Decomposing rural-urban differences in successful aging among older Indian adults

Prevalence of successful aging in older adults: A systematic review and meta-analysis

BACKGROUND

Successful aging (SA) describes the multidimensional aspects of achieving optimal physical and mental health and social well-being combinations in old age. Recent years have seen increasing interest in understanding SA prevalence. This study systematically evaluates the current state of SA globally, defined as multidimensional outcomes.

OBJECTIVE

To systematically evaluate the global prevalence of SA in older adults.

METHODS

We searched PubMed, Embase, Web of Science, Cochrane Library, China Biomedical Database, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and Weipu Database from inception to February 14, 2024. Two researchers independently conducted literature screening, data extraction, and quality evaluation. Meta-analysis was performed using Stata 16.0.

RESULTS

Thirty studies comprising 250,460 older adults were included. Meta-analysis showed the overall global prevalence of SA was 24.0 % [95 % CI (20.7 %, 27.3 %)]. Prevalence rates were 25.1 % in Asia, 21.5 % in Europe, 20.6 % in the Americas; 16.8 % in developed and 27.1 % in developing countries. Subgroup analyses indicated higher SA rates among male older adults, married/cohabiting, living in urban areas, and having higher education levels.

CONCLUSIONS

The global prevalence of SA among older adults is low, with variations across age groups, regions, and education levels. Due to the limitations of the included studies, further high-quality research is needed to validate these findings.

Changes in successful aging and its related indicators among community-dwelling older adults: The Korean Frailty and Aging Cohort Study (KFACS)

This study aims to determine the prevalence of successful aging (SA) and examine the association of changes in the indicators of SA and variations in SA status between 2016 and 2020. The study included 548 participants recruited for the Korean Frailty and Aging Cohort Study (KFACS). Compared to participants who achieved SA in 2016 (N = 393, 71.7%), the number of older adults with SA decreased by 7.8% in 2020. Among older adults preserving SA (SA→SA group, 54%), there were relatively small numbers of older adults who successfully maintained indicators, including chronic diseases (no→no, 9.5%), employment (yes→yes, 12.2%), and volunteer activities (yes→yes, 2.9%). Our findings suggest that interventions to strengthen the physical and psychological function of older adults are needed, and social support needs to be guaranteed to improve social engagement for older adults.

Unveiling the dynamics of social engagement and subjective health in older adults: A gendered perspective

OBJECTIVES

As populations age globally, understanding the dynamics that influence the well-being of older individuals become increasingly crucial. The research employs a comprehensive approach to unravel the multifaceted interplay between social engagements and subjective health perceptions of older Indians, with a special focus on gender differences.

SUBJECTS AND METHODS

This study used data from the Longitudinal Aging Study in India (LASI) wave 1, 2017-18 with a total sample of 30,533 older adults aged 60 years and above. Bivariate analysis, chi-square tests and unadjusted and adjusted average marginal effects from logistic regression models were used to assess the relationship between social engagements and subjective health among older adults, stratified by gender.

RESULTS

The prevalence of poor health status decreased with higher frequency of social networks among both men (pp. (percentage point) = 6.1; CI (Confidence Interval): 10.6, 1.6) and women (pp. = 9.2; CI: 14.9, 3.4). The adjusted average marginal effects demonstrate that with an increase in the overall score of social engagement, the likelihood of poor health is almost reduced by half. For men, the prevalence of poor health was 9.8 pp. (95 % CI: 13.7, 5.8), while for women, it was 9.3 pp. (95 % CI: 15.2, 3.1).

CONCLUSION

Gendered perspectives unveil unique patterns, highlighting how societal expectations and roles assigned to each gender may influence the subjective health perceptions of older individuals. This study adds to the expanding knowledge base to enhance the well-being and fulfillment of aging populations, considering the complex interplay of social dynamics and gendered perspectives.

Successful ageing is associated with falls among older adults in India: a large population based across-sectional study based on LASI

BACKGROUND

Falls are common in the elderly and can lead to adverse consequences, like injuries, hospitalization, disability even mortality. Successful ageing emerged in sight to assess physical, psychological and social status of older adults. This study is conducted to explore the association between them in a large Indian community-dwelling population.

METHODS

Data were based on the wave 1 survey of the Longitudinal Ageing Study in India (LASI). People aged 60 and above with complete information were included. The elderly met five standards including absence of chronic diseases, freedom from disability, high cognitive ability, free from depressive symptoms and active social engagement, were classified into successful agers. The assessment of falls, fall-related injuries and multiple falls depended on interview. Multivariate logistic regression was conducted to find the associations between falls, fall-injury, multiple falls and successful ageing after adjusting both socio-demographic and biological covariates. The log-likelihood ratio test was calculated interactions in subgroups.

RESULTS

31,345 participants in LASI were finally included in our study. Of them, 20.25% reported fall, and 25% were classified into successful agers. After full adjustment, successful ageing was negatively associated with falls (OR 0.70; 95%CI 0.65-0.76) and multiple falls (OR 0.70; 95%CI 0.63-0.78). And the association did not show the significance in older adults with fall-related injuries (OR 0.86; 95%CI 0.72-1.04).

CONCLUSIONS

Successful ageing was negatively associated with falls and multiple falls, but not fall-related injuries in older people in India. Future studies are demanded to explore the causal relationship and to reveal the underlying mechanism.

Geographical variation, demographic and socioeconomic disparities in Active Ageing: The situation in Thailand

Objectives

Being healthy and active is a goal to achieve a better quality of life as individuals age. This study aimed to explore and validate the Active Ageing (AA) model, and examine geographic variations, and demographic and socioeconomic disparities.

Study design

Utilising a cross-sectional secondary data analysis, the analytic unit is older adults aged 60-80 across all provinces in Thailand.

Methods

Exploratory Factor Analysis explored the AA structures, and the second-order Confirmatory Factor Analysis validated the model fit. Factor scores were used to identify geographic variation and sociodemographic disparities in AA. The association between geographic, and sociodemographic characteristics, and AA was examined through hierarchical regression analysis.

Results

The AA model, comprised of 14 indicators representing three latent factors-physical health, participation, and security-exhibited an optimal fit. Geographic inequality in AA emerged across the country, with specific areas linked to lower AA. An inverse relation between participation and security was observed. Rural residence, younger age, male, being married, and adequate income were associated with better AA. The association between AA and geographic, demographic, and socioeconomic emphasised the positive role of marital and economic status.

Conclusions

This study contributes to understanding the social determinants of health by constructing a comprehensive AA model. The findings highlight the geographic variations and demographic and socioeconomic disparities in AA across Thailand. While AA generally declines with age, a better economy may help alleviate these disparities. These findings underscore the need for tailored social and public health policies, avoiding a "one-size-fits-all" approach.

Association of food insecurity with successful aging among older Indians: study based on LASI

PURPOSE

Whether food insecurity (FI), a social determinant of health, is linked with successful aging (SA) in the older generation remains uncertain. This study explored the association of FI with SA among older Indians.

METHODS

Data were collected from the Longitudinal Ageing Study in India (LASI) wave 1 (2017-2018). Older adults (≥ 60 years) who completed both the FI and the SA surveys were selected. FI was indicated by the lack of access to enough food in the past year. SA was determined by five components: (1) low probability of diseases; (2) low probability of disability; (3) high cognitive functionality; (4) low probability of depression; and (5) active social engagement. The association of FI and SA was assessed using multivariable logistic regression adjusted for potential covariates. Subgroup analyses were performed to evaluate interactions with age, sex, alcohol use, smoking, and place of residence.

RESULTS

27,579 participants met the eligibility criteria. Overall prevalence was 7.13% for FI and 19.41% for SA. Following full adjustment, FI was inversely associated with SA (OR 0.56; 95% CI 0.49-0.65) and with each of SA's five components. No significant interactions of FI and SA were observed in subgroup analyses stratified by age, sex, alcohol use, smoking, or place of residence.

CONCLUSIONS

FI was inversely associated with SA among older Indians. These findings need to be validated by future studies which should also explore potential underlying mechanisms, and whether interventions decreasing FI might increase SA.

Depressive symptoms in the entire spectrum of cognitive ageing in Greece: evidence from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD)

OBJECTIVES

To study (i) the prevalence of mild and moderate-to-severe depressive symptoms in the entire spectrum of cognitive ageing in Greece and (ii) the relationship between these symptoms and demographic and clinical data.

METHODS

The study was based on the randomly selected cohort of the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD). Depressive symptoms were assessed with the 15-item version of the Geriatric Depression Scale. Participants also received a comprehensive neuropsychological assessment, while the clinical diagnoses of dementia and mild cognitive impairment were established according to international diagnostic criteria. Statistical analyses relied on comparison tests and a logistic (proportional odds) ordinal regression model.

RESULTS

Depressive symptoms were detected in 19.5% of the 1936 study participants, while 11.3% of both people with MCI and dementia had moderate-to-severe depressive symptoms. The regression model revealed that older adults with more severe depressive symptoms were more likely female, cognitively impaired, less educated, were treated with psychotropic medication and lived in Attica versus Thessaly.

CONCLUSIONS

Since depressive symptoms were detected in almost one in five older adults, healthcare professionals in Greece should safeguard the timely detection and effective treatment of such symptoms and the post-diagnostic care of older adults with depression.

Moderating role of functional/ mobility limitations in the association between sleep problems and hypertension among middle-aged and older adults in India

Hypertension has become a global health concern and is recognized as an important modifiable risk factor for cardiovascular diseases (CVDs). There are very limited studies in India and worldwide focused on sleep problems, activities of daily living (ADL), instrumental ADL (IADL) and mobility limitations, and their discrete and combined effects on hypertension. Therefore, this study examined whether sleep problems are associated with hypertension, and whether the association is more pronounced among middle-aged and older adults with functional/mobility limitations. This study used data from the Longitudinal Ageing Study in India (LASI) wave 1, 2017-18, with a total sample of 59,951 adults aged 45 years and above. Log-binomial regression, and interaction terms were used to assess the relationship between sleep problems and hypertension, and the moderating effect of functional/mobility limitations. Respondents with sleep problems had a 29 % higher prevalence of hypertension [PR (prevalence ratio): 1.29; CI (confidence interval): 1.20-1.39]. Those with ADL and IADL limitations had 20 % [PR: 1.20; CI: 1.09-1.32] and 9 % [PR: 1.09; CI: 1.00-1.18] greater prevalence of hypertension. Interaction analysis revealed that individuals with ADL, IADL, and mobility limitations had 58 %, 52 %, and 45 % higher prevalence of hypertension, respectively, and was especially pronounced among women. Our findings highlight that improved sleep can reduce the prevalence of hypertension in middle-aged and older adults. Individuals with functional/mobility limitations may need additional care and support from their family members or the community, which could lower the prevalence of elevated blood pressure due to their sleep problems.

Examining the rural-urban differentials in yoga and mindfulness practices among middle-aged and older adults in India: secondary analysis of a national representative survey

Physical activity and mental well-being play an important role in reducing the risk of various diseases and in promoting independence among older adults. Appropriate physical activity, including yoga and mindfulness practices, can help rectify the loss of independence due to aging and have a positive influence on physical health and functional activities. This study assessed rural-urban differences in yoga and mindfulness practices and their associated factors among middle-aged and older Indian adults. The total sample size considered for the current analysis was 72,250 middle-aged and older adults (aged ≥ 45 years). Bivariate and multivariable logistic regression analyses were used to estimate the prevalence of yoga and mindfulness practices and examine the associations of selected variables with yoga and mindfulness practices among the participants. Further, we used the Fairley decomposition technique to determine the factors contributing to rural-urban differences in the prevalence of yoga and mindfulness practices among middle-aged and older adults. More than 9% of middle-aged and older adults in rural areas and 14% in urban areas reported practicing yoga and mindfulness activities more than once per week. Adults aged ≥ 65 years were more likely to practice yoga and mindfulness activities than those who age 45-54 years were. Those with an education of ten years and above were 2.3 and 2.1 times higher likely to practice yoga in rural (AOR: 2.28; CI: 2.07-2.52) and urban (AOR: 2.13; CI: 1.91-2.37) areas compared to their uneducated peers, respectively. The largest contributors in diminishing the gap in yoga practice among participants were education (44.2%), caste (2.5%), chronic diseases such as hypertension (4.53%), diabetes (1.71%), high cholesterol (3.08%), self-reported pain (5.76%), and difficulties in instrumental activities of daily living (1.22%). The findings suggest that middle-aged and older adults in urban areas practice yoga and mindfulness activities more than their peers in rural areas do. Education level, household characteristics, and health outcomes such as chronic conditions, pain, and functional difficulties explain the observed differences in yoga and mindfulness practices across rural and urban areas. Age-appropriate healthy practices such as yoga and mindfulness should be encouraged to enhance the physical and mental well-being of middle-aged and older adults, especially in rural areas.

Active and productive ageing in India: evidence from the time use pattern of ageing adults

BACKGROUND

With the increasing proportion of older adults in India, it becomes essential to get an insight into the various influencing factors of successful ageing. However, the literature on successful ageing is minuscule in the Indian context. The present study attempted to understand successful ageing in terms of active and productive ageing by exploring their determining factors.

METHODS

The data were extracted from the Longitudinal Ageing Study in India (LASI) Wave-1 (2017-2018). We utilized self-reported time use information from the experimental module of the LASI. A total of 7837 ageing adults were included in the study. We employed descriptive statistics, bivariate analysis and a multinominal logistic regression model to examine the prevalence and the determinants of active and productive ageing.

RESULTS

The prevalence of inactive ageing was higher among the Indian ageing population (57.47%), followed by active ageing (29.59%) and productive ageing (12.94%). Poor sleep quality and the prevalence of morbidity and disability limited the ageing population from attaining active and productive ageing. Engagement in physical activity was significantly associated with active and productive ageing (β = 0.83, 99% CI: -0.72-0.94 and β = 0.82, 99% CI: 0.66-0.98), respectively. Rural ageing adults were more likely to attain active ageing and less likely to attain productive ageing.

CONCLUSION

Engagement in physical activities among the ageing population shall be promoted to attain active and productive ageing. Since the rural ageing population were less likely to attain productive ageing than their urban counterparts, opportunities to participate in more formal economic activities in rural areas could be promoted for the wellbeing of the second demographic dividend.

Physiologically based pharmacokinetic (PBPK) modelling of oral drug absorption in older adults - an AGePOP review

The older population consisting of persons aged 65 years or older is the fastest-growing population group and also the major consumer of pharmaceutical products. Due to the heterogenous ageing process, this age group shows high interindividual variability in the dose-exposure-response relationship and, thus, a prediction of drug safety and efficacy is challenging. Although physiologically based pharmacokinetic (PBPK) modelling is a well-established tool to inform and confirm drug dosing strategies during drug development for special population groups, age-related changes in absorption are poorly accounted for in current PBPK models. The purpose of this review is to summarise the current state-of-knowledge in terms of physiological changes with increasing age that can influence the oral absorption of dosage forms. The capacity of common PBPK platforms to incorporate these changes and describe the older population is also discussed, as well as the implications of extrinsic factors such as drug-drug interactions associated with polypharmacy on the model development process. The future potential of this field will rely on addressing the gaps identified in this article, which can subsequently supplement in-vitro and in-vivo data for more robust decision-making on the adequacy of the formulation for use in older adults and inform pharmacotherapy.

US Adults Practicing Healthy Lifestyles Before and During COVID-19: Comparative Analysis of National Surveys

BACKGROUND

Practicing healthy lifestyles can reduce the risk to develop noncommunicable diseases and the related mortality. Studies showed that practicing healthy lifestyles could enhance disease-free life expectancy and preserve bodily functions. However, engagement in healthy lifestyle behavior was suboptimal.

OBJECTIVE

This study aimed to define individuals' lifestyle characteristics before and during COVID-19 and determine the factors associated with practicing a healthy lifestyle. This cross-sectional study was conducted using data from the 2019 and 2021 Behavioral Risk Factor Surveillance System surveys.

METHODS

US individuals aged ≥18 years were interviewed via phone call. Healthy lifestyles were assessed through corresponding questions regarding the maintenance of optimal body weight, physical activity, daily consumption of at least five portions of fruits and vegetables, current smoking status, and alcohol consumption. Missing data were imputed using a package in the R statistical software. The effects of practicing a healthy lifestyle on cases without missing data and those with imputation were reported.

RESULTS

There were 550,607 respondents (272,543 and 278,064 from 2019 and 2021, respectively) included in this analysis. The rates of practicing a healthy lifestyle were 4% (10,955/272,543) and 3.6% (10,139/278,064) in 2019 and 2021, respectively. Although 36.6% (160,629/438,693) of all 2021 respondents had missing data, the results of the logistic regression analysis for cases without missing data and those with imputation were similar. Of the cases with imputation, women (odds ratio [OR] 1.87) residing in urban areas (OR 1.24) with high education levels (OR 1.73) and good or better health status (OR 1.59) were more likely to practice healthier lifestyles than young individuals (OR 0.51-0.67) with a low household income (OR 0.74-0.78) and chronic health conditions (OR 0.48-0.74).

CONCLUSIONS

A healthy lifestyle should be strongly promoted at the community level. In particular, factors associated with a low rate of practice of healthy lifestyles should be targeted.

Development of Self-Active Aging Index (S-AAI) among rural elderly in lower northern Thailand classified by age and gender

This study aimed to develop a Self-Active Aging Index (S-AAI) for the rural community of Thailand using the World Health Organization (WHO) framework, and score it according to age and gender. Overall, 1,098 elderly people were randomly selected. The self-reported questionnaires were categorized into three segments: health, participation, and security according to the WHO framework. An exploratory factor analysis was used to determine appropriate components. The S-AAI comprised 28 indicators and 9 factors: (1) mental/subjective health; (2) physical health; (3) health behavior and chronic disease; (4) vision and hearing; (5) oral health; (6) social participation; (7) stability in life; (8) financial stability; and (9) secure living. The overall S-AAI for all components was 0.65, with the index inversely proportional to age, but with no gender differences. The S-AAI is potentially Thailand's first multi-dimensional interactive aging assessment tool with a unique cultural context for rural areas. Although this tool is valid, it requires reliability testing.

Associations of Pain and Sarcopenia with Successful Aging among Older People in China: Evidence from CHARLS

OBJECTIVES

Sarcopenia and chronic pain are geriatric syndromes that negatively impact the lives of older people. The aim of this study was to explore the relationship among sarcopenia, pain, and successful aging among older persons participating in the China Health and Retirement Longitudinal Study (CHARLS).

DESIGN

Cohort study with a 2-year follow-up.

SETTING AND PARTICIPANTS

Data were derived from 2 waves of the CHARLS, and 4280 community-dwelling participants aged ≥ 60 years were included in the study.

METHODS

Sarcopenia status was defined according to the Asian Working Group for Sarcopenia 2019 (AWGS 2019) criteria. Successful aging was defined following Rowe and Kahn's multidimensional model. Pain was assessed by a self-reported questionnaire. A generalized estimating equation (GEE) was used to examine the associations.

RESULTS

Longitudinal results demonstrated that compared with no sarcopenia, possible sarcopenia [OR (95%CI): 0.600 (0.304~1.188)] was not significantly associated with successful aging. Pain only was strongly associated with successful aging [0.388 (0.251~0.600)], whereas the association between sarcopenia only and successful aging was weaker [0.509 (0.287~0.905)]. The likelihood of being successful aging was substantially lower in the presence of coexisting sarcopenia and pain [0.268 (0.108~0.759)].

CONCLUSIONS

Both pain and sarcopenia are significant predictors for achieving successful aging among community-dwelling older adults. Early identification of sarcopenia and pain permits the implementation of treatment strategies and presents an opportunity to mitigate the risk of being unsuccessful aging.

Rural urban differences in self-rated health among older adults: examining the role of marital status and living arrangements

BACKGROUND

The rural-urban gap in socioeconomic and morbidity status among older adults is prevalent in India. These disparities may impact the levels and factors of self-rated health (SRH). The objective of the study is to compare the levels and determinants of SRH between rural and urban areas by considering the moderating effects of marital status and living arrangements.

SUBJECTS AND METHODS

The present study used data from the Longitudinal Ageing Study in India (LASI) wave 1 (2017-18). A total sample of 30,633 older adults aged 60 years and above were selected for the study. Descriptive statistics, bivariate chi-square test, the interaction effect of living arrangements and marital status, and logistic estimation were applied to accomplish the study objectives.

RESULTS

The prevalence of poor SRH was found 7% higher in rural areas compared to urban counterparts. A substantial rural-urban disparity in the patterns of poor SRH was also observed. The interaction effect of marital status and living arrangement on self-rated health suggested that older adults who were currently unmarried and living alone were 38% more likely to report poor SRH than those who were currently married and co-residing in rural India. In addition to marital status and living situation, other factors that significantly influenced SRH include age, socio-cultural background (educational attainment and religion), economic background (employment status), health status (ADLs, IADLs, multi-morbidities), and geographic background (region).

CONCLUSION

The present study's findings demonstrated that, notwithstanding local variations, marital status and living circumstances significantly influenced SRH in India. In the present study, unmarried older people living alone were more susceptible to poor SRH in rural areas. The present study supports the importance of reinforcing the concepts of care and support for older individuals. There is a need for special policy attention to older individuals, particularly those unmarried and living alone. Although older individuals had difficulty performing ADLs and IADLs and had multi-morbidities, they reported poorer health. Therefore, offering them social support and top-notch medical assistance is crucial.

Prevalence of Anemia Among Elderly Population Residing in an Urban Area of West Bengal: A Community-Based Cross-Sectional Analytical Study

Context

India is experiencing a rapid increase in the elderly population (aged 60 years and above) compared to the last decade. The multifactorial condition of anemia grossly influences the health-related quality of life and mortality in this age group. We aimed to estimate the prevalence of anemia and its associated factors among older adults residing in an urban area of West Bengal, India.

Materials and Methods

The community-based cross-sectional analytical study was conducted in Kalyani Municipality, West Bengal, from March to April 2021. A simple random sampling technique was adopted to select study participants. Hemoglobin (Hb) was measured using a digital hemoglobinometer (HemoCue301), and data were collected using EpiCollect5 software.

Results

The mean (SD) age of 457 participants was 68.9 (7.3) years with 52.1% (n = 238) being males, 71.9% (n = 329) graduates, and 64.3% (n = 294) currently married. The prevalence of anemia was 65% (95% CI: 60.4-69.3). The prevalence of mild (Hb 11-11.9 gm/dL in females and 11-12.9 gm/dL in males), moderate (Hb 8-10.9 gm/dL), and severe anemia (Hb <8 gm/dL) was 41.6%, 22.8% and 0.7%, respectively. Anemia was significantly associated with age group (P < 0.01) and sex (P < 0.01), with the highest prevalence in the 80 years and above age category (85.2%) and in females (71.2%).

Conclusion

The prevalence of anemia is very high in older adults. There is an urgent need to include the elderly age group in the existing health programme for anemia, i.e., Anemia Mukt Bharat.

How socioeconomic status, social capital and functional independence are associated with subjective wellbeing among older Indian adults? A structural equation modeling analysis

Background

Subjective well-being (SWB) is of particular interest among gerontologists and health researchers with important implications for interventions especially in poor-resource settings. This study aimed to explore the possible pathways from socioeconomic status (SES), functional independence and social capital towards SWB among older adults in India.

Methods

Cross-sectional data from the “Building a Knowledge Base on Population Aging in India” (BKPAI) survey with a total sample of 9231 older adults aged 60 years and above were used. The outcome variable was low SWB (LSWB). The study used univariate and bivariate analysis for reporting the initial results. Further, the study employed the structural equation modeling (SEM) technique using maximum likelihood estimation (MLE) procedure to estimate the covariance matrix.

Results

Overall, about 27% of older adults reported LSWB. Reporting LSWB was more prevalent among older adults who had no income (30.8%) and those who had income but not sufficient to fulfil their basic needs (39.4%, p < 0.001). The prevalence of reporting LSWB was significantly higher among older adults who had no asset ownership (36.5%, p < 0.001) than those who had asset ownership. The path from the SEM shows that LSWB and SES are negatively related to each other. Moreover, LSWB had significant negative relationship with independence (β = -0.032, p < 0.001) and social capital (β = -0.020; p < 0.001). In addition, results found a positive relationship between SES and independence (β = 0.019; p < 0.001), SES and social capital (β = 0.016; p < 0.001), and independence and social capital (β = 0.033; p < 0.001).

Conclusions

The findings highlight that higher SES, good physical functioning as well as favorable social capital are interdependent factors of late-life wellbeing and a multidimensional approach in policymaking can ensure a successful and active ageing among older Indian adults.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14215-4.

Systematic identification and characterization of clinical and socio-economical correlates of granulomatous nasal and para-nasal sinuses: A large-scale study among patients of Odisha, India

Granulomatous formation in the nose and paranasal sinuses still presents an unmet clinical challenge as it affects both the physical health and personality of patients, and the lack of a systematic diagnostic and disease management approach has further complicated the scenario. Occurrence of granulomatous nasal disorder in the rural Indian population is associated with several factors such as lack of proper medical care, lack of hygienic and clean working and living conditions, and limited financial abilities to access the already overburdened primary healthcare system. This study aims to understand the correlation disease incidence, manifestation of signs and symptoms and associated socio-epidemiological parameters for 104,000 patients over a period of 23 months in Odisha. Primarily the study used socio-epidemiological surveys collected, annotated, and curated independently for granulomatous nasal disorder patients and compared this with their clinical records for signs & symptoms and performed several statistical analyses to better understand the disease incidence correlation with age, socio-economic and gender based parameters. Overall results suggest that males from low socio-economic background living in rural areas are the most vulnerable population and commonly affected with granulomatous nasal disorder (commonly Rhinosporidiosis sub-type) with common origin of the disease reported at the nasal septum and floor. We also highlight that change in the mass of nose followed by bleeds on touch, nasal discharge and hanging mass in throat are the most common manifestations presented by patients with granulomatous nasal disorders. Together, this research work identifies and characterise clinical and socio-economic factors that lead to and exacerbate the incidence of granulomatous nasal disorders.