and 332 people from urban India (Tata Longitudinal Study on Aging, TLSA cohort; July 8, 2015 to Oct 23, 2021). Using cross-sectional data from baseline clinical and biochemical assessments, we calculated metabolic syndrome prevalence using two well established criteria, namely consensus criteria and National Cholesterol Education Program - Adult Treatment Panel III (NCEP-ATP III) criteria; further, rural-urban, gender, and age-wise differences were compared.

FINDINGS

Proportions of metabolic syndrome were 46.2 and 54.8% as per consensus criteria in rural and urban participants, respectively; corresponding numbers using NCEP-ATP III criteria were 40.3 and 45.1%. Rural-dwelling older adults had a significantly lesser prevalence of all individual metabolic syndrome parameters except impaired triglycerides and high-density lipoprotein levels. Rural women had a significantly higher prevalence of metabolic syndrome than rural men, whereas there was no significant difference among urban participants. We did not observe any consistent age-wise trend when comparing both cohorts. There was high burden of comorbidities among both groups, mostly undiagnosed in rural participants.

INTERPRETATION

Roughly one in two older adults had metabolic syndrome, urban significantly more than rural, reaching an alarming 63.1% among urban participants aged 65-74 years. The very high prevalence of undiagnosed co-morbidities among rural adults is extremely concerning, calling for urgent public health measures in this marginalised and health-disparate population.

FUNDING

SANSCOG study is funded through the Centre for Brain Research (CBR), Indian Institute of Science (IISc) by Pratiksha Trust, the philanthropic arm of Mr. Kris Gopalakrishnan. TLSA is funded by Tata Trusts.

Evolving Food Choices Among the Urban Indian Middle-Class: A Qualitative Study

One of the leading risk factors for an escalating obesity burden in India is non-nutritious choices. Underpinned by the nutrition transition theory, this qualitative inquiry was designed to understand the urban middle-class Indian consumers’ views about processed foods and rapidly changing food choices. The study consisted of two phases, the first phase consisted of focus group discussions pertaining to the definition and conception of processed foods and the second phase consisted of interviews regarding the changing food environment. A convenience sample of Indian consumers aged 40–65 years were recruited from Mumbai and Kochi to participate in focus group discussions (FGD1 – nine participants and FGD2 – seven participants) and semi-structured face-to-face interviews (N = 22). Both discussions and interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to analyze the transcribed data. Features of processed foods mentioned were chemical and physical processing, prolonged shelf life and poor nutritional quality. Factors influencing food choices and consumption of processed foods reported by participants could be categorized into changes in the socio-cultural environment and changes in the food environment. Changes in the socio-cultural environment included globalization and urbanization, long work days and sedentary living, rise in income levels and decrease in household cooking. Changes in the food environment included increased availability and accessibility of processed foods, replacement of traditional Indian diet with Western food, food as indicators of status, food advertisements and convenience. These results are consistent with nutrition transition theory and provide useful direction for public health policies aimed at promoting healthy diets.

Prevalence, factors and inequalities in chronic disease multimorbidity among older adults in India: analysis of cross-sectional data from the nationally representative Longitudinal Aging Study in India (LASI)

OBJECTIVE

This study examines the prevalence, patterns and factors of chronic disease-related multimorbidity. Also, this study examines the inequality in the prevalence of multimorbidity among older adults in India.

DESIGN

Cross-sectional study; large nationally representative survey data.

SETTING AND PARTICIPANTS

We have used the first wave of a Longitudinal Ageing Study in India conducted in 2017-2018 across all the 35 states (excluded Sikkim) and union territories in India. This study used information from 31 373 older people aged 60+years in India.

PRIMARY AND SECONDARY OUTCOME MEASURES

The outcome variable for this study is multimorbidity. The study used multinomial logistic regression to examine the risk factors for multimorbidity among older adults. To measure the inequality in multimorbidity, the slope of index inequality and relative index of inequality have been used to understand the ranked-based inequality.

RESULTS

Almost one-fourth (24.1%) reported multimorbidity. The relative risk ratio (RRR) of multimorbidity (RRR=2.12; 95% CI=1.49 to 3.04) was higher among higher educated older adults than uneducated older adults. Furthermore, the RRR of multimorbidity (RRR=2.35; 95% CI=2.02 to 2.74) was higher among urban older adults than their rural counterparts. Older adults in the richest wealth quintile were more likely to report multimorbidities (RRR=2.86; 95% CI=2.29 to 3.55) than the poorest older adults. Good self-rated health and no activities of daily living disability were associated with a lower risk of multimorbidities.

CONCLUSIONS

This study contributes to the comprehensive knowledge of the prevalence, factors and inequality of the chronic disease-related multimorbidity among older adults in India. Considering India's ageing population and high prevalence of multimorbidity, the older adults must be preferred in disease prevention and health programmes, however, without compromising other subpopulations in the country. There is a need to develop geriatric healthcare services in India. Additionally, there is a need to disseminate awareness and management of multimorbidity among urban and highly educated older adults.

Gender and rural-urban differences in hypertension among youth in India: Insights from a large scale survey, 2015-16

Hypertension is considered one of the most persistent public health issues and the single largest contributor to avoidable morbidity and mortality in India. This study aims to investigate the prevalence and risk factors of hypertension in youths (15-29 years) by gender and rural-urban place of residence. Data from the fourth round of the National Family and Health Survey - 2015-16 (n = 395,207) was utilised for the study. After estimation of the stratified prevalence of hypertension by various characteristics, multivariable logistic regression analysis was conducted to assess the correlates of hypertension. The results revealed that the prevalence of hypertension in youths at the national level varied from 9.16% (Meghalaya) to 3.34% (Delhi). The stratified analysis suggests pronounced gender differences in the prevalence of hypertension among youth with insignificant rural-urban differences, although the prevalence was higher in urban areas. Overall, the prevalence of hypertension was found higher for male youths living in urban areas (7.82%) and females in rural areas (5.08%). Concurrently, results from regression analysis also suggest higher odds of hypertension for males residing in urban areas for a variety of demographic, socioeconomic, and health-risk factors. Advancing age, having no education, living in the northeast region, being overweight/obese and high blood glucose level was significantly associated with a greater likelihood of hypertension for both the gender and place of residence. Public health awareness regarding blood pressure needs to be tailored differently for both males and females considering the place of residence. The study suggests that more research should focus on blood pressure/hypertension among children, adolescents and youth since they point towards adult blood pressure patterns.

Patterns and predictors of non-communicable disease multimorbidity among older adults in India: evidence from longitudinal ageing study in India (LASI), 2017-2018

Escalating non-communicable disease multimorbidity rates among older adults is an emerging public health concern in India, but the literature sparsely addresses the epidemiology of multimorbidity. We explore levels, patterns, combinations and predictors of multimorbidity among older adults using information on 59,764 individuals, aged 45 years and older, from the first wave of Longitudinal Ageing Study in India (LASI), 2017-2018. We computed multimorbidity score for sixteen non-communicable diseases to identify frequently occurring morbidity patterns (dyads and triads) and assess the relationship between multimorbidity and selected background characteristics. Near third of the older adult population is affected by multimorbidity, with hypertension, gastrointestinal disorders, musculoskeletal disorders, diabetes and skin diseases being the most common. Policymakers should seek strategies to increase early detection and prevention of chronic diseases, delay the age at onset of disease for those who are not affected and improve management for those affected with multiple disease conditions.

Elder abuse/mistreatment and associated covariates in India: results from the Longitudinal Aging Study in India wave 1, 2017-2018

OBJECTIVES

Elder abuse has significant adverse consequences for the overall health and well-being of the elderly, including premature mortality. Using cross-sectional data, we assessed the prevalence of elder abuse in India, its variation across states, and associated factors.

METHODS

Nationally representative data from the first wave of the Longitudinal Aging Study in India were analyzed. Bivariate and multivariate analyses were used to study the prevalence, state variations, and associated factors of elder abuse.

RESULTS

Overall, 5.2% of elderly adults (≥60 years) had experienced abuse in the year prior to the survey and 3% had experienced abuse within their own household. Verbal abuse or disrespect was the most common form of abuse. Considerable variation was observed in the prevalence of elder abuse across states and union territories, with the highest prevalence observed in Bihar (11.6%) and Karnataka (10.1%). In regression analysis, education level emerged as a protective factor against elder abuse, particularly among women. Older adults who lived alone, had functional limitations, had multiple morbidities, and had been hospitalized in the past year were more likely to experience abuse. Older adults who experienced abuse were 2 times more likely to experience depressive symptoms.

CONCLUSIONS

Cross-state variation in the prevalence of elder abuse and subgroup differences suggest that state-specific interventions and essential monitoring of older adults with functional limitations, chronic diseases, and recent hospitalization can further reduce the prevalence and consequences of elder abuse in India.

Cost of Ambulatory Care in Diabetes: Findings From a Non-Communicable Disease Clinic of a Tertiary Care Institute in Eastern India

Background: This study was conducted to evaluate the cost of ambulatory care of diabetes in a non-communicable disease (NCD) clinic in eastern India.

Methods: This hospital-based cross-sectional cost description study was conducted from July to August 2018. A total of 192 diagnosed cases aged 18-70 years with a minimum history of one year since diagnosis attending the NCD clinic for the first time were included. Information was collected using a pre-tested schedule based on the cost of illness approach that consisted of socio-demographic details, disease status, and cost of ambulatory care. Cost of the drugs was calculated using a standardized repository of drug costs. The estimated expenditure of previous three months was calculated and extrapolated to one year to calculate yearly expenditure.

Results: The mean age of the study participants was 43.93±10.41 years and the mean duration of diabetes was 6.64±6.08 years. The median direct cost due to diabetes was Rs 9560 (136.57 USD) annually. It was higher in females (Rs 10,056, 143.45 USD) than in males (Rs 9020, 128.85 USD). In direct medical costs, a major part was constituted by the drugs, oral hypoglycemic agents, and/or insulin (approximately 70%).

Conclusions: In an ambulatory framework too, diabetes causes a substantial financial burden on the individual in India. In the wake of resource constraints in Indian health settings, the public health system needs to be adequately strengthened by policymakers to address the growing number of diabetics and long-standing complications.

Relationship between height and hypertension among women in India: Evidence from the fourth round of National Family Health Survey

BACKGROUND AND AIMS

Hypertension (HTN) is associated with significant morbidity and mortality, especially among women. Literature suggests an association between height and hypertension. We did this study to ascertain an association between hypertension and height and explore their determinants among Indian women of reproductive age group (15-49 years).

METHODS

We did a secondary data analysis of the National Family Health Survey-4 (2015-16) and included 5,36,093 women between 20 and 49 years. Blood pressure and height were measured using the standard procedures. Weighted analysis was done to depict the association between the two variables.

RESULTS

Overall prevalence of HTN was 13.49%. We observed an inverse association between height and mean blood pressure of the women, and shorter women had a higher prevalence of HTN. The height of women was found to be associated with lower systolic blood pressure but not with diastolic blood pressure. Women's height depicted significant associations with age and other socio-economic and geographical parameters. Prevalence of HTN depicted a significant association with height and across other subgroups stratified by these parameters.

CONCLUSION

We observed a positive association between the systolic BP and the height of the female. Height is one of the most convenient forms of identifying target groups that should not be missed during screening women for NCDs, especially during pregnancy to prevent premature morbidity and mortality. We recommend disseminating this concept to our primary health care workers, who are also the point of first contact for early screening and halt the burden of disease.