Decomposing urban-rural differences in multimorbidity among older adults in India: a study based on LASI data

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.

Spatial clustering of overweight/obesity among women in India: Insights from the latest National Family Health Survey

BACKGROUND

Overweight/obesity has become global health concern with increasing prevalence. This study examined district-level disparities and spatial clustering of overweight/obesity among women of reproductive age (WRA) in India using the latest National Family Health Survey-5 (2019-2021) data.

METHOD

Information of 623,656 women aged 15 to 49 from the NFHS-5 (2019-2021) were analysed in this study. The outcome variable was BMI as classified by the world health organisation (WHO). Utilising Global Moran's I, Anselin's Local Moran's I, and spatial regression models spatial clustering and associated factors were analysed.

RESULT

The study found that 24% (95% CI: 23.8-24.3) of WRA in India were overweight/obese in 2019-21. The prevalence was greatest in Punjab (41%) and lowest in Meghalaya (11%). Additionally, the Global Moran's I value for the outcome variable was 0.73, indicating a positive spatial autocorrelation in the overweight/obesity. Districts of Tamil Nadu, Andhra Pradesh, Karnataka, Kerala, Telangana, Punjab, Himachal Pradesh, Jammu & Kashmir, Haryana, and Delhi were hotspots of overweight/obesity. Several factors of overweight/obesity among WRA were identified, including place of residence (β: 0.034, p: 0.011), parity (β: 0.322, p: 0.002), social group (β: -0.031, p: 0.016), religion (β: -0.044, p: <0.001), household wealth status (β: 0.184, p: <0.001), mass-media exposure (β: 0.056, p: 0.031), and diabetes (β: 0.680, p: <0.001).

CONCLUSION

The study emphasizes the importance of targeted interventions and region-specific strategies, while also stressing the need to address associated factors to develop effective public health initiatives aimed at reducing overweight/obesity prevalence among WRA in India.

Multimorbidity, health Literacy, and quality of life among older adults in an urban slum in India: a community-based cross-sectional study

BACKGROUND

India is experiencing a rising burden of chronic disease multimorbidity due to an aging population and epidemiological transition. Older adults residing in urban slums are especially vulnerable due to challenges in managing multimorbidity amid deprived living conditions. This study aimed to assess the prevalence of multimorbidity, associated health literacy, and quality of life impact in this population.

METHODS

A community-based cross-sectional study was conducted among 800 adults aged ≥ 65 years in an urban slum in Gujarat, India. Data on sociodemographics, physical and mental health conditions, health literacy (HLS-SF-47), quality of life (Short Form-12 scale), and social determinants of health were collected. Multimorbidity is ≥ 2 physical or mental health conditions in one person.

RESULTS

The prevalence of multimorbidity was 62.5% (500/800). Multimorbidity was significantly associated with lower physical component summary (PCS) and mental component summary (MCS) scores on the SF-12 (p < 0.001). After adjusting for sociodemographic variables, the odds ratio of 0.81 indicates that for every 1 unit increase in the health literacy score, the odds of having multimorbidity decrease by 19%. Older age within the older adult cohort (per year increase) was associated with greater odds of multimorbidity (AOR 1.05, 95% CI 1.02-1.09). Physical inactivity (AOR 1.68, 95% CI 1.027-2.77) and lack of social support (AOR 1.57, 95% CI 1.01-2.45) also increased the likelihood of multimorbidity.

CONCLUSION

There is a substantial burden of multimorbidity among urban slum dwellers aged ≥ 65 years in India, strongly linked to modifiable risk factors like poor health literacy and social determinants of health. Targeted interventions are essential to alleviate this disproportionate burden among urban slum older adults.

Prevalence of Multimorbidity and Cardiovascular Risk Factors in a Romanian Occupational Medicine Private Facility

BACKGROUND

The past decades have witnessed an increasing interest in the field of multimorbidity, as common risk factors such as obesity, arterial hypertension or diabetes have surged worldwide, thus posing a burden on public health systems all over the world. Defined as the presence of two or more conditions in the same individual, multimorbidity and its prevalence have shown large heterogeneity among countries and age groups. This cross-sectional study aimed to assess the presence of cardiovascular risk factors and multimorbidity in a cohort of 4200 patients of a Romanian private occupational medicine facility in order to provide a better outlook on this domain, adapted to patients in the active population group.

METHODS

The cohort selected by us for the present study comprised all 4200 patients who visited our facility over the course of three months. Upon clinical examination of all patients, data were collected via on-paper registration and included into each individual's medical file, afterwards being digitally registered. Finally, the prevalence of each risk factor and multimorbidity was analyzed using Microsoft Excel 2019 version data analysis software.

RESULTS

Among all members of the cohort, 815 individuals (19.4%) had arterial hypertension, 614 patients (14.61%) were registered with obesity, 110 people (2.61%) had diabetes, and finally, 754 subjects (17.95%) had multimorbidity. Analysis of multimorbidity patterns showed a higher prevalence of multimorbidity among women (56.89%) and urban residents (68.03%).

CONCLUSION

The present study found a lower prevalence of multimorbidity and cardiovascular risk factors than other similar data in the literature. While this can be explained by multiple factors, such as the general addressability of private occupational medicine services, we also raise awareness about the fact that further populational studies regarding this topic need to address larger and more heterogeneous cohorts in order to provide data of utmost accuracy.

Comparative analysis of health status and health service utilization patterns among rural and urban elderly populations in Hungary: a study on the challenges of unhealthy aging

The demographic transition poses a significant challenge for health systems, especially in Central and Eastern European (CEE) countries, where the healthcare needs of aging populations are on the rise. This study aimed to describe and compare the health status and utilization of health services among the elderly residing in urban and rural areas of the most deprived region in Hungary. A comprehensive health survey was conducted in 2022, involving a randomly selected sample of 443 older adults (≥ 65 years) in Northeast Hungary. Multivariable logistic regression models adjusting for age, sex, education, financial status, chronic diseases, and activity limitations were used to investigate the association between type of residence and health service use. Among the study participants, 62.3% were female, 38.3% attained primary education, 12.5% reported a bad or very bad financial situation and 52.6% lived in urban areas. Overall, 24% of the elderly rated their health as very good or good (27.8% in urban and 19.7% in rural areas), while 57.8% (52.6% and 63.5% in urban and rural areas) reported limitations in daily activities. Compared to urban residents, rural residents reported lower rates of dentist visits (p = 0.006), specialist visits (p = 0.028), faecal occult blood testing (p < 0.001), colorectal cancer screening with colonoscopy (p = 0.014), and breast cancer screening (p = 0.035), and a higher rate of blood pressure measurement (p = 0.042). Multivariable models indicated that urban residence was positively associated with faecal occult blood testing (OR = 2.32, p = 0.014), but negatively associated with blood pressure (OR = 0.42, p = 0.017) and blood glucose measurements (OR = 0.48, p = 0.009). These findings highlight the influence of residence on health service utilization among older adults in Hungary. Further comprehensive studies are needed to better understand the health needs of the elderly population and to develop policies aimed at promoting healthy aging in CEE countries.

Characterizing Multimorbidity Prevalence and Adverse Outcomes in Ethnically and Culturally Diverse Sub-Populations in India: Gaps, Opportunities, and Future Directions

India is a large middle-income country and has surpassed China in overall population, comprising 20% of the global population (over 1.43 billion people). India is experiencing a major demographic shift in its aging population. Chronic diseases are common among older adults and can be persistent over the life course, lead to the onset of disability, and be costly. Among older adults in India, the existence of multiple comorbid chronic conditions (i.e., multimorbidity) is rapidly growing and represents a burgeoning public health burden. Prior research identified greater rates of multimorbidity (e.g., overweight/obesity diabetes, hypertension, cardiovascular disease, stroke, and malignancies) in minority populations in the United States (U.S.); however, limited studies have attempted to characterize multimorbidity among older adult sub-populations residing in India. To address this gap, we conducted a narrative review of studies on multimorbidity using the data from the Longitudinal Aging Study of India (LASI), the largest nationally representative longitudinal survey study of adults in India. Our definition of multimorbidity was the presence of more than two conditions in the same person. Our findings, based on 15 reviewed studies, aim to (1) characterize the definition and measurement of multimorbidity and to ascertain its prevalence in ethnically and culturally diverse sub-populations in India; (2) identify adverse outcomes associated with multimorbidity in the Indian adult population; and (3) identify gaps, opportunities, and future directions.

Decomposing the rural-urban differences in depression among multimorbid older patients in India: evidence from a cross-sectional study

BACKGROUND

In India, the prevalence of depression among older adults dealing with multiple health conditions varies between rural and urban areas due to disparities in healthcare access and cultural factors. The distinct patterns observed underscore the necessity for tailored research and interventions to address mental health inequalities among multimorbid older patients in diverse geographic contexts.

METHODS

This study used data from the Longitudinal Ageing Study in India (LASI) wave 1 (2017-18). A total of 7,608 adults aged ≥ 60 years who were diagnosed with two or more chronic conditions (such as hypertension, diabetes, cancer, chronic lung disease, chronic heart diseases, stroke, bone/joint disease, any neurological or psychiatric diseases, and high cholesterol) were included in this study. Descriptive statistics, bivariate analysis, logistic regression estimates, and Fairlie decomposition method were used to accomplish the study's objectives.

RESULTS

The prevalence of depression among older adults with multimorbidity was 9.48% higher in rural areas (38.33%) than in urban areas (28.85%).. Older adults with multimorbidity belonging to the scheduled caste group were 40% more likely to experience depression. Moreover, those with multimorbidity and any form of disability in activities of daily living (ADL) were 93% more likely to experience depression than those without disability, whereas those with multimorbidity and perceived good general health were 65% less likely to suffer from depression than those with poor self-perceived health. Additionally, decomposition analysis revealed that education (35.99%), caste status (10.30%), IADL disability (19.30%), and perceived discrimination (24.25%) were the primary factors contributing to the differences in depression prevalence among older adults with multimorbidity between rural and urban areas.

CONCLUSIONS

We found significant rural-urban differences in depression among older Indians with multimorbidity. The findings underscore the need for targeted interventions that address the unique challenges faced by older patients in rural areas, including lack of social capital, discrimination, and limited resources that enable access to healthcare services. Policymakers and healthcare professionals must collaboratively design and implement effective strategies to improve the mental health and overall well-being of rural older adults, particularly those with multiple comorbidities.

Rural-urban health differences among aging adults in India

Background

The aim of this study was to determine the rural-urban health differences among aging adults in India.

Methods

The national cross-sectional data of 67,489 individuals (≥45 years) in 2017-2018 from 35 states and union territories of India (excluding Sikkim) in 2017-2018 were analysed. Various sociodemographic data, well-being indicators, lifestyle factors and physical conditions were assessed by face-to-face interviews and physical measurement. Univariable and multivariable logistic regression was utilized to assess the predictors between residence status (rural dweller, urban migrant, and urban dweller) and various health indicator outcomes.

Results

Majority (70.4 %) of the participants lived in rural areas, 10.3 % were urban migrants and 19.3 % urban dwellers. In the multivariable logistic regression analysis, urban migrants and urban dwellers had a higher self-rated health status, cognitive functioning, physical inactivity, overweight or obesity and abdominal obesity than rural dwellers, while urban migrants and/or urban dwellers had lower functional disability, insomnia symptoms, current smokeless tobacco use, current smoking, heavy episodic drinking and underweight than rural dwellers. Furthermore, urban migrants and/or urban dwellers had higher odds of diabetes, hypertension, heart disease, cancer, high cholesterol than rural dwellers, while urban migrants and/or urban dwellers had lower odds of persistent headaches, major injury, recurrent fall, physical pain, periodontal disease, vision impairment, and gastrointestinal problems than rural dwellers.

Conclusion

Among 30 health indicators assessed, 16 had an urban migrant and/or urban dweller advantage, 8 had urban migrant and/or urban dweller penalty, and 6 did not differ between rural-urban groups. Public health promotion and health care should address differing health care needs of rural and urban middle-aged and older adults.

Prevalence and risk factor of diabetes among the elderly people in West Bengal: evidence-based LASI 1st wave

BACKGROUND

The complication of Diabetes is one of the important health issues among the older adult population in any region. The higher risks of diabetes prevalence among older adult people in the countries was due to social-cultural changes such as increasing urbanization, dietary changes, without physical activity, and unhealthy lifestyle behavior. The present study examines the prevalence and associated risk factors of diabetes among older adults in the state of West Bengal.

METHODS

The first wave of the Longitudinal Ageing Study in India 2017-18 was used to achieve the study objectives. Descriptive statistics with multinomial logistic regression models were used to carry out crude and adjusted odds ratios with 95% confidence intervals and examine the associated risk factors of diabetes prevalence among older adults.

RESULTS

The findings of the study indicate that the overall prevalence of diabetes among the study participants was found to be 12.4% which was significantly higher in urban areas (19%) compare to rural areas (6%). The socio-economic and bio-demographic factors like educational status, richest background family, marital status, obesity, and family history of diabetes were significantly associated with higher risks of diabetes prevalence among the older adult population in West Bengal. The risks of diabetes in the richest adult people were significantly higher than in the poorest adult people (OR = 2.78; 95% CI: 1.974-3.917). The higher risks of diabetes mellitus among the richest wealthy people are because of lifestyle behavior, smoking, and tobacco consumption respectively.

CONCLUSION

The study needs to policy and awareness program to reduce economic inequality and prevention of diabetes care and treatment-seeking behavior, especially for the older adult population in West Bengal.

The burden of disease-specific multimorbidity among older adults in India and its states: evidence from LASI

BACKGROUND

Around the world, advances in public health and changes in clinical interventions have resulted in increased life expectancy. Multimorbidity is becoming more of an issue, particularly in countries where the population is rapidly ageing. We aimed to determine the prevalence of multimorbidity and disease-specific multimorbidity and examine its association with demographic and socioeconomic characteristics among older adults in India and its states.

METHODS

The individual data from the longitudinal ageing study in India (LASI) were used for this study, with 11 common chronic conditions among older adults aged 60 and above years (N = 31,464). Descriptive statistics were used to report the overall prevalence of multimorbidity and disease-specific burden of multimorbidity. Multinomial logistic regression has been used to explore the factors associated with multimorbidity.

RESULTS

Prevalence of single morbidity was 30.3%, and multimorbidity was 32.1% among older people in India. Multimorbidity was higher among females and in urban areas and increased with age and among those living alone. Hypertension, arthritis and thyroid were highly prevalent among females and chronic lung diseases and stroke were highly prevalent among males. The older people in the state of Kerala had a high prevalence of multimorbidity (59.2%). Multimorbidity was found to be more likely in older age groups of 75-79 years (RR-1.69; CI: 1.53-1.87) and 80 years and above (RR-1.40; CI: 1.27-1.56) and in the Western (RR-2.16; CI: 1.90-2.44) and Southern regions (RR-2.89; CI: 2.57-3.24). Those who were living with a spouse (RR-1.60; CI: 1.15-2.23) were more likely to have multimorbidity. Disease-specific multimorbidity was high in chronic heart disease (91%) and low in angina (64.8%).

CONCLUSIONS

The findings suggest that multimorbidity has a positive relationship with advancing age, and disease-specific burden of multimorbidity is higher among chronic heart patients. Comorbidity, especially among those who already have chronic heart disease, stroke, cholesterol or thyroid disorder can have severe consequences on physical functioning, therefore, disease-specific health management needs to be enhanced.