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Joseph L, Krishnan A, Lekha TR, Sasidharan N, Thulaseedharan JV, Valamparampil MJ, Harikrishnan S, Greenfield S, Gill P, Davies J, Manaseki-Holland S, Jeemon P. Experiences and challenges of people living with multiple long-term conditions in managing their care in primary care settings in Kerala, India: A qualitative study. PLoS One 2024; 19:e0305430. [PMID: 38870110 PMCID: PMC11175503 DOI: 10.1371/journal.pone.0305430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/29/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Multimorbidity or multiple long-term conditions (MLTCs), the coexistence of two or more chronic conditions within an individual, presents a growing concern for healthcare systems and individuals' well-being. However, we know little about the experiences of those living with MLTCs in low- and middle-income countries (LMICs) such as India. We explore how people living with MLTCs describe their illness, their engagements with healthcare services, and challenges they face within primary care settings in Kerala, India. METHODS We designed a qualitative descriptive study and conducted in-depth, semi-structured interviews with 31 people (16 males and 15 females) from family health centres (FHCs) in Kerala. Interview data were recorded, transcribed, and thematic analysis using the Framework Method was undertaken. FINDINGS Two main themes and three sub-themes each were identified; (1) Illness impacts on life (a)physical issues (b) psychological difficulties (c) challenges of self-management and (2) Care-coordination maze (a)fragmentation and poor continuity of care (b) medication management; an uphill battle and (c) primary care falling short. All participants reported physical and psychological challenges associated with their MLTCs. Younger participants reported difficulties in their professional lives, while older participants found household activities challenging. Emotional struggles encompassed feelings of hopelessness and fear rooted in concerns about chronic illness and physical limitations. Older participants, adhering to Kerala's familial support norms, often found themselves emotionally distressed by the notion of burdening their children. Challenges in self-management, such as dietary restrictions, medication adherence, and physical activity engagement, were common. The study highlighted difficulties in coordinating care, primarily related to traveling to multiple healthcare facilities, and patients' perceptions of FHCs as fit for diabetes and hypertension management rather than their multiple conditions. Additionally, participants struggled to manage the task of remembering and consistently taking multiple medications, which was compounded by confusion and memory-related issues. CONCLUSION This study offers an in-depth view of the experiences of individuals living with MLTCs from Kerala, India. It emphasizes the need for tailored and patient-centred approaches that enhance continuity and coordination of care to manage complex MLTCs in India and similar LMICs.
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Affiliation(s)
- Linju Joseph
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Athira Krishnan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | - Neethu Sasidharan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | | | | | - Sheila Greenfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Paramjit Gill
- Academic Unit of Primary Care (AUPC) Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Justine Davies
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Semira Manaseki-Holland
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Panniyammakal Jeemon
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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Mulchandani R, Lyngdoh T, Gandotra S, Isser HS, Dhamija RK, Kakkar AK. Field based research in the era of the pandemic in resource limited settings: challenges and lessons for the future. Front Public Health 2024; 12:1309089. [PMID: 38487184 PMCID: PMC10938915 DOI: 10.3389/fpubh.2024.1309089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/30/2024] [Indexed: 03/17/2024] Open
Abstract
The coronavirus pandemic that began in December 2019, has had an unprecedented impact on the global economy, health systems and infrastructure, in addition to being responsible for significant mortality and morbidity worldwide. The "new normal" has brought along, unforeseen challenges for the scientific community, owing to obstructions in conducting field-based research in lieu of minimizing exposure through in-person contact. This has had greater ramifications for the LMICs, adding to the already existing concerns. As a response to COVID-19 related movement restrictions, public health researchers across countries had to switch to remote data collections methods. However, impediments like lack of awareness and skepticism among participants, dependence on paper-based prescriptions, dearth of digitized patient records, gaps in connectivity, reliance on smart phones, concerns with participant privacy at home and greater loss to follow-up act as hurdles to carrying out a research study virtually, especially in resource-limited settings. Promoting health literacy through science communication, ensuring digitization of health records in hospitals, and employing measures to encourage research participation among the general public are some steps to tackle barriers to remote research in the long term. COVID-19 may not be a health emergency anymore, but we are not immune to future pandemics. A more holistic approach to research by turning obstacles into opportunities will not just ensure a more comprehensive public health response in the coming time, but also bolster the existing infrastructure for a stronger healthcare system for countries.
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Affiliation(s)
- Rubina Mulchandani
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Tanica Lyngdoh
- Division of Reproductive, Child Health and Nutrition, Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Sheetal Gandotra
- Institute of Genomics and Integrative Biology, Council of Scientific and Industrial Research (CSIR), New Delhi, India
| | - H. S. Isser
- Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Rajinder K. Dhamija
- Department of Neurology, Institute of Human Behaviour and Allied Sciences, University of Delhi, New Delhi, India
| | - Ashish Kumar Kakkar
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Miao C, Fang X, Sun H, Yin Y, Li B, Shen W, Chen J, Huang X. The relationship between individual-level socioeconomic status and preference for medical service in primary health institutions: a cross-sectional study in Jiangsu, China. Front Public Health 2024; 11:1302523. [PMID: 38274517 PMCID: PMC10809986 DOI: 10.3389/fpubh.2023.1302523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024] Open
Abstract
Background While China's primary health care (PHC) system covers all citizens, the use of medical services supplied by primary health institutions (PHIs) is not at ideal levels. This study explored the impact of socioeconomic status (SES) on residents' first choice of medical services provided by PHIs. Methods This community-based, cross-sectional study was conducted in Jiangsu Province, China, from October 2021 to March 2022. A custom-designed questionnaire was used to evaluate 4,257 adults, of whom 1,417 chose to visit a doctor when they were sick. Logistic regression was used to test the relationships among SES, other variables and the choice of medical services, and interaction effects were explored. Results A total of 1,417 subjects were included in this study (48.7% female; mean age 44.41 ± 17.1 years). The results showed that older age (p < 0.01), rural residence (p < 0.01), a preference for part-time medical experts in PHIs (p < 0.01), and lack of coverage by basic medical insurance (p < 0.05) were associated with the first choice to use PHIs. In the multiple logistic regression model, SES was not associated with the first choice of medical services supplied by PHIs (p > 0.05), but it interacted with three variables from the Commission on Social Determinants of Health Framework (material circumstances, behaviors and biological factors, and psychosocial factors). Conclusion Vulnerable individuals who are the target visitors to PHIs are older, live in rural areas, and suffer from chronic diseases. SES, as a single factor, did not impact whether medical services at PHIs were preferred, but it mediated relationships with other factors.
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Affiliation(s)
- Chunxia Miao
- School of Management, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xin Fang
- School of Management, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Hong Sun
- School of Economics and Management, Nanjing Forestry University, Nanjing, Jiangsu, China
| | - Yani Yin
- Personnel Department, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Bo Li
- School of Management, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Wenxing Shen
- School of Economics and Management, Nanjing Forestry University, Nanjing, Jiangsu, China
| | - Jie Chen
- Nursing Department, Children's Hospital of Fudan University, Shanghai, China
| | - Xiaojing Huang
- School of Management, Xuzhou Medical University, Xuzhou, Jiangsu, China
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Varanasi R, Sinha A, Bhatia M, Nayak D, Manchanda RK, Janardhanan R, Lee JT, Tandon S, Pati S. Epidemiology and impact of chronic disease multimorbidity in India: a systematic review and meta-analysis. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2024; 14:26335565241258851. [PMID: 38846927 PMCID: PMC11155324 DOI: 10.1177/26335565241258851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/16/2024] [Indexed: 06/09/2024]
Abstract
Objectives This is the first systematic review and meta-analysis of the prevalence of multimorbidity, its risk factors including socioeconomic factors, and the consequences of multimorbidity on health systems and broader society in India. Methods A systematic review of both published and grey literature from five databases (Medline, Embase, EBSCO, Scopus, and ProQuest) was conducted including original studies documenting prevalence or patient outcomes associated with multimorbidity among adults in India. We excluded studies that did not explicitly mention multimorbidity. Three independent reviewers did primary screening based on titles and abstracts followed by full-text review for potential eligibility. The risk of bias was independently assessed by two reviewers following the Appraisal Tool for Cross-Sectional Studies. We presented both qualitative and quantitative (through meta-analysis) summaries of the evidence. The protocol for this study was prospectively registered with PROSPERO (CRD42021257281). Results The review identified 5442 articles out of which 35 articles were finally included in this study. Twenty-three studies were based on the primary data while 12 used secondary data. Eleven studies were conducted in hospital/primary care setting while 24 were community-based. The pooled prevalence of multimorbidity based on (n=19) studies included for meta-analysis was 20% (95% CI: 19% to 20%). The most frequent outcomes were increased healthcare utilization, reduced health-related quality of life, physical and mental functioning. Conclusion We identified a wide variance in the magnitude of multimorbidity across age groups and regions with most of the studies from eastern India. Nation-wide studies, studies on vulnerable populations and interventions are warranted.
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Affiliation(s)
- Roja Varanasi
- Amity Institute of Public Health, Noida, India
- Central Council for Research in Homoeopathy, New Delhi, India
| | - Abhinav Sinha
- ICMR-Regional Medical Research Centre, Bhubaneswar, India
| | | | - Debadatta Nayak
- Amity Institute of Public Health, Noida, India
- Central Council for Research in Homoeopathy, New Delhi, India
| | - Raj K Manchanda
- Homoeopathic Sectional Committee, AYUSH Department, Bureau of Indian Standards, Government of India, New Delhi, India
| | - Rajeev Janardhanan
- Amity Institute of Public Health, Noida, India
- SRM Institute of Science & Technology, Kattankulathur, India
| | - John Tayu Lee
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Simran Tandon
- Amity School of Health Sciences, Amity University, Mohali, India
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Ansari S, Anand A, Hossain B. Exploring multimorbidity clusters in relation to healthcare use and its impact on self-rated health among older people in India. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002330. [PMID: 38153935 PMCID: PMC10754468 DOI: 10.1371/journal.pgph.0002330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/17/2023] [Indexed: 12/30/2023]
Abstract
The conventional definition of multimorbidity may not address the complex treatment needs resulting from interactions between multiple conditions, impacting self-rated health (SRH). In India, there is limited research on healthcare use and SRH considering diverse disease combinations in individuals with multimorbidity. This study aims to identify multimorbidity clusters related to healthcare use and determine if it improves the self-rated health of individuals in different clusters. This study extracted information from cross-sectional data of the first wave of the Longitudinal Ageing Study in India (LASI), conducted in 2017-18. The study participants were 31,373 people aged ≥ 60 years. A total of nineteen chronic diseases were incorporated to identify the multimorbidity clusters using latent class analysis (LCA) in the study. Multivariable logistic regression was used to examine the association between identified clusters and healthcare use. A propensity score matching (PSM) analysis was utilised to further examine the health benefit (i.e., SRH) of using healthcare in each identified cluster. LCA analysis identified five different multimorbidity clusters: relatively healthy' (68.72%), 'metabolic disorder (16.26%), 'hypertension-gastrointestinal-musculoskeletal' (9.02%), 'hypertension-gastrointestinal' (4.07%), 'complex multimorbidity' (1.92%). Older people belonging to the complex multimorbidity [aOR:7.03, 95% CI: 3.54-13.96] and hypertension-gastrointestinal-musculoskeletal [aOR:3.27, 95% CI: 2.74-3.91] clusters were more likely to use healthcare. Using the nearest neighbor matching method, results from PSM analysis demonstrated that healthcare use was significantly associated with a decline in SRH across all multimorbidity clusters. Findings from this study highlight the importance of understanding multimorbidity clusters and their implications for healthcare utilization and patient well-being. Our findings support the creation of clinical practice guidelines (CPGs) focusing on a patient-centric approach to optimize multimorbidity management in older people. Additionally, finding suggest the urgency of inclusion of counseling and therapies for addressing well-being when treating patients with multimorbidity.
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Affiliation(s)
- Salmaan Ansari
- Centre for Health Services Studies, University of Kent, Kent, England, United Kingdom
| | - Abhishek Anand
- Department of Family and Generations, International Institute for Population Sciences, Mumbai, India
| | - Babul Hossain
- Department of Family and Generations, International Institute for Population Sciences, Mumbai, India
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Rafferty J, Lee A, Lyons RA, Akbari A, Peek N, Jalali-najafabadi F, Ba Dhafari T, Lyons J, Watkins A, Bailey R. Using hypergraphs to quantify importance of sets of diseases by healthcare resource utilisation: A retrospective cohort study. PLoS One 2023; 18:e0295300. [PMID: 38100428 PMCID: PMC10723667 DOI: 10.1371/journal.pone.0295300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 11/20/2023] [Indexed: 12/17/2023] Open
Abstract
Rates of Multimorbidity (also called Multiple Long Term Conditions, MLTC) are increasing in many developed nations. People with multimorbidity experience poorer outcomes and require more healthcare intervention. Grouping of conditions by health service utilisation is poorly researched. The study population consisted of a cohort of people living in Wales, UK aged 20 years or older in 2000 who were followed up until the end of 2017. Multimorbidity clusters by prevalence and healthcare resource use (HRU) were modelled using hypergraphs, mathematical objects relating diseases via links which can connect any number of diseases, thus capturing information about sets of diseases of any size. The cohort included 2,178,938 people. The most prevalent diseases were hypertension (13.3%), diabetes (6.9%), depression (6.7%) and chronic obstructive pulmonary disease (5.9%). The most important sets of diseases when considering prevalence generally contained a small number of diseases, while the most important sets of diseases when considering HRU were sets containing many diseases. The most important set of diseases taking prevalence and HRU into account was diabetes & hypertension and this combined measure of importance featured hypertension most often in the most important sets of diseases. We have used a single approach to find the most important sets of diseases based on co-occurrence and HRU measures, demonstrating the flexibility of the hypergraph approach. Hypertension, the most important single disease, is silent, underdiagnosed and increases the risk of life threatening co-morbidities. Co-occurrence of endocrine and cardiovascular diseases was common in the most important sets. Combining measures of prevalence with HRU provides insights which would be helpful for those planning and delivering services.
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Affiliation(s)
- James Rafferty
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Alexandra Lee
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Ronan A. Lyons
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Niels Peek
- Division of Informatics, Imaging and Data Science, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
- Alan Turing Institute, London, United Kingdom
| | - Farideh Jalali-najafabadi
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Thamer Ba Dhafari
- Division of Informatics, Imaging and Data Science, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Jane Lyons
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Alan Watkins
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Rowena Bailey
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
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Sharma SK, Nambiar D, Ghosh A. Sex differences in non-communicable disease multimorbidity among adults aged 45 years or older in India. BMJ Open 2023; 13:e067994. [PMID: 36972971 PMCID: PMC10069553 DOI: 10.1136/bmjopen-2022-067994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVE Older male and female adults differ in key characteristics such as disease-specific life expectancy, health behaviours and clinical presentations and non-communicable disease multimorbidity (NCD-MM). Therefore, examining the sex differences in NCD-MM among older adults is vital, as this issue is understudied in low-income and middle-income country (LMIC) contexts such as India, and has been growing in the past few decades. DESIGN Large scale nationally representative cross-sectional study. SETTINGS AND PARTICIPANTS Longitudinal Ageing Study in India (LASI 2017-2018) had data on 27 343 men and 31 730 women aged 45+, drawn from a sample of 59 073 individuals across India. PRIMARY AND SECONDARY OUTCOMES MEASURES We operationalised NCD-MM based on prevalence of the presence of two or more long-term chronic NCD morbidities. Descriptive statistics and bivariate analysis along with multivariate statistics were used. RESULTS Women aged 75+ had a higher prevalence of multimorbidity as compared with men (52.1% vs 45.17%). NCD-MM was more common among widows (48.5%) than widowers (44.8%). The female-to-male ratios of ORs (RORs) for NCD-MM associated with overweight/obesity and prior history of chewing tobacco were 1.10 (95% CI: 1.01 to 1.20) and 1.42 (95% CI: 1.12 to 1.80), respectively. The female-to-male RORs show that the odds of NCD-MM were greater in formerly working women (1.24 (95% CI: 1.06 to 1.44)) relative to formerly working men. The effect of increasing NCD-MM on limitations in activities of daily living and instrumental ADL was greater in men than women but reversed for the hospitalisation. CONCLUSIONS We found significant sex differences in NCD-MM prevalence among older Indian adults, with various associated risk factors. The patterns underlying these differences warrant greater study, given existing evidence on differential longevity, health burdens and health-seeking patterns all of which operate in a larger structural context of patriarchy. Health systems in turn must respond to NCD-MM mindful of these patterns and aim to redress some of the larger inequities they reflect.
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Affiliation(s)
| | - Devaki Nambiar
- The George Institute for Global Health India, New Delhi, India
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Arpita Ghosh
- The George Institute for Global Health India, New Delhi, India
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Chowdhury SR, Chandra Das D, Sunna TC, Beyene J, Hossain A. Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis. EClinicalMedicine 2023; 57:101860. [PMID: 36864977 PMCID: PMC9971315 DOI: 10.1016/j.eclinm.2023.101860] [Citation(s) in RCA: 84] [Impact Index Per Article: 84.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Knowing the prevalence of multimorbidity among adults across continents is a crucial piece of information for achieving Sustainable Development Goal 3.4, which calls for reducing premature death due to non-communicable diseases. A high prevalence of multimorbidity indicates high mortality and increased healthcare utilization. We aimed to understand the prevalence of multimorbidity across WHO geographic regions among adults. METHODS We performed a systematic review and meta-analysis of surveys designed to estimate the prevalence of multimorbidity among adults in community settings. We searched PubMed, ScienceDirect, Embase and Google Scholar databases for studies published between January 1, 2000, and December 31, 2021. The random-effects model estimated the pooled proportion of multimorbidity in adults. Heterogeneity was quantified using I2 statistics. We performed subgroup analyses and sensitivity analyses based on continents, age, gender, multimorbidity definition, study periods and sample size. The study protocol was registered with PROSPERO (CRD42020150945). FINDINGS We analyzed data from 126 peer-reviewed studies that included nearly 15.4 million people (32.1% were male) with a weighted mean age of 56.94 years (standard deviation of 10.84 years) from 54 countries around the world. The overall global prevalence of multimorbidity was 37.2% (95% CI = 34.9-39.4%). South America (45.7%, 95% CI = 39.0-52.5) had the highest prevalence of multimorbidity, followed by North America (43.1%, 95% CI = 32.3-53.8%), Europe (39.2%, 95% CI = 33.2-45.2%), and Asia (35%, 95% CI = 31.4-38.5%). The subgroup study highlights that multimorbidity is more prevalent in females (39.4%, 95% CI = 36.4-42.4%) than males (32.8%, 95% CI = 30.0-35.6%). More than half of the adult population worldwide above 60 years of age had multimorbid conditions (51.0%, 95% CI = 44.1-58.0%). Multimorbidity has become increasingly prevalent in the last two decades, while the prevalence appears to have stayed stable in the recent decade among adults globally. INTERPRETATION The multimorbidity patterns by geographic regions, time, age, and gender suggest noticeable demographic and regional differences in the burden of multimorbidity. According to insights about prevalence among adults, priority is required for effective and integrative interventions for older adults from South America, Europe, and North America. A high prevalence of multimorbidity among adults from South America suggests immediate interventions are needed to reduce the burden of morbidity. Furthermore, the high prevalence trend in the last two decades indicates that the global burden of multimorbidity continues at the same pace. The low prevalence in Africa suggests that there may be many undiagnosed chronic illness patients in Africa. FUNDING None.
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Affiliation(s)
- Saifur Rahman Chowdhury
- Department of Public Health, North South University, Dhaka, Bangladesh
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Dipak Chandra Das
- Department of Public Health, North South University, Dhaka, Bangladesh
| | | | - Joseph Beyene
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Ahmed Hossain
- College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Global Health Institute, North South University, Dhaka, Bangladesh
- Corresponding author.
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9
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Gummidi B, Gautam V, John O, Ghosh A, Jha V. Patterns of multimorbidity among a community-based cohort in rural India. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2023; 13:26335565221149623. [PMID: 36644651 PMCID: PMC9832245 DOI: 10.1177/26335565221149623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/19/2022] [Indexed: 01/03/2023]
Abstract
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.
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Affiliation(s)
- Balaji Gummidi
- The George Institute for Global
Health, New Delhi, India
| | | | - Oommen John
- The George Institute for Global
Health, New Delhi, India,Manipal Academy of Higher
Education, Manipal, India
| | - Arpita Ghosh
- The George Institute for Global
Health, New Delhi, India,Manipal Academy of Higher
Education, Manipal, India
| | - Vivekanand Jha
- The George Institute for Global
Health, New Delhi, India,Manipal Academy of Higher
Education, Manipal, India,Faculty of
Medicine, Imperial College
London, London, UK,University of New South
Wales, Sydney, Australia,Vivekanand Jha, George Institute for Global
Health, 308, Third Floor, Elegance Tower, Plot No. 8, Jasola District Centre,
New Delhi 110025 India.
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10
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Jafree SR, Muzammil A, Burhan SK, Bukhari N, Fischer F. Impact of a digital health literacy intervention and risk predictors for multimorbidity among poor women of reproductive years: Results of a randomized-controlled trial. Digit Health 2023. [DOI: 10.1177/20552076221144506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objective The objective of this study was to deliver an intervention to improve health awareness for infection prevention, hygiene, and sanitation to assess its impact. Furthermore, it aimed to identify the risk of multimorbidity in women of reproductive years from low socio-economic background. Methods A randomized control trial was conducted in Pakistan among women aged 15–45 years. Overall, 820 women participated in the baseline survey; 388 women were part of the control group and 360 of the intervention group. A digital health literacy intervention was delivered by 91 trained community health workers. Data were analyzed using descriptive statistics and multivariate logistic regression. Results About 35.9% of women suffered from multimorbidity. The intervention group showed higher odds of confidence in managing health with respect to skill and technique acquisition (AOR = 2.21; 95% CI 1.01–4.84), self-monitoring and insight (AOR = 2.97; 95% CI 1.29–6.80) as well as sanitation and hygiene (AOR = 1.42; 95% CI 1.07–1.93). Two primary outcomes related to hand hygiene and protective behavior against infection did not show any significant improvement. The secondary outcomes of the study related to impact on overall health-related quality of life, social integration and support, and emotional well-being also did not show any significant improvement. Conclusions Digital health literacy interventions and multimorbidity management for women of reproductive years at the primary level are a way forward to alleviate communicable and non-communicable disease burden in developing countries like Pakistan. These efforts are also critical to improve maternal and child health in developing regions.
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Affiliation(s)
- Sara Rizvi Jafree
- Department of Sociology, Forman Christian College University, Lahore, Pakistan
| | - Anam Muzammil
- Department of Mass Communications, Forman Christian College University, Lahore, Pakistan
| | | | - Nadia Bukhari
- School of Pharmacy, University College London, London, UK
| | - Florian Fischer
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Institute of Gerontological Health Services and Nursing Research, Ravensburg-Weingarten University of Applied Sciences, Weingarten, German
- Bavarian Research Center for Digital Health and Social Care, Kempten University of Applied Sciences, Kempten, Germany
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Pengpid S, Peltzer K, Anantanasuwong D. Bidirectional association between functional disability and multimorbidity among middle-aged and older adults in Thailand. Front Public Health 2022; 10:1055699. [PMID: 36544805 PMCID: PMC9760803 DOI: 10.3389/fpubh.2022.1055699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/14/2022] [Indexed: 12/07/2022] Open
Abstract
Objectives The purpose of this study was to assess the bidirectional association between multimorbidity (MM) and functional disability among middle-aged and older adults in a longitudinal study in Thailand. Methods We analyzed longitudinal data of participants aged 45 years and older from two consecutive waves (in 2015 and 2017) of the Health, Aging, and Retirement in Thailand (HART). Functional disability was assessed with a 4-item activity of daily living (ADL) scale. Logistic regression analysis was conducted to assess the association between baseline functional disability and incident MM (≥2), and baseline morbidity and incident functional disability. Results The results indicate that a total of 1,716 individuals without morbidity at baseline and 3,529 without functional disability at baseline were included. At follow-up, 16.7 and 20.0% of functional disability cases and 7.1 and 3.6% of nonfunctional disability cases developed 2 morbidities and 3 or more morbidities, respectively, and 6.6% of MM cases and 4.0% of non-MM cases developed a functional disability. In the final logistic regression model adjusted for education, income, age, marital status, sex, smoking tobacco, body mass index (BMI), alcohol use, physical activity, and social engagement, functional disability at baseline was positively associated with incident MM (≥2) (adjusted odds ratio [aOR]: 2.58, 95% CI: 1.42-4.72), and MM (≥3) at baseline was positively associated with incident functional disability (aOR: 1.97, 95% CI: 1.13-3.43). Conclusion Multimorbidity and functional disability were bidirectionally associated.
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Affiliation(s)
- Supa Pengpid
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand,Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa,Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Karl Peltzer
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand,Department of Psychology, University of the Free State, Bloemfontein, South Africa,Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan,*Correspondence: Karl Peltzer
| | - Dararatt Anantanasuwong
- Center for Aging Society Research (CASR) at National Institute of Development Administration (NIDA), Bangkok, Thailand
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12
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Defining and measuring multimorbidity in primary care in Singapore: Results of an online Delphi study. PLoS One 2022; 17:e0278559. [PMID: 36455000 PMCID: PMC9714819 DOI: 10.1371/journal.pone.0278559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 11/18/2022] [Indexed: 12/03/2022] Open
Abstract
Multimorbidity, common in the primary care setting, has diverse implications for both the patient and the healthcare system. However, there is no consensus on the definition of multimorbidity globally. Thus, we aimed to conduct a Delphi study to gain consensus on the definition of multimorbidity, the list and number of chronic conditions used for defining multimorbidity in the Singapore primary care setting. Our Delphi study comprised three rounds of online voting from purposively sampled family physicians in public and private settings. Delphi round 1 included open-ended questions for idea generation. The subsequent two rounds used questions with pre-selected options. Consensus was achieved based on a pre-defined criteria following an iterative process. The response rates for the three rounds were 61.7% (37/60), 86.5% (32/37) and 93.8% (30/32), respectively. Among 40 panellists who responded, 46.0% were 31-40 years old, 64.9% were male and 73.0% were from the public primary healthcare setting. Based on the findings of rounds 1, 2 and 3, consensus on the definition of a chronic condition, multimorbidity and finalised list of chronic conditions were achieved. For a condition to be chronic, it should last for six months or more, be recurrent or persistent, impact patients across multiple domains and require long-term management. The consensus-derived definition of multimorbidity is the presence of three or more chronic conditions from a finalised list of 23 chronic conditions. We anticipate that our findings will inform multimorbidity conceptualisation at the national level, standardise multimorbidity measurement in primary care and facilitate resource allocation for patients with multimorbidity.
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Skou ST, Mair FS, Fortin M, Guthrie B, Nunes BP, Miranda JJ, Boyd CM, Pati S, Mtenga S, Smith SM. Multimorbidity. Nat Rev Dis Primers 2022; 8:48. [PMID: 35835758 PMCID: PMC7613517 DOI: 10.1038/s41572-022-00376-4] [Citation(s) in RCA: 224] [Impact Index Per Article: 112.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 02/06/2023]
Abstract
Multimorbidity (two or more coexisting conditions in an individual) is a growing global challenge with substantial effects on individuals, carers and society. Multimorbidity occurs a decade earlier in socioeconomically deprived communities and is associated with premature death, poorer function and quality of life and increased health-care utilization. Mechanisms underlying the development of multimorbidity are complex, interrelated and multilevel, but are related to ageing and underlying biological mechanisms and broader determinants of health such as socioeconomic deprivation. Little is known about prevention of multimorbidity, but focusing on psychosocial and behavioural factors, particularly population level interventions and structural changes, is likely to be beneficial. Most clinical practice guidelines and health-care training and delivery focus on single diseases, leading to care that is sometimes inadequate and potentially harmful. Multimorbidity requires person-centred care, prioritizing what matters most to the individual and the individual's carers, ensuring care that is effectively coordinated and minimally disruptive, and aligns with the patient's values. Interventions are likely to be complex and multifaceted. Although an increasing number of studies have examined multimorbidity interventions, there is still limited evidence to support any approach. Greater investment in multimorbidity research and training along with reconfiguration of health care supporting the management of multimorbidity is urgently needed.
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Affiliation(s)
- Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark.
| | - Frances S Mair
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Quebec, Canada
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Bruno P Nunes
- Postgraduate Program in Nursing, Faculty of Nursing, Universidade Federal de Pelotas, Pelotas, Brazil
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Epidemiology and Health Policy & Management, Johns Hopkins University, Baltimore, MD, USA
| | - Sanghamitra Pati
- ICMR Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Sally Mtenga
- Department of Health System Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar Es Salaam, Tanzania
| | - Susan M Smith
- Discipline of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Russell Building, Tallaght Cross, Dublin, Ireland
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Rodrigues LP, de Oliveira Rezende AT, Delpino FM, Mendonça CR, Noll M, Nunes BP, de Oliviera C, Silveira EA. Association between multimorbidity and hospitalization in older adults: systematic review and meta-analysis. Age Ageing 2022; 51:6649133. [PMID: 35871422 PMCID: PMC9308991 DOI: 10.1093/ageing/afac155] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background Multimorbidity is defined as the presence of multiple chronic conditions in the same individual. Multimorbidity is more prevalent in older adults and can lead to several adverse health outcomes. Methods We systematically reviewed evidence from observational studies to verify the association between multimorbidity and hospitalization in older adults. Furthermore, we also aimed to identify whether it changes according to gender, advanced age, institutionalization, and wealth of the country of residence. We searched the PubMed, Embase and Scopus databases from December 2020 to April 2021. The analysed outcomes were as follows: hospitalization, length of stay and hospital readmission. Results Of the 6,948 studies identified in the databases, 33 were included in this review. From the meta-analysis results, it was found that multimorbidity, regardless of the country’s wealth, was linked to hospitalization in older adults (OR = 2.52, CI 95% = 1.87–3.38). Both definitions of multimorbidity, ≥2 (OR = 2.35, 95% CI = 1.34–4.12) and ≥3 morbidities (OR = 2.52, 95% CI = 1.87–3.38), were associated with hospitalization. Regardless of gender, multimorbidity was associated with hospitalization (OR = 1.98, 95% CI = 1.67–2.34) and with readmission (OR = 1.07, 95% CI = 1.04–1.09). However, it was not possible to verify the association between multimorbidity and length of stay. Conclusions Multimorbidity was linked to a higher hospitalization risk, and this risk was not affected by the country’s wealth and patient’s gender. Multimorbidity was also linked to a higher hospital readmission rate in older adults. PROSPERO Registration (Registration number: CRD42021229328).
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Affiliation(s)
- Luciana Pereira Rodrigues
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Goiás, Goiânia, Brazil
| | | | - Felipe Mendes Delpino
- Department of Nursing in Public Health, Federal University of Pelotas, Pelotas, Brazil
| | | | - Matias Noll
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Goiás, Goiânia, Brazil.,Federal Institute Goiano, Campus Ceres, Goiás, Brazil.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Bruno Pereira Nunes
- Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Cesar de Oliviera
- Department of Epidemiology & Public Health, Institute of Epidemiology & Health Care, University College London, London, UK
| | - Erika Aparecida Silveira
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Goiás, Goiânia, Brazil.,Federal Institute Goiano, Campus Ceres, Goiás, Brazil
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Ismail S, Stanley A, Jeemon P. Prevalence of multimorbidity and associated treatment burden in primary care settings in Kerala: a cross-sectional study in Malappuram District, Kerala, India. Wellcome Open Res 2022; 7:67. [PMID: 35592547 PMCID: PMC9086527 DOI: 10.12688/wellcomeopenres.17674.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2022] [Indexed: 12/21/2022] Open
Abstract
Background: Multimorbidity or co-existence of two or more chronic conditions is common and associated with reduced quality of life and increased risk of death. We aimed to estimate the prevalence and pattern of multimorbidity in primary care settings in Kerala and the associated treatment burden, and quality of life. Methods: A cross-sectional survey was conducted among 540 adult participants in Malappuram District, Kerala. A multi-stage cluster sampling method was employed. Hypertension, diabetes, chronic obstructive pulmonary disease, depression and anxiety screening were done by trained medical professionals. The remaining medical conditions were self-reported by the respondent and verified with patient held health records. The health-related quality of life [HRQoL] was measured using the EQ-5D-5L tool. The MTBQ tool was used for measuring the multimorbidity treatment burden. Logistic regression was used to identify variables associated with multi-morbidity. Results: Overall, the prevalence of multimorbidity was 39.8% (35.7 – 44.1). The prevalence of multimorbidity among men (42.6%) was relatively higher than that in women (38.1%). Lower educational attainment, higher age group, and overweight or obesity status were independently associated with higher prevalence of multimorbidity. The most common pairs of coexisting chronic conditions reported in the study were hypertension and diabetes in males (66.7%) and females (70.8%). All domains of quality of life were impaired in individuals with multimorbidity. Conclusion: Multimorbidity is a norm and affects two of five participants seeking care in primary care settings in Kerala. The social gradient in the prevalence of multimorbidity was evident with higher prevalence in individuals with low educational attainment. Multimorbidity seriously impairs quality of life and increases treatment burden. The focus of management should move beyond individual diseases, and pivot towards interventions targeting multi-morbidity management, with a specific focus for people living in lower socio-economic strata.
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Affiliation(s)
- Sunaib Ismail
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Antony Stanley
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Panniyammakal Jeemon
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
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Reddy MM, Zaman K, Yadav R, Yadav P, Kumar K, Kant R. Prevalence, Associated Factors, and Health Expenditures of Noncommunicable Disease Multimorbidity-Findings From Gorakhpur Health and Demographic Surveillance System. Front Public Health 2022; 10:842561. [PMID: 35462842 PMCID: PMC9019118 DOI: 10.3389/fpubh.2022.842561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Noncommunicable disease (NCD) multimorbidity throws a unique challenge to healthcare systems globally in terms of not only management of disease, but also familial, social, and economic implications associated with it. Objective To assess the prevalence of NCD multimorbidity and its associated risk factors along with health expenditures among adults (≥18 years) living in a rural area. Methods A secondary data analysis of the first-round survey done as part of the Gorakhpur Health and Demographic Surveillance Site (GHDSS) was done. Information related to self-reported morbidity and other variables related to sociodemographics and out-of-pocket expenditure (OOPE) was captured using a pretested questionnaire. Multivariable cluster adjusted binomial regression analysis was done to identify factors associated with multimorbidity. Results The overall prevalence of NCD multimorbidity was found to be 1.8% (95% CI: 1.7-1.9%). The prevalence of NCD multimorbidity was highest among elderly (≥60 years) [6.0% (95% CI: 5.5-6.5%)] and among women [2.4% (95% CI: 2.3-2.6%)]. Sociodemographic factors, such as age, gender, occupation, education, marital status, religion, caste, and household wealth, were all found to be independently associated with NCD multimorbidity. The median annual OOPE was found to be significantly higher among those with NCD multimorbidity (INR 20,000) compared with those with no NCD (INR 5,000) or having only one NCD (INR 8,000). Conclusion Among the adults in GHDSS, about 13 in every 100 were suffering from at least one NCD and around two in 100 were having NCD multimorbidity. Those with NCD multimorbidity spent almost four times higher annual OOPE compared with those without NCDs.
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Affiliation(s)
- Mahendra M Reddy
- Indian Council of Medical Research-Regional Medical Research Centre (ICMR-RMRC), Gorakhpur, India
| | - Kamran Zaman
- Indian Council of Medical Research-Regional Medical Research Centre (ICMR-RMRC), Gorakhpur, India
| | - Rajaram Yadav
- Indian Council of Medical Research-Regional Medical Research Centre (ICMR-RMRC), Gorakhpur, India
| | - Priyanka Yadav
- Indian Council of Medical Research-Regional Medical Research Centre (ICMR-RMRC), Gorakhpur, India
| | - Kaushik Kumar
- Indian Council of Medical Research-Regional Medical Research Centre (ICMR-RMRC), Gorakhpur, India
| | - Rajni Kant
- Indian Council of Medical Research-Regional Medical Research Centre (ICMR-RMRC), Gorakhpur, India
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Chauhan S, Patel R, Kumar S. 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). BMJ Open 2022; 12:e053953. [PMID: 35351706 PMCID: PMC8961109 DOI: 10.1136/bmjopen-2021-053953] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
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.
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Affiliation(s)
- Shekhar Chauhan
- International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Ratna Patel
- International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Shubham Kumar
- International Institute for Population Sciences, Mumbai, Maharashtra, India
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Chauhan S, Srivastava S, Kumar P, Patel R. Decomposing urban-rural differences in multimorbidity among older adults in India: a study based on LASI data. BMC Public Health 2022; 22:502. [PMID: 35291975 PMCID: PMC8922782 DOI: 10.1186/s12889-022-12878-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multimorbidity is defined as the co-occurrence of two or more than two diseases in the same person. With rising longevity, multimorbidity has become a prominent concern among the older population. Evidence from both developed and developing countries shows that older people are at much higher risk of multimorbidity; however, urban-rural differential remained scarce. Therefore, this study examines urban-rural differential in multimorbidity among older adults by decomposing the risk factors of multimorbidity and identifying the covariates that contributed to the change in multimorbidity. METHODS The study utilized information from 31,464 older adults (rural-20,725 and urban-10,739) aged 60 years and above from the recent release cross-sectional data of the Longitudinal Ageing Study in India (LASI). Descriptive, bivariate, and multivariate decomposition analysis techniques were used. RESULTS Overall, significant urban-rural differences were found in the prevalence of multimorbidity among older adults (difference: 16.3; p < 0.001). The multivariate decomposition analysis revealed that about 51% of the overall differences (urban-rural) in the prevalence of multimorbidity among older adults was due to compositional characteristics (endowments). In contrast, the remaining 49% was due to the difference in the effect of characteristics (Coefficient). Moreover, obese/overweight and high-risk waist circumference were found to narrow the difference in the prevalence of multimorbidity among older adults between urban and rural areas by 8% and 9.1%, respectively. Work status and education were found to reduce the urban-rural gap in the prevalence of multimorbidity among older adults by 8% and 6%, respectively. CONCLUSIONS There is a need to substantially increase the public sector investment in healthcare to address the multimorbidity among older adults, more so in urban areas, without compromising the needs of older adults in rural areas.
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Affiliation(s)
- Shekhar Chauhan
- Department of Family and Generations, International Institute for Population Sciences, Mumbai, India
| | - Shobhit Srivastava
- Research Scholar, International Institute for Population Sciences, Mumbai, India
| | - Pradeep Kumar
- Consultant- Research & Data Analysis, Population Council India Office, Zone 5A, India Habitat Centre, Lodi Road, 110003, New Delhi, India
| | - Ratna Patel
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India.
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Fleitas Alfonzo L, King T, You E, Contreras-Suarez D, Zulkelfi S, Singh A. Theoretical explanations for socioeconomic inequalities in multimorbidity: a scoping review. BMJ Open 2022; 12:e055264. [PMID: 35197348 PMCID: PMC8882654 DOI: 10.1136/bmjopen-2021-055264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To document socioepidemiological theories used to explain the relationship between socioeconomic disadvantage and multimorbidity. DESIGN Scoping review. METHODS A search strategy was developed and then applied to multiple electronic databases including Medline, Embase, PsychInfo, Web of Science, Scielo, Applied Social Sciences, ERIC, Humanities Index and Sociological Abstracts. After the selection of studies, data were extracted using a data charting plan. The last search was performed on the 28 September 2021. Extracted data included: study design, country, population subgroups, measures of socioeconomic inequality, assessment of multimorbidity and conclusion on the association between socioeconomic variables and multimorbidity. Included studies were further assessed on their use of theory, type of theories used and context of application. Finally, we conducted a meta-narrative synthesis to summarise the results. RESULTS A total of 64 studies were included in the review. Of these, 33 papers included theories as explanations for the association between socioeconomic position and multimorbidity. Within this group, 16 explicitly stated those theories and five tested at least one theory. Behavioural theories (health behaviours) were the most frequently used, followed by materialist (access to health resources) and psychosocial (stress pathways) theories. Most studies used theories as post hoc explanations for their findings or for study rationale. Supportive evidence was found for the role of material, behavioural and life course theories in explaining the relationship between social inequalities and multimorbidity. CONCLUSION Given the widely reported social inequalities in multimorbidity and its increasing public health burden, there is a critical gap in evidence on pathways from socioeconomic disadvantage to multimorbidity. Generating evidence of these pathways will guide the development of intervention and public policies to prevent multimorbidity among people living in social disadvantage. Material, behavioural and life course pathways can be targeted to reduce the negative effect of low socioeconomic position on multimorbidity.
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Affiliation(s)
- Ludmila Fleitas Alfonzo
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tania King
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Emily You
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | - Diana Contreras-Suarez
- Melbourne Institute: Applied Economic and Social Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Syafiqah Zulkelfi
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ankur Singh
- Centre of Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Ismail S, Stanley A, Jeemon P. Prevalence of multimorbidity and associated treatment burden in primary care settings in Kerala: a cross-sectional study in Malappuram District, Kerala, India. Wellcome Open Res 2022; 7:67. [DOI: 10.12688/wellcomeopenres.17674.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Multimorbidity or co-existence of two or more chronic conditions is common and associated with reduced quality of life and increased risk of death. We aimed to estimate the prevalence and pattern of multimorbidity in primary care settings in Kerala and the associated treatment burden, and quality of life. Methods: A cross-sectional survey was conducted among 540 adult participants in Malappuram District, Kerala. A multi-stage cluster sampling method was employed. Hypertension, diabetes, chronic obstructive pulmonary disease, depression and anxiety screening were done by trained medical professionals. The remaining medical conditions were self-reported by the respondent and verified with patient held health records. The health-related quality of life [HRQoL] was measured using the EQ-5D-5L tool. The MTBQ tool was used for measuring the multimorbidity treatment burden. Logistic regression was used to identify variables associated with multi-morbidity. Results: Overall, the prevalence of multi-morbidity was 39.8% (35.7 – 44.1). The prevalence of multi-morbidity among men (42.6%) was relatively higher than that in women (38.1%). Lower educational attainment, higher age group, and overweight or obesity status were independently associated with higher prevalence of multimorbidity. The most common pairs of coexisting chronic conditions reported in the study were hypertension and diabetes in males (66.7%) and females (70.8%). All domains of quality of life were impaired in individuals with multimorbidity. Conclusion: Multimorbidity is a norm and affects two of five participants seeking care in primary care settings in Kerala. The social gradient in the prevalence of multimorbidity was evident with higher prevalence in individuals with low educational attainment. Multimorbidity seriously impairs quality of life and increases treatment burden. The focus of management should move beyond individual diseases, and pivot towards interventions targeting multi-morbidity management, with a specific focus for people living in lower socio-economic strata.
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Boehnke JR, Rana RZ, Kirkham JJ, Rose L, Agarwal G, Barbui C, Chase-Vilchez A, Churchill R, Flores-Flores O, Hurst JR, Levitt N, van Olmen J, Purgato M, Siddiqi K, Uphoff E, Vedanthan R, Wright J, Wright K, Zavala GA, Siddiqi N. Development of a core outcome set for multimorbidity trials in low/middle-income countries (COSMOS): study protocol. BMJ Open 2022; 12:e051810. [PMID: 35172996 PMCID: PMC8852662 DOI: 10.1136/bmjopen-2021-051810] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION 'Multimorbidity' describes the presence of two or more long-term conditions, which can include communicable, non-communicable diseases, and mental disorders. The rising global burden from multimorbidity is well documented, but trial evidence for effective interventions in low-/middle-income countries (LMICs) is limited. Selection of appropriate outcomes is fundamental to trial design to ensure cross-study comparability, but there is currently no agreement on a core outcome set (COS) to include in trials investigating multimorbidity specifically in LMICs. Our aim is to develop international consensus on two COSs for trials of interventions to prevent and treat multimorbidity in LMIC settings. METHODS AND ANALYSIS Following methods recommended by the Core Outcome Measures in Effectiveness Trials initiative, the development of these two COSs will occur in parallel in three stages: (1) generation of a long list of potential outcomes for inclusion; (2) two-round online Delphi surveys and (3) consensus meetings. First, to generate an initial list of outcomes, we will conduct a systematic review of multimorbidity intervention and prevention trials and interviews with people living with multimorbidity and their caregivers in LMICs. Outcomes will be classified using an outcome taxonomy. Two-round Delphi surveys will be used to elicit importance scores for these outcomes from people living with multimorbidity, caregivers, healthcare professionals, policy makers and researchers in LMICs. Finally, consensus meetings including all of these stakeholders will be held to agree outcomes for inclusion in the two COSs. ETHICS AND DISSEMINATION The study has been approved by the Research Governance Committee of the Department of Health Sciences, University of York, UK (HSRGC/2020/409/D:COSMOS). Each participating country/research group will obtain local ethics board approval. Informed consent will be obtained from all participants. We will disseminate findings through peer-reviewed open access publications, and presentations at global conferences selected to reach a wide range of LMIC stakeholders. PROSPERO REGISTATION NUMBER CRD42020197293.
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Affiliation(s)
- Jan R Boehnke
- School of Health Sciences, University of Dundee, Dundee, UK
- Department of Health Sciences, University of York, York, UK
| | - Rusham Zahra Rana
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Jamie J Kirkham
- Centre for Biostatistics, The University of Manchester, Manchester, UK
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | | | - Rachel Churchill
- Centre for Reviews and Dissemination and Cochrane Common Mental Disorders, University of York, York, UK
| | - Oscar Flores-Flores
- Facultad de Medicina Humana, Centro de Investigación del Envejecimiento (CIEN), Universidad San Martin de Porres, Lima, Peru
- Asociación Benéfica PRISMA, Lima, Peru
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Naomi Levitt
- Chronic Disease Initiative for Africa and Division of Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Josefien van Olmen
- Department of Family Medicine and Population Health, University of Antwerp, Antwerpen, Belgium
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK
- Hull York Medical School, York, UK
| | - Eleonora Uphoff
- Centre for Reviews and Dissemination and Cochrane Common Mental Disorders, University of York, York, UK
| | - Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, New York University, New York, New York, USA
| | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Najma Siddiqi
- Department of Health Sciences, University of York, York, UK
- Hull York Medical School, York, UK
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Kaluvu L, Asogwa OA, Marzà-Florensa A, Kyobutungi C, Levitt NS, Boateng D, Klipstein-Grobusch K. Multimorbidity of communicable and non-communicable diseases in low- and middle-income countries: A systematic review. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2022; 12:26335565221112593. [PMID: 36081708 PMCID: PMC9445468 DOI: 10.1177/26335565221112593] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim of this systematic review is to analyse existing evidence on prevalence, patterns, determinants, and healthcare challenges of communicable and non-communicable disease multimorbidity in low- and middle-income countries (LMICs). METHODS PubMed, Cochrane, and Embase databases were searched from 1st January 2000 to 31st July 2020. The National Institute of Health (NIH) quality assessment tool was used to critically appraise studies. Findings were summarized in a narrative synthesis. The review was registered with PROSPERO (CRD42019133453). RESULTS Of 3718 articles screened, 79 articles underwent a full text review of which 11 were included for narrative synthesis. Studies reported on 4 to 20 chronic communicable and non-communicable diseases; prevalence of multimorbidity ranged from 13% in a study conducted among 242,952 participants from 48 LMICS to 87% in a study conducted among 491 participants in South Africa. Multimorbidity was positively associated with older age, female sex, unemployment, and physical inactivity. Significantly higher odds of multimorbidity were noted among obese participants (OR 2.33; 95% CI: 2.19-2.48) and those who consumed alcohol (OR 1.44; 95% CI: 1.25-1.66). The most frequently occurring dyads and triads were HIV and hypertension (23.3%) and HIV, hypertension, and diabetes (63%), respectively. Women and participants from low wealth quintiles reported higher utilization of public healthcare facilities. CONCLUSION The identification and prevention of risk factors and addressing evidence gaps in multimorbidity clustering is crucial to address the increasing communicable and non-communicable disease multimorbidity in LMICs. To identify communicable and non-communicable diseases trends over time and identify causal relationships, longitudinal studies are warranted.
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Affiliation(s)
- Lucy Kaluvu
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | | | - Anna Marzà-Florensa
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Naomi S Levitt
- Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Daniel Boateng
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Divison of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Hussain MH, Jilanee DA, Aziz S, Tariq S, Devi A, Avendaño-Capriles CA, Tousif S, Barkat R. Predictors of Quality of Life Among People Living With Multimorbidity in Karachi, Pakistan: A Cross-Sectional Study. Cureus 2021; 13:e18803. [PMID: 34796076 PMCID: PMC8590824 DOI: 10.7759/cureus.18803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Multimorbidity is defined as the coexistence of more than one chronic condition in one individual. It is related to enhanced rates of disability and mortality, enhanced disease burden, decreased function levels, and it can affect the wellbeing and daily activities of people, including loss of autonomy and independence. The aim of the current study is to determine the predictors of quality of life among patients with multimorbidity in Karachi, Pakistan. Methodology It was a cross-sectional study conducted in 12 health care facilities of six districts in Karachi, Pakistan. Two health care facilities were selected from each district using a convenient sampling technique. The total sample size of this study was 690, equally distributed among 12 health care facilities. Results The majority of participants (33.47%) belonged to the age group of 40 to 49 years, while 29.85% of participants had an age between 30 to 39 years. More than half of the participants were females (50.87%). Overall, the multivariate analysis showed being male, married, younger, high educational status and employed were positively associated with quality of life. While having lower family income is negatively associated with quality of life. Conclusion The findings of this study had important implications for identifying distinct multimorbidity individuals who were at risk of a lower quality of life, and they emphasized the need for disease detection and treatment at an early stage. The study can also give important evidence for decision-makers when it comes to allocating health resources more efficiently, and health administrative departments can improve chronic disease management.
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Affiliation(s)
| | - Daniyal A Jilanee
- Medicine, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Safa Aziz
- Medicine, Ziauddin University, Karachi, PAK
| | | | - Arti Devi
- Medicine, Ziauddin University, Karachi, PAK
| | | | | | - Rahil Barkat
- Epidemiology, Indus Hospital Research Center, The Indus Hospital, Karachi, PAK
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Pati S, Sinha R, Panda M, Puri P, Pati S. Profile of multimorbidity in outpatients attending public healthcare settings: A descriptive cross-sectional study from Odisha, India. J Family Med Prim Care 2021; 10:2900-2914. [PMID: 34660423 PMCID: PMC8483093 DOI: 10.4103/jfmpc.jfmpc_2436_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/18/2021] [Accepted: 02/24/2021] [Indexed: 11/04/2022] Open
Abstract
Background Multimorbidity, the co-occurrence of two or more long-term conditions (LTC) in individuals, is associated with greater healthcare utilization, expenditure, and premature mortality, thus positing a challenge for patients and healthcare providers. Given its sparsely available epidemiological evidence, we aimed to describe the profile of multimorbidity in a representative sample of public healthcare outpatients in India. Methods A facility-based cross-sectional study was conducted from 1st July to 31st December 2015 in Odisha, India. Fifteen public healthcare facilities were selected by stratified random sampling. Data was collected from 1,870 adult outpatients attending these settings using Multimorbidity Assessment Questionnaire for Primary Care (MAQ-PC) tool. Result Nearly 3/4th of both women and men outpatients were either obese or overweight. >1/2 had multimorbidity (≥2 LTC) while 1/3rd had ≥3 LTC. Most prevalent condition was hypertension (63%), followed by chronic backache and arthritis. Cancer and psychiatric illness were least reported. Multimorbidity increased with age group, socioeconomic status, and education level. Females across all age groups had higher reported multimorbidity than males. Diabetes--hypertension was frequently occurring dyad. Both physical and mental component of quality of life was reduced in multimorbidity. Conclusion Multimorbidity is becoming a norm in healthcare practice with high prevalence in females and older adults. Health services for non-communicable diseases need to include commonly occurring dyads along with health promotion. Higher prevalence in females reinforces the need to incorporate gender differences while studying multimorbidity. Analysis of multimorbidity epidemiology through an equity lens could illuminate the underpinning complexities and heterogeneities of this phenomenon.
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Affiliation(s)
- Sanghamitra Pati
- ICMR Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | | | - Meely Panda
- All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Parul Puri
- International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Sandipana Pati
- Centre for Chronic Diseases and Injuries and Indian Institute of Public Health Bhubaneswar, Public Health Foundation of India, Bhubaneswar, Odisha, India
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Pati S, Mahapatra P, Dwivedi R, Athe R, Sahoo KC, Samal M, Das RC, Hussain MA. Multimorbidity and Its Outcomes Among Patients Attending Psychiatric Care Settings: An Observational Study From Odisha, India. Front Public Health 2021; 8:616480. [PMID: 33968863 PMCID: PMC8096979 DOI: 10.3389/fpubh.2020.616480] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/30/2020] [Indexed: 12/17/2022] Open
Abstract
Background: Multimorbidity, the presence of two or more chronic health conditions is linked to premature mortality among psychiatric patients since the presence of one can further complicate the management of either. Little research has focused on the magnitude and effect of multimorbidity among psychiatric patients in low-and middle-income settings. Our study, provides the first ever data on multimorbidity and its outcomes among patients attending psychiatric clinics in Odisha, India. It further explored whether multimorbidity was associated with higher medical expenditure and the interaction effect of psychiatric illness on this association. Methods: This cross-sectional study included 500 adult patients presenting to the psychiatric clinic of a medical college hospital in Odisha over a period of 6 months (February 2019–July 2019). A validated structured questionnaire, “multimorbidity assessment questionnaire for psychiatric care” (MAQ-PsyC) was used for data collection. We used multinomial logistic model for the effect estimation. Odds ratios (OR) and 95% confidence intervals (CI) for high healthcare utilization and expenditure were calculated by number and pattern of multimorbidity. Data was analyzed by STATA 14. Results: Half (50%) of the psychiatric outpatients had multimorbidity. The relative probabilities of having one additional condition were 5.3 times (RRR = 5.3; 95% CI: 2.3, 11.9) and multiple morbidities were 6.6 times (RRR = 6.6; 95%CI: 3.3, 13.1) higher for patients in 60+ age group. Healthcare utilization i.e., medication use and physician consultation was significantly higher for psychiatric conditions such as mood disorders, schizophrenia, schizotypal and delusional disorders, and for hypertension, cancer, diabetes, among somatic conditions. Out of pocket expenditure (OOPE) was found to be highest for laboratory investigations, followed by medicines and transport expenditure. Within psychiatric conditions, mood disorders incurred highest OOPE ($93.43) while hypertension was the most leading for OOPE in physical morbidities ($93.43). Psychiatric illnesses had a significant interaction effect on the association between multimorbidity and high medical expenditure (P = 0.001). Conclusion: Multimorbidity is highly prevalent in psychiatric patients associated with significantly high healthcare utilization and medical expenditure. Such disproportionate effect of psychiatric multimorbidity on healthcare cost and use insinuates the need for stronger financial protection and tailor-made clinical decision making for these vulnerable patient subgroups.
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Affiliation(s)
- Sanghamitra Pati
- Indian Council of Medical Research (ICMR)-Regional Medical Research Centre, Bhubaneswar, India
| | - Pranab Mahapatra
- Department of Psychiatry, Kalinga Institute of Medical Sciences, Kalinga Institute of Industrial Technology (KIIT) University, Bhubaneswar, India
| | - Rinshu Dwivedi
- Department of Humanities and Science (Economics), Indian Institute of Information Technology, Tiruchirappalli, India
| | - Ramesh Athe
- Department of Humanities and Science (Mathematics), Indian Institute of Information Technology, Dharwad, India
| | - Krushna Chandra Sahoo
- Indian Council of Medical Research (ICMR)-Regional Medical Research Centre, Bhubaneswar, India
| | - Mousumi Samal
- Indian Council of Medical Research (ICMR)-Regional Medical Research Centre, Bhubaneswar, India
| | - Ram Chandra Das
- Department of Psychiatry, Kalinga Institute of Medical Sciences, Kalinga Institute of Industrial Technology (KIIT) University, Bhubaneswar, India
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Knowledge of prescribed drugs among primary care patients: findings from Prover Project. Int J Clin Pharm 2021; 43:1265-1273. [PMID: 33713008 DOI: 10.1007/s11096-021-01246-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 02/09/2021] [Indexed: 10/21/2022]
Abstract
Background Evidence on patient medication knowledge and associated factors within primary care patients is limited, especially in developing countries. Objective To estimate the prevalence and investigate the role of individual and contextual factors on insufficient medication knowledge among primary care patients. Setting Public community pharmacies in a health pole city (234,937 inhab.) in Minas Gerais State, Brazil. Methods Exit-survey conducted with a representative sample of 1221 patients (≥ 18 years) interviewed after dispensing. Data collected for medicines included its name, therapeutic indication, dosage, time of administration, treatment duration, side effects and warnings. Information were compared to the prescription and official guidelines. Descriptive statistics and logistic regression analysis were applied. Main outcome measure Insufficient patient medication knowledge. Results Prevalence of insufficient medication knowledge was 30.1%. Side effects (96.3%) and warnings (71.1%) had the highest percentage of misses. Musculoskeletal system drugs presented the lowest knowledge score (mean = 5.9; SD = 1.9). Significant determinants of insufficient medication knowledge with respective odds ratio (OR) were: level of education (≤ 3 years, OR 1.50; 95% CI 1.06-2.11 and 4-7 years, OR 1.37; 95% CI 1.02-1.84), number of comorbidities (≤ 2, OR 1.36; 95% CI 1.04-1.77), use of prescription drugs in the last 15 days (no, OR 2.22; 95% CI 1.31-3.76) and number of people able to lend money (no person, OR 1.34; 95% CI 1.04-1.74). Conclusion Counselling and monitoring practices should be tailored to patients with less schooling, that are initiating treatment and with low disease burden. Equally important is the need to implement strategies to increase the patient's level of social capital to improve treatment knowledge.
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Pengpid S, Peltzer K. Chronic conditions, multimorbidity, and quality of life among patients attending monk healers and primary care clinics in Thailand. Health Qual Life Outcomes 2021; 19:61. [PMID: 33622328 PMCID: PMC7903786 DOI: 10.1186/s12955-021-01707-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 02/16/2021] [Indexed: 12/20/2022] Open
Abstract
Background The study aimed to assess chronic diseases, multimorbidity, and QoL among patients attending two different treatment settings in Thailand. Methods In all, 1409 attendees of three monk healer or three health centres were assessed with self-reported measures on chronic conditions and Quality of Life (QoL). Results Results indicate that the most common chronic conditions were common mental disorder (25.2%), followed by hypertension (22.8%), high blood cholesterol (18.0%), fatigue disorder (14.4%), diabetes (14.0%), migraine headaches (13.7%), sleeping problem (12.2%), and ulcer (11.0%). In all, 40.6% had multimorbidity (two or more chronic conditions) (42.4% in the monk healer and 38.9% in the primary care setting). In ANCOVA analysis, adjusted for sex, age, employment status, marital status, education, economic status, comorbidity, and health care setting, the poorest overall QoL was found among clients with common mental disorders (58.5 mean score), followed by emphysema or asthma (60.2), sleeping problem (61.5), migraine headaches (62.7), fatigue disorder (63.3), substance use disorder (63.6) and ulcer (64.3). The overall QoL was poorer among monk healer clients (66.5) than primary care patients (68.8). In adjusted logistical regression analysis, being a monk healer attendee, older age (55–93 years), and high debt were positively, and being employed and better overall quality of life were negatively associated with multimorbidity, overall, for the monk healer and primary care setting. In adjusted linear regression analyses, primary health care attenders, older age, were employed and post-secondary education increased the odds of better overall QoL. Conclusion Multimorbidity was higher among clients attending monk healers than those attending primary care facilities and QoL was poorer among clients seeking care from monk healers than those attending primary care. High multimorbidity was found and major chronic conditions were found to have poor QoL. Determinants of multimorbidity and QoL in two different treatment settings provide information to improve the management of chronic conditions.
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Affiliation(s)
- Supa Pengpid
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, Thailand.,Department of Research Administration and Development, University of Limpopo, Turfloop, Mankweng, South Africa
| | - Karl Peltzer
- Department of Psychology, University of the Free State, Bloemfontein, South Africa.
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Pati S, Mahapatra P, Kanungo S, Uddin A, Sahoo KC. Managing Multimorbidity (Multiple Chronic Diseases) Amid COVID-19 Pandemic: A Community Based Study From Odisha, India. Front Public Health 2021; 8:584408. [PMID: 33598442 PMCID: PMC7882709 DOI: 10.3389/fpubh.2020.584408] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 12/14/2020] [Indexed: 12/12/2022] Open
Abstract
While most of the studies to date demonstrate the deleterious effect of multiple chronic diseases on COVID-19 risk and outcome, there is sparse information available on the effect of the pandemic on multimorbidity management, with no reports yet from India. We sought to explore the effect of COVID-19 pandemic on routine and emergency care for multimorbidity among community-dwelling adults in Odisha, India. A community-based cross-sectional study was undertaken pandemic lockdown, in Khurda district of Odisha, India. Around 600 individuals having at least one chronic disease residing in rural, urban residential and slums were interviewed using a specifically developed questionnaire MAQ COVID-19. The association of socio-demographic characteristics and multimorbidity with pandemic-related care challenges was examined by multiple logistic regression. Principal Component Analysis was employed to minimize the dimensionality of factors related to multimorbidity care. Multimorbidity was highly prevalent in younger age group (46-60 years) with cardio-metabolic clusters being dominant. Individuals with multimorbidity experienced significantly higher care challenges than those with single condition (AOR = 1.48, 95% CI = 1.01-2.05) with notable disruption in treatment and routine check-up. Most frequently cited concerns were-physician consultation (43%), diagnostic-services (26%), transport (33%), and mobility restrictions (21%). Multivariate analysis revealed older adults living alone in urban residence to have higher challenges than their rural counterparts. Patient activation for self-care, multimorbidity literacy, and technology-enabled tele-consultation could be explored as potential interventions. Future studies should qualitatively explore the challenges of physicians as well as garner an in-depth understanding of multimorbidity management in the vulnerable subgroups.
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Affiliation(s)
- Sanghamitra Pati
- Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, India
| | - Pranab Mahapatra
- Department of Psychiatry, Kalinga Institute of Medical Sciences, Bhubaneswar, India
| | - Srikanta Kanungo
- Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, India
| | - Azhar Uddin
- Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, India
| | - Krushna Chandra Sahoo
- Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, India
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Pati S, Sahoo K, Kanungo S, Mahapatra P. Non-communicable diseases care during COVID-19 pandemic: A mixed-method study in Khurda district of Odisha, India. Indian J Med Res 2021. [PMID: 34380806 PMCID: PMC8555599 DOI: 10.4103/ijmr.ijmr_3185_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background & objectives: During any public health emergency, a need-based national non-communicable diseases (NCD) preparedness plan is essential. People living with NCDs could face challenges owing to restricted mobility, low access to medical care and suboptimal logistics during the pandemic. The present study explored the effect of the COVID-19 pandemic on NCD care in a district of Odisha State of India. Methods: This study was carried out during May-June 2020 in the Khurda district of Odisha. A community-based explanatory mixed-method study was followed. Data collection comprised 12 in-depth interviews and 491 structured interviews using Likert-questionnaire with individuals having at least one NCD. Mantel-Haenszel's Chi-square test was used to assess the difference in the effect of COVID-19 on the routine NCD care. Qualitative data were analyzed by content analysis. Results: Findings revealed that nearly two-thirds of participants encountered challenges in their routine investigation (69%), day-care procedures (67%) and reaching hospital (61%). Around half of them reported having trouble in doctor appointments (59%), emergency treatment (56%), access to the pharmacy (47%) and delay in healthcare (46%). Thirty seven per cent perceived that they could not access care because of social restriction/lockdown, 29 per cent attributed arranging finance as a constraint to visiting hospitals and 16 per cent avoided going to the hospital, fearing COVID-19 infection. Interpretation & conclusions: Our findings showed that people with chronic NCDs faced multiple challenges in accessing health care during the pandemic. A cohesive doctor-pharmacy-patient engagement is vital for managing NCD care during a pandemic. During emergencies, changes in dispensing practices and service provision closer to the patients are crucial. Additionally, health literacy and home-based NCD management should be encouraged.
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Sahoo KC, Kanungo S, Mahapatra P, Pati S. Non-communicable diseases care during COVID-19 pandemic: A mixed-method study in Khurda district of Odisha, India. Indian J Med Res 2021; 153:649-657. [PMID: 34380806 PMCID: PMC8555599 DOI: 10.4103/0971-5916.323435] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND & OBJECTIVES During any public health emergency, a need-based national non-communicable diseases (NCD) preparedness plan is essential. People living with NCDs could face challenges owing to restricted mobility, low access to medical care and suboptimal logistics during the pandemic. The present study explored the effect of the COVID-19 pandemic on NCD care in a district of Odisha State of India. METHODS This study was carried out during May-June 2020 in the Khurda district of Odisha. A community-based explanatory mixed-method study was followed. Data collection comprised 12 in-depth interviews and 491 structured interviews using Likert-questionnaire with individuals having at least one NCD. Mantel-Haenszel's Chi-square test was used to assess the difference in the effect of COVID-19 on the routine NCD care. Qualitative data were analyzed by content analysis. RESULTS Findings revealed that nearly two-thirds of participants encountered challenges in their routine investigation (69%), day-care procedures (67%) and reaching hospital (61%). Around half of them reported having trouble in doctor appointments (59%), emergency treatment (56%), access to the pharmacy (47%) and delay in healthcare (46%). Thirty seven per cent perceived that they could not access care because of social restriction/lockdown, 29 per cent attributed arranging finance as a constraint to visiting hospitals and 16 per cent avoided going to the hospital, fearing COVID-19 infection. INTERPRETATION & CONCLUSIONS Our findings showed that people with chronic NCDs faced multiple challenges in accessing health care during the pandemic. A cohesive doctor-pharmacy-patient engagement is vital for managing NCD care during a pandemic. During emergencies, changes in dispensing practices and service provision closer to the patients are crucial. Additionally, health literacy and home-based NCD management should be encouraged.
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Affiliation(s)
- Krushna Chandra Sahoo
- Regional Resource Hub, Health Technology Assessment in India, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Srikanta Kanungo
- Regional Resource Hub, Health Technology Assessment in India, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Pranab Mahapatra
- Department of Psychiatry, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sanghamitra Pati
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India,For correspondence: Dr Sanghamitra Pati, ICMR-Regional Medical Research Centre, Bhubaneswar 751 023, Odisha, India e-mail:
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