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Zhang S, Strayer N, Vessels T, Choi K, Wang GW, Li Y, Bejan CA, Hsi RS, Bick AG, Velez Edwards DR, Savona MR, Phillips EJ, Pulley JM, Self WH, Hopkins WC, Roden DM, Smoller JW, Ruderfer DM, Xu Y. PheMIME: an interactive web app and knowledge base for phenome-wide, multi-institutional multimorbidity analysis. J Am Med Inform Assoc 2024:ocae182. [PMID: 39127052 DOI: 10.1093/jamia/ocae182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 06/03/2024] [Accepted: 07/18/2024] [Indexed: 08/12/2024] Open
Abstract
OBJECTIVES To address the need for interactive visualization tools and databases in characterizing multimorbidity patterns across different populations, we developed the Phenome-wide Multi-Institutional Multimorbidity Explorer (PheMIME). This tool leverages three large-scale EHR systems to facilitate efficient analysis and visualization of disease multimorbidity, aiming to reveal both robust and novel disease associations that are consistent across different systems and to provide insight for enhancing personalized healthcare strategies. MATERIALS AND METHODS PheMIME integrates summary statistics from phenome-wide analyses of disease multimorbidities, utilizing data from Vanderbilt University Medical Center, Mass General Brigham, and the UK Biobank. It offers interactive and multifaceted visualizations for exploring multimorbidity. Incorporating an enhanced version of associationSubgraphs, PheMIME also enables dynamic analysis and inference of disease clusters, promoting the discovery of complex multimorbidity patterns. A case study on schizophrenia demonstrates its capability for generating interactive visualizations of multimorbidity networks within and across multiple systems. Additionally, PheMIME supports diverse multimorbidity-based discoveries, detailed further in online case studies. RESULTS The PheMIME is accessible at https://prod.tbilab.org/PheMIME/. A comprehensive tutorial and multiple case studies for demonstration are available at https://prod.tbilab.org/PheMIME_supplementary_materials/. The source code can be downloaded from https://github.com/tbilab/PheMIME. DISCUSSION PheMIME represents a significant advancement in medical informatics, offering an efficient solution for accessing, analyzing, and interpreting the complex and noisy real-world patient data in electronic health records. CONCLUSION PheMIME provides an extensive multimorbidity knowledge base that consolidates data from three EHR systems, and it is a novel interactive tool designed to analyze and visualize multimorbidities across multiple EHR datasets. It stands out as the first of its kind to offer extensive multimorbidity knowledge integration with substantial support for efficient online analysis and interactive visualization.
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Affiliation(s)
- Siwei Zhang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
| | | | - Tess Vessels
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Karmel Choi
- Psychiatric & Neuro Developmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, United States
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Geoffrey W Wang
- Department of Statistics, North Carolina State University, Raleigh, NC 27695, United States
| | - Yajing Li
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
| | - Cosmin A Bejan
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
| | - Ryan S Hsi
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Alexander G Bick
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Digna R Velez Edwards
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Michael R Savona
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Elizabeth J Phillips
- Center for Drug Safety and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, United States
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, WA 6150, Australia
| | - Jill M Pulley
- Vanderbilt Institute for Clinical and Translational Science, Vanderbilt University Medical Center, Nashville, TN 37203, United States
| | - Wesley H Self
- Vanderbilt Institute for Clinical and Translational Science, Vanderbilt University Medical Center, Nashville, TN 37203, United States
| | - Wilkins Consuelo Hopkins
- Vanderbilt Institute for Clinical and Translational Science, Vanderbilt University Medical Center, Nashville, TN 37203, United States
| | - Dan M Roden
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Jordan W Smoller
- Psychiatric & Neuro Developmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, United States
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, United States
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA 02142, United States
| | - Douglas M Ruderfer
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, United States
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN 37212, United States
| | - Yaomin Xu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
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Gupta P, Bharati B, Sundar Sahu K, Mahapatra P, Pati S. Self-reported symptom burden among patients attending public health care facilities in India: Looking through ICPC-3 lens. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0001835. [PMID: 38709793 PMCID: PMC11073677 DOI: 10.1371/journal.pgph.0001835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 04/02/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION The objectives of this study were: 1) to describe the socio-demographics and classify the chief complaints and reasons to encounter facilities of patients presenting to public healthcare facilities; 2) to explore differences in these complaints and: International Classification of Primary Care-3 (ICPC-3) groups across socio-demographic and health system levels. METHODS This is a cross-sectional study conducted in three districts of Odisha, India. Within each district, the district hospital (DH), one Sub-district hospital (SDH) (if available), two Community health centers (CHCs), and two Primary health care centers (PHCs) were selected. Thus, a total of three DHs, three SDHs, six CHCs, and six PHCs were covered. Two tertiary healthcare facilities were also included. Patients aged 18 years and older, attending the Outpatient Departments (OPD) of sampled health facilities were chosen as study participants through systematic random sampling. RESULTS A total of 3044 patients were interviewed. In general, 65% of the sample reported symptoms as their chief complaint for reason of encounter, whereas 35% reported disease and diagnosis. The most common reasons to encounter health facilities were fever, hypertension, abdominal pain, chest pain, arthritis, skin disease, cough, diabetes, and injury. Among the symptoms, the highest number of patients reported the general category (29%), followed by the digestive system (16%). In the disease category, the circulatory system has the highest proportion, followed by the musculatory system. In symptom categories, general, digestive, and musculatory systems were the key systems for the reasons of encounter in outpatient departments irrespective of different groups of the population. In terms of different tiers of health systems, the top three reasons to visit OPD were dominated by the circulatory system, respiratory system, and musculatory system. CONCLUSION This is the first Indian study using the ICPC-3 classification for all three levels of health care. Irrespective of age, socio-economic variables, and tiers of healthcare, the top three groups to visit public health facilities according to the ICPC-3 classification were consistent i.e., general, digestive, and circulatory. Implementation of standard management and referral guidelines for common diseases under these groups will improve the quality and burden at public health facilities in India.
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Affiliation(s)
- Priti Gupta
- Research Department, Centre for Chronic Disease Control, New Delhi, India
| | - Bhavna Bharati
- Department of Public Health, Bhubaneswar Advanced Rehabilitation Center, Bhubaneswar, Odisha, India
| | - Kirti Sundar Sahu
- Department of Public Health, Bhubaneswar Advanced Rehabilitation Center, Bhubaneswar, Odisha, India
| | - Pranab Mahapatra
- Department of Psychiatry, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Sanghamitra Pati
- Department of Health Research, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
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Chauhan A, Parmar M, Rajesham JD, Shukla S, Sahoo KC, Chauhan S, Chitiboyina S, Sinha A, Srigana G, Gorla M, Pati S. Landscaping tuberculosis multimorbidity: findings from a cross-sectional study in India. BMC Public Health 2024; 24:453. [PMID: 38350875 PMCID: PMC10863254 DOI: 10.1186/s12889-024-17828-z] [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: 08/22/2023] [Accepted: 01/19/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Multimorbidity, the concurrent presence of two or more chronic conditions is an emerging public health challenge. Till date, most of the research have focused on the presence and interaction of selected co-morbidities in tuberculosis (TB). There exist a critical knowledge gap on the magnitude of multimorbidity among TB patients and its impact on health outcomes. METHODS We undertook a cross-sectional study to assess the prevalence and patterns of multimorbidity among newly diagnosed TB patients in two states of India. A total of 323 patients were interviewed using a structured multimorbidity assessment questionnaire for primary care (MAQ-PC). MAQ-PC is already validated for Indian population and elicits 22 chronic conditions. We defined TB multimorbidity as the co-existence of TB with one or more chronic conditions and identified commonly occurring dyads (TB + single condition) and triads (TB + two conditions). RESULTS More than half (52%) of TB patients reported multimorbidity. Among dyads, depression, diabetes mellitus (DM), acid peptic disease (APD), hypertension, chronic alcoholism, arthritis and chronic back ache (CBA) were the most common co-occurring conditions while 'DM + arthritis', 'depression + APD', 'depression + DM' were the most commonly occurring triads among TB patients. Factors such as increasing age, low levels of education, alcohol abusers, drug-resistant TB and having health insurance were significantly associated with multimorbidity among TB patients. CONCLUSIONS Our findings suggest high prevalence of multimorbidity among newly diagnosed TB patients in India. The presence of concordant and discordant conditions with TB may increase the health complexity, thus necessitating appropriate care protocols. Given, the current situation, wherein TB and non-communicable diseases (NCD) services are delivered through collaborative framework between programmes, there is a need for addressing multimorbidity at the healthcare delivery level.
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Affiliation(s)
- A Chauhan
- Public Health Foundation of India, New Delhi, India
| | - M Parmar
- World Health Organization, Country Office for India, New Delhi, India
| | - J D Rajesham
- State Tuberculosis Cell, Hyderabad, Telangana, India
| | - S Shukla
- World Health Organization, National Tuberculosis Elimination Programme - Technical Support Network, New Delhi, India
| | - K C Sahoo
- Indian Council of Medical Research-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - S Chauhan
- World Health Organization, National Tuberculosis Elimination Programme - Technical Support Network, New Delhi, India
| | - S Chitiboyina
- State TB Training and Demonstration Centre, Hyderabad, Telangana, India
| | - A Sinha
- Indian Council of Medical Research-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - G Srigana
- World Health Organization, National Tuberculosis Elimination Programme - Technical Support Network, New Delhi, India
| | - M Gorla
- World Health Organization, National Tuberculosis Elimination Programme - Technical Support Network, New Delhi, India
| | - Sanghamitra Pati
- Indian Council of Medical Research-Regional Medical Research Centre, Bhubaneswar, Odisha, India.
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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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lohani S, Sharma SK, Singh SB, Uranw S, Ghimire A. Prevalence of multimorbidity and its associated risk factors among population of Mechinagar municipality of Nepal. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2024; 14:26335565241237892. [PMID: 38496747 PMCID: PMC10943707 DOI: 10.1177/26335565241237892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 02/20/2024] [Indexed: 03/19/2024]
Abstract
Background Multimorbidity is a group of conditions, it has significant impact on the population as a whole, resulting in lower quality of life, higher mortality, frequent use of medical services, and consequently higher healthcare costs. The objective of this study is to document the prevalence of common multimorbidity and its associated risk factors among population of Mechinagar Municipality. Methods Community-based cross-sectional study was conducted where selected multimorbidity were assessed in selected areas of Mechinagar municipality of Jhapa District . Systematic random sampling technique was used to select 590 adult participants from three pre-defined pocket areas. Pre-designed semi-structured multimorbidity assessment questionnaire for primary care (MAQ-PC)was used to assess prevalence of multimorbidity. Multiple logistic regression was conducted to identify the strongest determinants of multimorbidity. Results The prevalence of multimorbidity was 22.4%.Hypertension, Diabetes mellitus and COPD was seen in 39.2%, 7.8.% and 4.4% of the participants respectively . Participants with advancing age i. e. 40-49yrs were 12.62 times (AOR) more likely to have multimorbidity compared to their counterparts who were 20-29yrs old( p=<0.01,CI3.01-15.28) after adjusting for occupation, physical activity and family history of kidney disease. Working individuals, Physical inactivity and positive family history of kidney disease were the strongest determinates of multimorbidity. Conclusions The study revealed that participants with increasing age, working individuals, physical inactivity and family history of kidney disease were more vulnerable of having multimorbidity. The findings of our study indicate need of intervention strategies and community-based health promotion programs in reducing burden of chronic disease among adult population.
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Affiliation(s)
- Suman lohani
- B.P Koirala Institute of Health Sciences, Dharan, Nepal
- Bharatpur Hospital, Bharatpur, Nepal
| | | | | | | | - Anup Ghimire
- B.P Koirala Institute of Health Sciences, Dharan, Nepal
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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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Varanasi R, Sinha A, Nayak D, Manchanda RK, Janardhanan R, Tandon S, Pati S. Prevalence and correlates of multimorbidity among patients attending AYUSH primary care settings in Delhi-National Capital Region, India. BMC Complement Med Ther 2023; 23:429. [PMID: 38031066 PMCID: PMC10685658 DOI: 10.1186/s12906-023-04158-7] [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: 02/26/2023] [Accepted: 09/07/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION India has a multifaceted healthcare system and recognizes complementary and alternative systems of medicine (AYUSH) that cater to the healthcare needs of people. Multimorbidity requires frequent visits to physicians and long-term use of medications, due to which people tend to prefer AYUSH systems as they provide holistic patient-centered treatment. Hence, we aimed to estimate the prevalence of multimorbidity and assess its correlates among patients attending AYUSH primary care clinics in Delhi. METHODS A cross-sectional study was conducted among 943 patients aged ≥ 18 years attending various AYUSH primary care clinics in Delhi from September 2021 to February 2022, employing a stratified random sampling technique. Descriptive statistics such as frequency and proportion were used to report the prevalence of multimorbidity (two or more chronic conditions in an individual out of the 33 conditions listed as per the Multimorbidity Assessment Questionnaire for Primary Care). A multivariable logistic regression assessed the association between various socio-demographic characteristics and multimorbidity, presented as an adjusted odds ratio (AOR) with a 95% confidence interval (CI). RESULTS The prevalence of diabetes (14.7%) was found to be the highest (out of all included chronic conditions) among the patients attending various AYUSH primary care settings. The overall prevalence of multimorbidity was observed to be around 39.4%. We observed a higher likelihood of having multimorbidity among participants aged ≥ 70 years [AOR: 9.19 (95% CI: 3.75-22.54)], females [AOR: 1.57 (95% CI: 1.04-2.37)], and middle class [AOR: 2.23 (95% CI: 1.45-3.43)]. CONCLUSION Multimorbidity was evidently prevalent across AYUSH primary care settings, which cannot be overlooked. The results suggest behavioral change communication may be aimed at older individuals, females, and the middle class.
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Affiliation(s)
- Roja Varanasi
- Amity Institute of Public Health, Amity University, Noida, India.
- Central Council for Research in Homoeopathy, Ministry of AYUSH, New Delhi, India.
| | - Abhinav Sinha
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Debadatta Nayak
- Amity Institute of Public Health, Amity University, Noida, India
- Central Council for Research in Homoeopathy, Ministry of AYUSH, New Delhi, India
| | | | - Rajiv Janardhanan
- Amity Institute of Public Health, Amity University, Noida, India
- SRM Institute of Science & Technology, Chennai, Tamil Nadu, India
| | - Simran Tandon
- Amity School of Health Sciences, Amity University, Mohali, Punjab, India
| | - Sanghamitra Pati
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India.
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Lieber J, Banjara SK, Mallinson PAC, Mahajan H, Bhogadi S, Addanki S, Birk N, Song W, Shah AS, Kurmi O, Iyer G, Kamalakannan S, Kishore Galla R, Sadanand S, Dasi T, Kulkarni B, Kinra S. Burden, determinants, consequences and care of multimorbidity in rural and urbanising Telangana, India: protocol for a mixed-methods study within the APCAPS cohort. BMJ Open 2023; 13:e073897. [PMID: 38011977 PMCID: PMC10685937 DOI: 10.1136/bmjopen-2023-073897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION The epidemiological and demographic transitions are leading to a rising burden of multimorbidity (co-occurrence of two or more chronic conditions) worldwide. Evidence on the burden, determinants, consequences and care of multimorbidity in rural and urbanising India is limited, partly due to a lack of longitudinal and objectively measured data on chronic health conditions. We will conduct a mixed-methods study nested in the prospective Andhra Pradesh Children and Parents' Study (APCAPS) cohort to develop a data resource for understanding the epidemiology of multimorbidity in rural and urbanising India and developing interventions to improve the prevention and care of multimorbidity. METHODS AND ANALYSIS We aim to recruit 2100 APCAPS cohort members aged 45+ who have clinical and lifestyle data collected during a previous cohort follow-up (2010-2012). We will screen for locally prevalent non-communicable, infectious and mental health conditions, alongside cognitive impairments, disabilities and frailty, using a combination of self-reported clinical diagnosis, symptom-based questionnaires, physical examinations and biochemical assays. We will conduct in-depth interviews with people with varying multimorbidity clusters, their informal carers and local healthcare providers. Deidentified data will be made available to external researchers. ETHICS AND DISSEMINATION The study has received approval from the ethics committees of the National Institute of Nutrition and Indian Institute of Public Health Hyderabad, India and the London School of Hygiene and Tropical Medicine, UK. Meta-data and data collection instruments will be published on the APCAPS website alongside details of existing APCAPS data and the data access process (www.lshtm.ac.uk/research/centres-projects-groups/apcaps).
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Affiliation(s)
- Judith Lieber
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | | | - Poppy Alice Carson Mallinson
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Hemant Mahajan
- National Institute of Nutrition, Hyderabad, Telangana, India
| | | | | | - Nick Birk
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Wenbo Song
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
- Nagasaki University, Nagasaki, Japan
| | - Anoop Sv Shah
- Centre for Global Chronic Conditions, Faculty of Epidemiology and Population Health, Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Om Kurmi
- Coventry University, Coventry, UK
| | - Gowri Iyer
- Indian Institute of Public Health Hyderabad, Hyderabad, India
| | - Sureshkumar Kamalakannan
- SACDIR, Public Health Foundation of India, New Delhi, India
- International Center for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Shilpa Sadanand
- Indian Institute of Public Health Hyderabad, Hyderabad, India
| | - Teena Dasi
- National Institute of Nutrition, Hyderabad, Telangana, India
| | - Bharati Kulkarni
- National Institute of Nutrition, Hyderabad, Telangana, India
- Indian Council of Medical Research, New Delhi, India
| | - Sanjay Kinra
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
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Mkhwanazi TW, Modjadji P, Mokgalaboni K, Madiba S, Roomaney RA. Multimorbidity, Treatment, and Determinants among Chronic Patients Attending Primary Health Facilities in Tshwane, South Africa. Diseases 2023; 11:129. [PMID: 37873773 PMCID: PMC10594487 DOI: 10.3390/diseases11040129] [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: 08/23/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/25/2023] Open
Abstract
The growing burden of non-communicable diseases amidst the largest burden of HIV in South Africa leads to disease combinations of multimorbidity with the complexity of care. We conducted a cross-sectional study to assess multimorbidity, medication adherence, and associated factors among out-patients with chronic diseases in primary health care (PHC) facilities in Tshwane, South Africa. A structured questionnaire was used to collect data on comorbidities and medication adherence, along with socio-demographic and lifestyle factors. Logistic regression models were used to analyse the determinants of multimorbidity and medication adherence. In all 400 patients with chronic diseases (mean age: 47 ± 12 years) living in poor environments, common chronic conditions were hypertension (62%), diabetes (45%), HIV (44%), TB (33%), hypercholesterolemia (18%), and gout (13%). The proportion of concordant comorbidity (i.e., diseases with similar risk profiles and management) was 72%, more than 28% of discordant comorbidity (i.e., diseases not related in pathogenesis or management). Most patients had two coexisting chronic conditions (75%), while few had more than two chronic conditions (23%) and single-occurring conditions (2%). Prevalence rates for common multimorbidity patterns were 25% (HIV and TB), 17% (hypertension and diabetes), 9% (hypertension, diabetes, and hypercholesterolemia), and 2% (hypertension diabetes and HIV), while medication adherence was estimated at 74%. In multivariate analysis, multimorbidity was associated with an older age and lower socio-economic status, while medication non-adherence was associated with a younger age and socio-economic factors. The study highlights the presence of multimorbidity among primary care patients attributed to hypertension, diabetes, HIV, and TB in South Africa with non-adherence to medication in one-third of patients. Policies are needed for education on multimorbidity with a need to optimize lifestyle modifications, perhaps proactive outreach or nursing contact with high-risk patients with public-health-sensitive conditions, such as HIV and/or TB, as well as patients with a history of non-adherence to medications. Considerations should be given to the development of a medication adherence scale for multiple chronic conditions beyond assessing adherence to a single index medication.
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Affiliation(s)
- Thandiwe Wendy Mkhwanazi
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa
| | - Perpetua Modjadji
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa
| | - Kabelo Mokgalaboni
- Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Florida Campus, Roodepoort 1709, South Africa
| | - Sphiwe Madiba
- Faculty of Health Sciences, University of Limpopo, Polokwane 0700, South Africa
| | - Rifqah Abeeda Roomaney
- Burden of Disease Research Unit, South African Medical Research Council, Parowvallei, Tygerberg, Cape Town 7505, South Africa
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Ahmed W, Muhammad T, Muneera K. Prevalence of early and late onset of chronic diseases and multimorbidity and its association with physical, mental and functional health among older Indian adults. BMC Geriatr 2023; 23:563. [PMID: 37710170 PMCID: PMC10502995 DOI: 10.1186/s12877-023-04264-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Identifying people with early and late onset of chronic conditions might help target the subpopulations that are more vulnerable to negative mental, physical and functional health outcomes. The current study aimed to examine the association of early and late onset of chronic single and multiple morbidities with self-perceived physical and mental health, functional limitations and physical inactivity among older Indian adults. METHODS Cross-sectional study was conducted using data from the Longitudinal Ageing Study in India (LASI) Wave 1 (2017-2018). The total sample size for the present study was 31,386 older adults age 60 years or older. Multivariable binary logistic regression analysis was used to establish the association between the outcomes (poor perceived physical/mental health, functional difficulty and physical inactivity) and explanatory variables (early [ = < 50 years of age] and late [> 50 years]) onset of chronic illnesses such as hypertension, diabetes, heart attack, heart disease, stroke, cancer, lung disease, arthritis, osteoporosis and psychiatric disease). RESULTS Overall, 24.21% of the sample population had poor self-perceived physical health, whereas 8.67% of participants had poor self-perceived mental health. The prevalence of difficulty in ADL, difficulty in IADL, and physical inactivity was 23.77%, 48.36%, and 68.9%, respectively. Odds of poor perceived mental health were higher for the respondents with early as well as late onset of hypertension, stroke, and arthritis; while individuals with late onset of diabetes, and heart disease had higher odds of poor perceived mental health than those without chronic disease. Individuals with early onset of single morbidity were more likely to report ADL difficulty (adjusted odds ratio [AOR]: 1.33, confidence interval [CI]: 1.06-1.67); while those with late onset of single (AOR: 1.34, CI: 1.17-1.53) and multimorbidity (AOR: 1.91, CI: 1.63-2.24) were more likely to report ADL difficulty compared with individuals without morbidity. Individuals with early as well as late-onset of multimorbidity had more than two times higher odds of reporting poor physical health, poor mental health and IADL difficulty compared with individuals without chronic disease. CONCLUSIONS The present study revealed that early and/or late onset of chronic single and/or multiple morbidities significantly predicted poor self-perceived physical and mental health, functional limitations and physical inactivity among older Indian adults. The findings further suggest that late onset of chronic diseases such as cancer and stroke and multi-morbidity had stronger associations with physical inactivity that may help identify high risk groups for screening and support.
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Affiliation(s)
- Waquar Ahmed
- School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India
| | - T Muhammad
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, India.
| | - K Muneera
- National Institute of Technology, Calicut, Kerala, 673601, India
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Zhang S, Strayer N, Vessels T, Choi K, Wang GW, Li Y, Bejan CA, Hsi RS, Bick AG, Velez Edwards DR, Savona MR, Philips EJ, Pulley J, Self WH, Hopkins WC, Roden DM, Smoller JW, Ruderfer DM, Xu Y. PheMIME: An Interactive Web App and Knowledge Base for Phenome-Wide, Multi-Institutional Multimorbidity Analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.23.23293047. [PMID: 37547012 PMCID: PMC10402210 DOI: 10.1101/2023.07.23.23293047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Motivation Multimorbidity, characterized by the simultaneous occurrence of multiple diseases in an individual, is an increasing global health concern, posing substantial challenges to healthcare systems. Comprehensive understanding of disease-disease interactions and intrinsic mechanisms behind multimorbidity can offer opportunities for innovative prevention strategies, targeted interventions, and personalized treatments. Yet, there exist limited tools and datasets that characterize multimorbidity patterns across different populations. To bridge this gap, we used large-scale electronic health record (EHR) systems to develop the Phenome-wide Multi-Institutional Multimorbidity Explorer (PheMIME), which facilitates research in exploring and comparing multimorbidity patterns among multiple institutions, potentially leading to the discovery of novel and robust disease associations and patterns that are interoperable across different systems and organizations. Results PheMIME integrates summary statistics from phenome-wide analyses of disease multimorbidities. These are currently derived from three major institutions: Vanderbilt University Medical Center, Mass General Brigham, and the UK Biobank. PheMIME offers interactive exploration of multimorbidity through multi-faceted visualization. Incorporating an enhanced version of associationSubgraphs, PheMIME enables dynamic analysis and inference of disease clusters, promoting the discovery of multimorbidity patterns. Once a disease of interest is selected, the tool generates interactive visualizations and tables that users can delve into multimorbidities or multimorbidity networks within a single system or compare across multiple systems. The utility of PheMIME is demonstrated through a case study on schizophrenia. Availability and implementation The PheMIME knowledge base and web application are accessible at https://prod.tbilab.org/PheMIME/. A comprehensive tutorial, including a use-case example, is available at https://prod.tbilab.org/PheMIME_supplementary_materials/. Furthermore, the source code for PheMIME can be freely downloaded from https://github.com/tbilab/PheMIME. Data availability statement The data underlying this article are available in the article and in its online web application or supplementary material.
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Affiliation(s)
- Siwei Zhang
- Department of Biostatistics, Vanderbilt University, Nashville, TN, USA
| | | | - Tess Vessels
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Karmel Choi
- Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston MA
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston MA
| | | | - Yajing Li
- Department of Biostatistics, Vanderbilt University, Nashville, TN, USA
| | - Cosmin A Bejan
- Department of Biomedical informatics, Vanderbilt University, Nashville, TN, USA
| | - Ryan S Hsi
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alexander G Bick
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Digna R Velez Edwards
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael R Savona
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth J Philips
- Center for Drug Safety and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
| | - Jill Pulley
- Vanderbilt Institute for Clinical and Translational Science, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wesley H Self
- Vanderbilt Institute for Clinical and Translational Science, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wilkins Consuelo Hopkins
- Vanderbilt Institute for Clinical and Translational Science, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dan M Roden
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jordan W Smoller
- Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston MA
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston MA
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA
| | - Douglas M Ruderfer
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical informatics, Vanderbilt University, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yaomin Xu
- Department of Biostatistics, Vanderbilt University, Nashville, TN, USA
- Department of Biomedical informatics, Vanderbilt University, Nashville, TN, USA
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Gupta P, Cunningham SA, Ali MK, Mohan S, Mahapatra P, Pati SC. Multimorbidity clusters and associated health care cost among patients attending psychiatric clinics in Odisha, India. Indian J Psychiatry 2023; 65:736-741. [PMID: 37645353 PMCID: PMC10461583 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_463_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 03/30/2023] [Accepted: 05/31/2023] [Indexed: 08/31/2023] Open
Abstract
Introduction There is a dearth of data on common multimorbidity clusters and the healthcare costs for individuals with mental health disorders. This study aimed to identify clinically meaningful physical-mental multimorbidity clusters, frequently occurring clusters of conditions, and healthcare utilization patterns and expenditure among patients attending a psychiatric outpatient clinic. Materials and Methods Data were collected in the psychiatric outpatient department among patients aged 18 years and above in February-July 2019 (n = 500); follow-up data on non-communicable disease incidence were collected after 18 months. For analysis, morbidity clusters were defined using two approaches: 1) agglomerative hierarchical clustering method to identify clusters of diseases; and 2) non-hierarchical cluster k mean analysis to identify clusters of patients. Self-reported healthcare costs in these clusters were also calculated. Result Two disease clusters were identified: using the 1st approach were; 1) hypertension, diabetes, and mood disorder; 2) Neurotic, stress-related, and somatoform disorders, and acid peptic disease. Three clusters of patients identified using the 2nd approach were identified: 1) those with mood disorders and cardiometabolic, musculoskeletal, and thyroid diseases; 2) those with neurotic, substance use, and organic mental disorders, cancer, and epilepsy; and 3) those with Schizophrenia. Patients in Cluster 1 were taking more than six medicines and had more hospital visits. Within 18 months, 41 participants developed either one or two chronic conditions, most commonly diabetes, hypertension, or thyroid disease. Conclusion Cardiometabolic diseases are most commonly clustered with mood disorders. There is a need for blood pressure and sugar measurement in psychiatric clinics and mood disorder screening in cardiac, endocrinology, and primary care clinics.
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Affiliation(s)
- Priti Gupta
- Research Department, Centre for Chronic Disease Control, New Delhi, India
| | | | - Mohammed K. Ali
- Department of Global Health, Emory University, Atlanta, Georgia
| | - Sailesh Mohan
- Centre for Chronic Conditions and Injuries (CCCI), Public Health Foundation of India, Delhi, India
| | - Pranab Mahapatra
- Department of Psychiatry, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Sanghamitra C. Pati
- Department of Health Research, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
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Palo SK, Nayak SR, Sahoo D, Nayak S, Mohapatra AK, Sahoo A, Dash P, Pati S. Prevalence and pattern of multimorbidity among chronic kidney disease patients: a community study in chronic kidney disease hotspot area of Eastern India. Front Med (Lausanne) 2023; 10:1131900. [PMID: 37250643 PMCID: PMC10213441 DOI: 10.3389/fmed.2023.1131900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 04/27/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Chronic kidney disease (CKD) is mostly asymptomatic until reaching an advanced stage. Although conditions such as hypertension and diabetes can cause it, CKD can itself lead to secondary hypertension and cardiovascular disease (CVD). Understanding the types and prevalence of associated chronic conditions among CKD patient could help improve screening for early detection and case management. Methods A cross sectional study of 252 CKD patients in Cuttack, Odisha (from the last 4 years CKD data base) was telephonically carried out using a validated Multimorbidity Assessment Questionnaire for Primary Care (MAQ-PC) tool with the help of an android Open Data Kit (ODK). Univariate descriptive analysis was done to determine the socio-demographic distribution of CKD patients. A Cramer's heat map was generated for showing Cramer's coefficient value of association of each diseases. Results The mean age of participants was 54.11 (±11.5) years and 83.7% were male. Among the participants, 92.9% had chronic conditions (24.2% with one, 26.2% with two and 42.5% with three or more chronic conditions). Most prevalent chronic conditions were hypertension (48.4%), peptic ulcer disease (29.4%), osteoarthritis (27.8%) and diabetes (13.1%). Hypertension and osteoarthritis were found to be most commonly associated (Cramer's V coefficient = 0.3). Conclusion Increased vulnerability to chronic conditions among CKD patients make them at higher risk for mortality and compromised quality of life. Regular screening of CKD patient for other chronic conditions (hypertension, diabetes, peptic ulcer disease, osteoarthritis and heart diseases) would help in detecting them early and undertake prompt management. The existing national program could be leveraged to achieve this.
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Affiliation(s)
| | | | - Debadutta Sahoo
- Model Rural Health Research Unit, ICMR-RMRCBB, Cuttack, India
| | - Swetalina Nayak
- Model Rural Health Research Unit, ICMR-RMRCBB, Cuttack, India
| | | | - Aviram Sahoo
- Model Rural Health Research Unit, ICMR-RMRCBB, Cuttack, India
| | - Pujarini Dash
- Model Rural Health Research Unit, ICMR-RMRCBB, Cuttack, India
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14
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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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Maniyara K, Kodali PB, Thankappan KR. Prevalence, awareness, treatment, control and correlates of prevalence and control of hypertension among older adults in Kerala: A Mixed Methods Study. Indian Heart J 2023:S0019-4832(23)00044-5. [PMID: 36963664 DOI: 10.1016/j.ihj.2023.03.004] [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: 11/01/2022] [Revised: 03/01/2023] [Accepted: 03/19/2023] [Indexed: 03/26/2023] Open
Abstract
INTRODUCTION We conducted this study among older adults with the following objectives: (1) To find out the prevalence, awareness, treatment and control of hypertension, (2) To understand the factors associated with hypertension prevalence and control. METHODS A mixed-methods study employing a sequential exploratory design was conducted with a survey of 300 participants aged >=60 years, and 15 in-depth interviews. Blood Pressure (BP) and waist circumference were measured using standard protocol. Survey data were analysed using univariate and multivariate procedures. In-depth interviews were analysed employing thematic analysis. RESULTS Hypertension prevalence was 72.3% (95% CI= 67.1-77.2), 68.2% (CI=61.8-74.2) were aware, 65.4% (CI=59.0-71.6) were treated and 24% (CI=18.6-29.9) achieved adequate control. Inadequate physical activity [(adjusted odds ratio (AOR)]=2.34; CI=1.19-4.59), current alcohol use (AOR=2.28; CI=1.06-4.91) and self-reported diabetes (AOR=2.02; CI=1.15-3.52) were associated with hypertension prevalence. Those who reported diabetes (AOR=2.72, CI =1.34-5.55), with education level up to high school (AOR = 2.58, CI = 1.11-6.00) and who were in the age group 60-70 years (AOR=2.14, CI= 1.09-4.20) were more likely to have controlled hypertension compared to their counterparts. From the in-depth interviews it was found that availability and accessibility of services, family support, financial wellbeing, habits and beliefs and conducive environment played a role in hypertension diagnosis and management. DISCUSSION Prevalence of hypertension was high in this population along with poor control. Efforts are required to improve hypertension control focussing on older adults with low education and those who are aged 70 years and above.
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Affiliation(s)
- Karthika Maniyara
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod India, Pin 671320
| | - Prakash Babu Kodali
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod India, Pin 671320.
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16
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Singh SK, Chauhan K, Puri P. Chronic non-communicable disease burden among reproductive-age women in India: evidence from recent demographic and health survey. BMC Womens Health 2023; 23:20. [PMID: 36650531 PMCID: PMC9843940 DOI: 10.1186/s12905-023-02171-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 01/10/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Chronic disease burden among women leads to various detrimental consequences, impacting women's health throughout their life course and off-springs. The present study explores the chronic disease profile among reproductive-aged women and analyzes the effects of various covariates on multimorbidity among reproductive-aged women in India. Here, multimorbidity is defined as an individual suffering from two or more chronic conditions. METHODS The present study employed the most recent National Family Health Survey round, 2019-2021. The study utilized information on 695,707 non-pregnant women aged 15-49 years. The study used descriptive, bivariate, and multivariable ordered logistic regression analysis to explore the burden of chronic non-communicable diseases and multimorbidity. RESULTS The mean age of women with single chronic condition-related morbidity is 30 years, whereas it was 35 years for those with multimorbidity. Approximately 28% of urban women suffered from multimorbidity. Further, significant factors that affect multimorbidity include age, educational attainment, working status, marital status, parity, menopause, religion, region, wealth index, tobacco use, alcohol consumption, and dietary patterns. CONCLUSIONS The present study hints that women in the reproductive age group are at very high risk of developing multimorbidity in India. Most of the programs and policies are focused on the elderly population in terms of awareness and facilitating them with better health services. However, right now, one should also prioritize the emerging chronic condition related to chronic conditions other than hypertension, diabetes, and cancer among the study population, which is escalating as soon as women reach 30 years of age.
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Affiliation(s)
- Shri Kant Singh
- grid.419349.20000 0001 0613 2600Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, Maharashtra India
| | - Kirti Chauhan
- grid.419349.20000 0001 0613 2600Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, Maharashtra India
| | - Parul Puri
- grid.419349.20000 0001 0613 2600Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, Maharashtra India
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17
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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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Ghosal S, Sinha A, Kerketta S, Acharya AS, Kanungo S, Pati S. Oral health among adults aged ≥45 years in India: Exploring prevalence, correlates and patterns of oral morbidity from LASI wave-1. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Debsarma D, Saha J, Choudhary BK. Prevalence, pattern, and correlates of multimorbidity among adult and old aged women in India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Zhang X, Padhi A, Wei T, Xiong S, Yu J, Ye P, Tian W, Sun H, Peiris D, Praveen D, Tian M. Community prevalence and dyad disease pattern of multimorbidity in China and India: a systematic review. BMJ Glob Health 2022; 7:bmjgh-2022-008880. [PMID: 36113890 PMCID: PMC9486196 DOI: 10.1136/bmjgh-2022-008880] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 08/18/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Driven by the increasing life expectancy, China and India, the two most populous countries in the world are experiencing a rising burden of multimorbidity. This study aims to explore community prevalence and dyad patterns of multimorbidity in China and India. METHODS We conducted a systematic review of five English and Chinese electronic databases. Studies involving adults 18 years or older at a community level, which reported multimorbidity prevalence and/or patterns were included. A modified Newcastle-Ottawa Scale was used for quality assessment. Despite large heterogeneity among reported studies, a systematic synthesis of the results was conducted to report the findings. RESULTS From 13 996 studies retrieved, 59 studies met the inclusion criteria (46 in China, 9 in India and 4 in both). The median prevalence of multimorbidity was 30.7% (IQR 17.1, 49.4), ranging from 1.5% to 90.5%. There was a large difference in multimorbidity prevalence between China and India, with median prevalence being 36.1% (IQR 19.6, 48.8) and 28.3% (IQR 8.9, 56.8), respectively. Among 27 studies that reported age-specific prevalence, 19 studies found multimorbidity prevalence increased with age, while 8 studies observed a paradoxical reduction in the oldest age group. Of the 34 studies that reported sex-specific prevalence, 86% (n=32) observed a higher prevalence in females. The most common multimorbidity patterns from 14 studies included hypertensive diseases combined with diabetes mellitus, arthropathies, heart diseases and metabolic disorders. All included studies were rated as fair or poor quality. CONCLUSION Multimorbidity is highly prevalent in China and India with hypertensive diseases and other comorbidities being the most observed patterns. The overall quality of the studies was low and there was a lack of representative samples in most studies. Large epidemiology studies, using a common definition of multimorbidity and national representative samples, with sex disaggregation are needed in both countries. PROSPERO REGISTRATION NUMBER CRD42020176774.
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Affiliation(s)
- Xinyi Zhang
- School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China.,The George Institute for Global Health, China, Beijing, China
| | - Asutosh Padhi
- The George Institute for Global Health, India, Hyderabad, Telangana, India
| | - Ting Wei
- The George Institute for Global Health, China, Beijing, China
| | - Shangzhi Xiong
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jie Yu
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Pengpeng Ye
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Wenijng Tian
- School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Hongru Sun
- School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - David Peiris
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Devarsetty Praveen
- The George Institute for Global Health, India, Hyderabad, Telangana, India.,The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Maoyi Tian
- School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China .,The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
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Khan R, Khan A, Mohammed I, Dan F, Cooper V, Charles S, Charles N, Clarke W, Clarke J, Creary D, Chankersingh A. Investigating the leading reasons for primary health care encounters and its implications for health care in Trinidad and Tobago. A systematic review. J Family Med Prim Care 2022; 11:4949-4980. [PMID: 36505547 PMCID: PMC9731049 DOI: 10.4103/jfmpc.jfmpc_1803_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/12/2021] [Accepted: 12/16/2021] [Indexed: 12/15/2022] Open
Abstract
This systematic review aims at offering a comparative analysis of the leading reasons for encounters (RFEs) of patients presenting to primary care facilities. A systemic search was carried out using MEDLINE/PUBMED, CINAHL, Google Scholar, LILACS, and PROQUEST to identify the studies relevant to RFEs in primary health care in June 2020. Fifteen studies met the eligibility criteria which included originality, published between 2015 and 2020, listed two to five RFEs at a primary health care facility, and included patients with acute and/or chronic conditions. The mean total RFEs recorded were 6753.07 (Standard deviation = 17446.38, 95% Confidence Interval 6,753.0667 ± 8,829.088 [± 130.74%]). The most common RFE chapters recorded were Respiratory and Digestive chapters. The patients recorded fever as the most frequently reported RFE while cough was ranked as most common. The physicians reported hypertension as the most frequently reported and most common RFE. The most frequently physician and patient reported RFEs to the primary health care are hypertension and fever. Respiratory and Digestive were the most frequently reported chapters. The findings are useful for the proper implementation of services, facilities, and equipment utilized in Trinidad and Tobago primary health care.
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Affiliation(s)
- Raveed Khan
- Public Health and Primary Care Unit, Department of Paraclinical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago,The School of Medicine, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago,Address for correspondence: Dr. Raveed Khan, Public Health and Primary Care Unit, Department of Paraclinical Sciences, The School of Medicine, Faculty of Medical Sciences, The University of the West Indies, St. Augustine - 00000, Trinidad and Tobago. E-mail:
| | - Adam Khan
- The School of Medicine, Faculty of Medicine and Health Sciences, Royal College of Surgeons, Dublin, Ireland
| | - Ishmail Mohammed
- The School of Medicine, Faculty of Medicine and Health Sciences, Royal College of Surgeons, Dublin, Ireland
| | - Farhaana Dan
- The School of Medicine, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Valtio Cooper
- The School of Medicine, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Sherise Charles
- The School of Medicine, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Nkese Charles
- The School of Medicine, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Whitney Clarke
- The School of Medicine, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Jeniece Clarke
- The School of Medicine, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Devonia Creary
- The School of Medicine, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Ashley Chankersingh
- The School of Medicine, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
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Shetty GM, Jain S, Thakur H, Khanna K. Prevalence of low back pain in India: A systematic review and meta-analysis. Work 2022; 73:429-452. [DOI: 10.3233/wor-205300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Although many studies have investigated the prevalence of low back pain (LBP) among Indian subjects, no meta-analysis has been conducted to determine the comprehensive epidemiological point, annual, lifetime prevalence of LBP among Indian subjects. OBJECTIVE: The purpose of this systematic review and meta-analysis was to investigate the point, annual, and lifetime prevalence of LBP in the Indian population. METHODS: We searched PubMed, Embase, Science Direct, and Cochrane Library databases for relevant studies that reported point, annual, or lifetime prevalence of LBP among Indian subjects,. Pooled point, annual and lifetime prevalence rates were calculated. Meta-analysis, subgroup analysis, sensitivity analysis and publication bias assessment were performed. RESULTS: Ninety-seven studies were included in this review. Fifty-four studies included in the review (55.5%) were found to be of higher methodological quality. The pooled point, annual, and lifetime prevalence of LBP in India was 48% (95% CI 40–56%); 51% (95% CI 45–58%), and 66% (95% CI 56–75%), respectively. The pooled prevalence rates were highest among females, the rural population, and among elementary workers. CONCLUSION: The point, annual, and lifetime prevalence rates of LBP in the Indian population is higher compared to global and other ethnic populations affecting a large proportion of the population, especially among women, rural population and in elementary workers. The findings of this study can be the basis for formulating policy regarding the prevention and treatment of LBP in a large part of the global population.
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Affiliation(s)
- Gautam M. Shetty
- Knee and Orthopaedic Clinic, Mumbai, India
- QI Spine Clinic, New Delhi, India
- AIMD Research, Mumbai, India
| | | | - Harshad Thakur
- National Institute of Health and Family Welfare, New Delhi, India
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Puri P, Singh SK, Pati S. Identifying non-communicable disease multimorbidity patterns and associated factors: a latent class analysis approach. BMJ Open 2022; 12:e053981. [PMID: 35820748 PMCID: PMC9277367 DOI: 10.1136/bmjopen-2021-053981] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 05/27/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE In the absence of adequate nationally-representative empirical evidence on multimorbidity, the existing healthcare delivery system is not adequately oriented to cater to the growing needs of the older adult population. Therefore, the present study identifies frequently occurring multimorbidity patterns among older adults in India. Further, the study examines the linkages between the identified patterns and socioeconomic, demographic, lifestyle and anthropometric correlates. DESIGN The present findings rest on a large nationally-representative sample from a cross-sectional study. SETTING AND PARTICIPANTS The study used data on 58 975 older adults (45 years and older) from the Longitudinal Ageing Study in India, 2017-2018. PRIMARY AND SECONDARY OUTCOME MEASURES The study incorporated a list of 16 non-communicable diseases to identify commonly occurring patterns using latent class analysis. The study employed multinomial logistic regression models to assess the association between identified disease patterns with unit-level socioeconomic, demographic, lifestyle and anthropometric characteristics. RESULTS The present study demonstrates that older adults in the country can be segmented into six patterns: 'relatively healthy', 'hypertension', 'gastrointestinal disorders-hypertension-musculoskeletal disorders', 'musculoskeletal disorders-hypertension-asthma', 'metabolic disorders' and 'complex cardiometabolic disorders'. Additionally, socioeconomic, demographic, lifestyle and anthropometric factors are significantly associated with one or more identified disease patterns. CONCLUSIONS The identified classes 'hypertension', 'metabolic disorders' and 'complex cardiometabolic disorders' reflect three stages of cardiometabolic morbidity with hypertension as the first and 'complex cardiometabolic disorders' as the last stage of disease progression. This underscores the need for effective prevention strategies for high-risk hypertension group. Also, targeted interventions are essential to reduce the burden on the high-risk population and provide equitable health services at the community level.
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Affiliation(s)
- Parul Puri
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Shri Kant Singh
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Sanghamitra Pati
- Department of Health Research, Indian Council of Medical Research Chandrasekharpur, Bhubaneswar, Orissa, India
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Berner K, Tawa N, Louw Q. Multimorbidity patterns and function among adults in low- and middle-income countries: a scoping review protocol. Syst Rev 2022; 11:139. [PMID: 35799277 PMCID: PMC9261061 DOI: 10.1186/s13643-022-01996-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A fifth of adults in low- and middle-income countries (LMICs) have multimorbid conditions, which are linked to socio-economic deprivation and aging. Multimorbidity is associated with high rates of functional problems and disability, increased healthcare utilization, and lower quality of life. Literature on multimorbidity and associations with function is mostly from high-income countries (HICs) and focused among older adults. Moreover, data regarding disease patterns and their impact on person-centered outcomes are limited. There is a need for research into understanding common patterns of multimorbidity, and their association with functional impairments, particularly in LMICs. Such information may contribute towards evidence-based and context-relevant strategic policy, planning, and delivery models for health and rehabilitation services, which is imperative in attaining Universal Health Coverage (UHC). The planned scoping review aims to provide an overview of the scope and nature of existing literature on multimorbidity patterns and function among adults in LMICs. METHODS A scoping review will be conducted using a five-step framework and reported according to the PRISMA-ScR guidelines. A comprehensive electronic search of PubMed/MEDLINE, Scopus, EBSCOhost, Scielo, Cochrane and Google Scholar will be conducted and updated from the last pilot search ran in September 2020. Studies of any design will be included if they are reported in English, published (between January 1976 and the last search date) in a peer-reviewed journal, and describe multimorbidity patterns and associations with physical functional impairments, activity limitations or participation restrictions among adults in LMICs. Search results will be independently screened by two reviewers and data extraction will cover study characteristics, participants' characteristics, multimorbidity measures, patterns analysis, and functional measures. Descriptive statistics and narrative synthesis will be used to synthesize and summarize findings. DISCUSSION Patients with multimorbidity have unique and cross-cutting needs, hence the need for integrated and person-centered approaches to policy, planning, and delivery of medical and rehabilitation services. Considering the shift towards UHC and primary healthcare-led management of chronic diseases, the proposed scoping review is timely. Findings will provide insights into the current extent and scope of multimorbidity research, and guide future inquiry in the field. TRIAL REGISTRATION Open Science Framework (OSF), https://osf.io/gcy7z/.
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Affiliation(s)
- Karina Berner
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town, 8000, South Africa.
| | - Nassib Tawa
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town, 8000, South Africa.,Centre for Research in Spinal Health and Rehabilitation Medicine, Department of Rehabilitation Sciences, College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, P. O. Box 62000, Nairobi, 00200, Kenya
| | - Quinette Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town, 8000, South Africa
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Sinha A, Kerketta S, Ghosal S, Kanungo S, Pati S. Multimorbidity Among Urban Poor in India: Findings From LASI, Wave-1. Front Public Health 2022; 10:881967. [PMID: 35719649 PMCID: PMC9201724 DOI: 10.3389/fpubh.2022.881967] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/06/2022] [Indexed: 12/17/2022] Open
Abstract
Background Multimorbidity has become a norm in low-and middle-income countries such as India requiring notable health system improvements to combat. Urban population is a heterogeneous group where poor are at a risk of facing inequity in accessing healthcare services which can jeopardize our efforts to attain universal health coverage (UHC). We aimed to estimate the prevalence, assess correlates and patterns of multimorbidity among urban poor. Further, we assessed the outcomes of multimorbidity such as healthcare utilization, expenditure and self-rated health. Methods Longitudinal Aging Study in India (LASI), wave-1 is a nationally representative survey conducted amongst participants aged ≥45 years in 2017–18. We included 9,327 participants residing in urban areas, categorized as poor based on monthly per capita expenditure. Descriptive statistics computed prevalence with 95% uncertainty interval. Multivariable logistic regression was executed to assess the association between multimorbidity and various correlates, expressed as adjusted odds ratio. An ordinal regression model was run between self-rated health and number of chronic conditions. Results The prevalence of multimorbidity was 45.26% among the urban poor. Hypertension and oral morbidities were the most commonly observed dyad. Respondents who were poorer [AOR: 1.27 (1.06–1.51)] had higher chances of having multimorbidity than the poorest. Respondents with a health insurance [AOR: 1.40 (1.14–1.70)] had a higher risk of having multimorbidity. In-patient admission was significantly higher among participants having multimorbidity. Out of pocket expenditure increased while self-rated health deteriorated with each additional morbid condition. Conclusion Multimorbidity is found to be increasingly prevalent among urban poor and individuals having health insurance which demonstrates the need to expand healthcare insurance schemes such as Ayushman Bharat for urban poor to achieve UHC.
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Affiliation(s)
- Abhinav Sinha
- Department of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar, India
| | - Sushmita Kerketta
- Department of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar, India
| | - Shishirendu Ghosal
- Department of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar, India
| | - Srikanta Kanungo
- Department of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar, India
| | - Sanghamitra Pati
- Department of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar, India
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Gupta P, Patel SA, Sharma H, Jarhyan P, Sharma R, Prabhakaran D, Tandon N, Mohan S. Burden, patterns, and impact of multimorbidity in North India: findings from a rural population-based study. BMC Public Health 2022; 22:1101. [PMID: 35655207 PMCID: PMC9159928 DOI: 10.1186/s12889-022-13495-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 05/13/2022] [Indexed: 11/10/2022] Open
Abstract
Aim To estimate the prevalence, socio-demographic determinants, common disease combinations, and health impact of multimorbidity among a young rural population. Methods We conducted a cross-sectional survey among participants aged ≥30 years in rural Punjab, North India, from Jan 2019 to April 2019. Multimorbidity was defined as the coexistence of ≥two conditions using a 14-condition tool validated in India. We also calculated a multimorbidity-weighted index (MWI), which provides a weight to each disease based on its impact on physical functioning. Logistic regression was conducted to evaluate the association with sociodemographic variables, mental health (PHQ-9), physical functioning (ADL scale), and self-rated health (SRH). Results We analyzed data from 3213 adults [Mean age 51.5 (±13), 54% women]. Prevalence of single chronic condition, multimorbidity, and MWI was 28.6, 18% and − 1.9 respectively. Age, higher wealth index and ever use alcohol were significantly associated with multimorbidity. Overall, 2.8% of respondents had limited physical functioning, 2.1% had depression, and 61.5% reported low SRH. Poorer health outcomes were more prevalent among the elderly, women, less educated, and those having lower wealth index and multimorbidity, were found to be significantly associated with poor health outcomes. Conclusions The burden of multimorbidity was high in this young rural population, which portends significant adverse effects on their health and quality of life. The Indian health system should be reconfigured to address this emerging health priority holistically, by adopting a more integrated and sustainable model of care. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13495-0.
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Boro B, Saikia N. Association of multimorbidity and physical activity among older adults in India: an analysis from the Longitudinal Ageing Survey of India (2017-2018). BMJ Open 2022; 12:e053989. [PMID: 35580974 PMCID: PMC9115039 DOI: 10.1136/bmjopen-2021-053989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To examine the association of multimorbidity and physical activity among older adults in India. DESIGN A cross-sectional study was conducted using large representative survey data. SETTING AND PARTICIPANTS The study used data from the nationally representative 'Longitudinal Ageing Study in India (LASI),' conducted during 2017-2018. The study included a total sample of 65 336 older adults aged 45 years and above in India. METHODS Moderate and vigorous physical activities were measured separately by self-reported questionnaires. Physical activity was calculated as minutes of metabolic equivalent tasks per week. The outcome variable was a categorical variable where 2=the prevalence of more than one morbidity, 1=presence of one morbidity and 0=none. Bivariate analysis and multinomial logistic regression were applied to fulfil the objectives. RESULTS 27.39% of older adults in India had multimorbidity. 31.02% of older adults did not engage in any moderate physical activities. Also, 59.39% of older adults did not engage in any vigorous physical activities. Older adults reporting low (adjusted relative risk ratio (A RRR): 1.10, 95% CI 1.03 to 1.18) and moderate (A RRR): 1.05, 95% CI 0.98 to 1.13) level of moderate physical activity were significantly more likely to suffer from multimorbidity compared with no involvement in moderate physical activity. However, older adults who reported high (A RRR: 0.79, 95% CI 0.75 to 0.84), moderate (A RRR: 0.88, 95% CI 0.80 to 0.98) and low level of vigorous physical activity (A RRR: 0.94, 95% CI 0.86 to 1.02) had significantly less multimorbidity in comparison to those who never engaged in vigorous physical activity. CONCLUSION Lack of physical activity is associated with multimorbidity among older adults. Physical activity promotion should be adopted as a primary strategy in reducing the burden of morbidity and multimorbidity.
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Affiliation(s)
- Bandita Boro
- Centre for the Study of Regional Development, Jawaharlal Nehru University, New Delhi, Delhi, India
| | - Nandita Saikia
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, Maharashtra, India
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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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Gala P, Sriram V, Kotian C, Ballala K, Vedanthan R, Perish E, Umakanth S, Meltzer D. Perceptions of the Doctor-Patient Relationship Among Patients in a Private, Secondary-Level Hospital in Southern India. Front Public Health 2022; 9:768705. [PMID: 35463195 PMCID: PMC9019150 DOI: 10.3389/fpubh.2021.768705] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction An epidemic of non-communicable diseases (NCDs) in India is fueling a growing demand for primary care and hospitalization services. Difficulties in coordinating inpatient and outpatient care create significant barriers to providing high-quality medical care. In this paper, we describe patient experiences, perceptions, and expectations of doctor-patient relationships in a secondary-level private hospital in Karnataka, India. Methods We conducted a cross-sectional, mixed-method needs assessment with surveys and in-depth interviews at Dr. TMA Pai Hospital (TMAPH), a secondary-level, private sector hospital in Karnataka, India. Inclusion criteria included all adults over 18 years old hospitalized at TMAPH in the past year. Patients were consecutively recruited from August 2019-October 2019 and asked to rate aspects of their relationship with their primary care provider (PCP). Descriptive statistics and multivariable logistic regression were used to analyze predictors of the doctor-patient relationship. Patients were interviewed regarding their perceptions of care coordination and doctor-patient relationships. General Thematic Analysis was utilized to analyze qualitative data and develop themes. Quantitative and qualitative findings were then merged to interpret the various dimensions of doctor-patient relationships. Results A total of 150 patients (47.3% male) enrolled. Ten patients underwent qualitative interviews. The median patient age was 67 years (IQR 56-76). 112 (74.7%) of patients identified a PCP either at or outside of TMAPH. 89% had diabetes and/or hypertension. Compared to patients without a PCP, having a PCP led to a significantly higher adjusted odds of always spending optimal time with their doctors (aOR 2.7, 95% CI 1.1-6.8, p = 0.04), and always receiving clear instructions on managing their medical conditions (aOR 2.5, 95% CI 1.0-6.1, p = 0.04). The following themes were developed from patient interviews: (1) patients trusted and respected their PCP believing they were receiving high quality care; and (2) despite perceived fragmentation in care, patients spoke favorably of their relationships with their doctors. Conclusions Among a sample of recently hospitalized patients, those with a PCP reported more positive doctor-patient relationships, though rates of dissatisfaction with doctors were still high. Further research and strategies are required to optimize continuity of care and doctor-patient relationships across the entire continuum of outpatient and inpatient care.
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Affiliation(s)
- Pooja Gala
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States.,Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Veena Sriram
- School of Population and Public Health, School of Public Policy and Global Affairs, University of British Columbia, Vancouver, BC, Canada
| | - Chitra Kotian
- Department of Medicine, Dr. TMA Pai Hospital (Udupi), Melaka Manipal Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Kirthinath Ballala
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Emily Perish
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Shashikiran Umakanth
- Department of Medicine, Dr. TMA Pai Hospital (Udupi), Melaka Manipal Medical College, Manipal Academy of Higher Education, Manipal, India
| | - David Meltzer
- Department of Medicine, University of Chicago, Chicago, IL, United States
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PATI SANGHAMITRA, PURI PARUL, GUPTA PRITI, PANDA MEELY, MAHAPATRA PRANAB. Emerging multimorbidity patterns and their links with selected health outcomes in a working-age population group. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E152-E160. [PMID: 35647382 PMCID: PMC9121685 DOI: 10.15167/2421-4248/jpmh2022.63.1.2303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 02/15/2022] [Indexed: 11/14/2022]
Abstract
Background The study aims to identify recurrent multimorbidity pattern among individuals in the age-group 15-64 years. Further, the study examines the association of these identified patterns with sociodemographic variables and selected health outcomes. Methods The study utilized data on 2912 individuals in the age-group 15-64 years collected under the burden of diseases study among patients attending public health care settings of Odisha. A latent class analysis was used to identify commonly occurring disease clusters. Results The findings suggested that 2.4% of the individuals were multimorbid. Two latent disease clusters were identified, low co-morbidity and Hypertension-Diabetes-Arthritis. Findings highlighted that age, belonging to a non-aboriginal ethnicity and urban area increased the risk of being in the 'Hypertension-Diabetes-Arthritis' group. Furthermore, 50% of the individual in the 'Hypertension-Diabetes-Arthritis' group reported poor quality of life, whereas 30% reported poor self-rated health compared to only 11% by their counterparts. Additionally, the mean health score reported by the individuals in the 'Hypertension-Diabetes-Arthritis' group was 39.9 compared to 46.9 by their counterparts. Conclusions The study findings hint towards increasing burden of multimorbidity among the working age population, which depicts a shift in causation of diseases as a result of which preventive measures also need to be taken much prior.
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Affiliation(s)
- SANGHAMITRA PATI
- Government of India-ICMR-Regional Medical Research Centre, India
| | - PARUL PURI
- International Institute for Population Sciences (IIPS), India
- Correspondence: Parul Puri International Institute for Population Sciences (IIPS), India – E-mail:
| | | | - MEELY PANDA
- Kalinga Institute of Medical Sciences, KIIT University, 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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Dash P, Mohapatra SR, Pati S. Metabolomics of Multimorbidity: Could It Be the Quo Vadis? Front Mol Biosci 2022; 9:848971. [PMID: 35359598 PMCID: PMC8962190 DOI: 10.3389/fmolb.2022.848971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/28/2022] [Indexed: 11/16/2022] Open
Abstract
Multimorbidity, the simultaneous presence of two or more chronic diseases, affects the health care to a great extent. Its association with health care cost, more disability, and poor quality of life makes it a major public health risk. The matter of worry is that management of a multimorbid condition is complicated by the fact that multiple types of treatment may be required to treat different diseases at a time, and the interaction between some of the therapies can be detrimental. Understanding the causal factors of simultaneously occurring disease conditions and investigating the connected pathways involved in the whole process may resolve the complication. When different disease conditions present in an individual share common responsible factors, treatment strategies targeting at those common causes will certainly reduce the chance of development of multimorbidity occurring because of those factors. Metabolomics that can dig out the underlying metabolites/molecules of a medical condition is believed to be an effective technique for identification of biomarkers and intervention of effective treatment strategies for multiple diseases. We hypothesize that understanding the metabolic profile may shed light on targeting the common culprit for different/similar chronic diseases ultimately making the treatment strategy more effective with a combinatorial effect.
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Affiliation(s)
- Pujarini Dash
- Regional Medical Research Centre, Bhubaneswar, India
| | - Soumya R. Mohapatra
- Department of Research and Development, Kalinga Institute of Medical Sciences, KIIT Deemed to Be University, Bhubaneswar, India
- School of Biotechnology, Kalinga Institute of Industrial Technology (KIIT), Deemed to Be University, Bhubaneswar, India
| | - Sanghamitra Pati
- Regional Medical Research Centre, Bhubaneswar, India
- *Correspondence: Sanghamitra Pati,
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Puri P, Pati S. Exploring the Linkages Between Non-Communicable Disease Multimorbidity, Health Care Utilization and Expenditure Among Aboriginal Older Adult Population in India. Int J Public Health 2022; 67:1604333. [PMID: 35321051 PMCID: PMC8934770 DOI: 10.3389/ijph.2022.1604333] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/07/2022] [Indexed: 01/11/2023] Open
Abstract
Objective: The study investigates the magnitude and correlates of non-communicable disease multimorbidity and explores its linkages with health care utilization and out-of-pocket expenditure among aboriginal or tribal older adults. Methods: The study employed data on 11,365 older adults from Scheduled Tribes from the Longitudinal Ageing Study in India, 2017-18. A disease score was computed integrating sixteen non-communicable diseases. Descriptive, bivariate, and multivariable analyses were performed to identify the magnitude and correlates of multimorbidity. The study further explored the linkages between selected diseases and multimorbidity with health care utilization and expenditure. Results: The findings suggest that 27.1 and 14.5% of the aboriginal population lived with single or multiple disease, respectively. Hypertension and gastrointestinal disorders were frequent diseases. Higher age, Muslim religion, higher education, unemployment, and affluent background were the major correlates of multimorbidity. Health care utilization, mean expenditure on hospitalization, and outpatient visits increased significantly with multimorbidity. Conclusion: Multimorbidity is emerging as a health care challenge among the aboriginal population. Measures need to be taken to assess the multimorbidity burden and reduce health care expenditure, ensuring health equity among country’s vulnerable population.
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Affiliation(s)
- Parul Puri
- International Institute for Population Sciences (IIPS), Mumbai, India
| | - Sanghamitra Pati
- Regional Medical Research Center (ICMR), Bhubaneswar, India
- *Correspondence: Sanghamitra Pati,
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Puri P, Singh SK. Patterns and predictors of non-communicable disease multimorbidity among older adults in India: evidence from longitudinal ageing study in India (LASI), 2017-2018. J Public Health Policy 2022; 43:109-128. [PMID: 34997210 DOI: 10.1057/s41271-021-00321-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 12/13/2022]
Abstract
Escalating non-communicable disease multimorbidity rates among older adults is an emerging public health concern in India, but the literature sparsely addresses the epidemiology of multimorbidity. We explore levels, patterns, combinations and predictors of multimorbidity among older adults using information on 59,764 individuals, aged 45 years and older, from the first wave of Longitudinal Ageing Study in India (LASI), 2017-2018. We computed multimorbidity score for sixteen non-communicable diseases to identify frequently occurring morbidity patterns (dyads and triads) and assess the relationship between multimorbidity and selected background characteristics. Near third of the older adult population is affected by multimorbidity, with hypertension, gastrointestinal disorders, musculoskeletal disorders, diabetes and skin diseases being the most common. Policymakers should seek strategies to increase early detection and prevention of chronic diseases, delay the age at onset of disease for those who are not affected and improve management for those affected with multiple disease conditions.
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Affiliation(s)
- Parul Puri
- International Institute for Population Sciences, Govandi Station Road, Mumbai, Maharashtra, India.
| | - Shri Kant Singh
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, Maharashtra, India
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Muhammad T, Boro B, Kumar M, Srivastava S. Gender differences in the association of obesity-related measures with multi-morbidity among older adults in India: evidence from LASI, Wave-1. BMC Geriatr 2022; 22:171. [PMID: 35232371 PMCID: PMC8886975 DOI: 10.1186/s12877-022-02869-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 02/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Co-existence of multiple chronic diseases is increasingly becoming a norm among ageing population. The study aims to investigate the prevalence of multimorbidity and the association between anthropometric measures of obesity and multimorbidity among men and women aged 60 years and above in India. Methods The present study is based on the first wave of the Longitudinal Aging Study in India. The analytical sample size for the study was 28,050 older adults aged 60 years and above. Descriptive statistics and multivariable analysis using logistic regression models were conducted. Results Body Mass Index (BMI) based-obesity is more prevalent among older women than men (26.3% vs. 17.6%). Similarly, higher proportion of older women was at high-risk waist circumference (37.1% vs 8.9%) and waist-hip ratio (78.5 vs 75.4%) than men respectively. In Model-I, after controlling for several covariates, older adults with overweight/obesity were 1.6 times more likely to have multi-morbidity than non-obese older adults (Adjusted OR = 1.61; 95% CI: 1.48–1.74). Similarly, older adults with high-risk waist circumference [Adjusted OR: 1.66; 95% CI: 1.52–1.80] and waist-hip ratio [Adjusted OR: 1.45; 95% CI: 1.33–1.59] also had higher odds of having multi-morbidity in reference to their counterparts. In model-3 it was found that females with high-risk waist-hip ratio had 14% lower odds of multimorbidity than males with high-risk waist-hip ratio [Adjusted OR: 0.86; 95%CI: 0.78–0.94]. Conclusion The findings of the study show significant gender difference in the prevalence of multimorbidity, men being at increased risk in the multivariate analysis which is uncommon in the existing epidemiological research. Interactive effect of male gender with anthropometric measures on multimorbidity reported in our study probably due to increased unhealthy behaviours among men requires further research.
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Affiliation(s)
- T Muhammad
- International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
| | - Bandita Boro
- Centre for the Study of Regional Development (CSRD), School of Social Sciences-3 (SSS 3), Jawaharlal Nehru University (JNU), New Delhi, 110067, India
| | - Manish Kumar
- International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
| | - Shobhit Srivastava
- International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India.
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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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Puri P, Shil A, Shetty A, Dhar B, Singh SK, Pati S, Billah B. Contribution of modifiable risk factors on the burden of diabetes among women in reproductive age-group in India: a population based cross-sectional study. J Public Health Policy 2022; 43:89-108. [PMID: 35042964 DOI: 10.1057/s41271-021-00334-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 01/24/2023]
Abstract
The diabetes burden is rapidly accelerating in India, particularly since the 2000s. We explore the burden and contribution of modifiable risk factors in diabetes among reproductive women across geographic regions of India. The study uses data from the National Family Health Survey in India 2015-2016, Census of India 2011, and World Population Prospects 2015. We computed Population Attributable Fractions and the number of total and estimated avoidable diabetic cases across regions. The prevalence of diabetic cases in India were 24.4 per 1000 women, varying across geographic regions. Diabetes affected around 8.2 million women (15-49 years) in India. Overweight (PAF = 19.5%) and obesity (PAF = 18.3%) contributed to the diabetes burden; if mitigated optimally, these can reduce diabetic cases by 2.8 million in India. Controlling diabetes should be region specific for maximum impact. Extending chronic disease screening during maternal and child health consultations might help decelerate the growing menace of diabetes in the country.
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Affiliation(s)
- Parul Puri
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, Maharashtra, India.
| | - Apurba Shil
- International Institute for Population Sciences, Mumbai, Maharashtra, India.,Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Aishwarya Shetty
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Bidita Dhar
- International Institute for Population Sciences, Mumbai, Maharashtra, India.,Department of Migration and Urban Studies, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Shri Kant Singh
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Sanghamitra Pati
- Department of Health Research Chandrasekharpur, ICMR Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, Odisha, India
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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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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Puri P, Singh SK. Exploring the non-communicable disease (NCD) network of multi-morbid individuals in India: A network analysis. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000512. [PMID: 36962702 PMCID: PMC10021153 DOI: 10.1371/journal.pgph.0000512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 06/09/2022] [Indexed: 11/18/2022]
Abstract
Nationally representative evidence discussing the interplay of non-communicable diseases (diseases) are scarce in India. Therefore, the present study aims to fill this research void by providing empirical evidence on disease networking using a large nationally representative cross-sectional sample segregated by gender among older adults in India. The analysis utilized data on 10,606 multimorbid women and 7,912 multimorbid men from the Longitudinal Ageing Study in India (LASI), 2017-18. Multimorbidity was defined as the co-occurrence of two or more diseases in an individual using a list of 16 self-reported diseases. Weighted networks were visualized to illustrates the complex relationships between the diseases using network analysis. The findings suggest that women possess a higher burden of multimorbidity than men. Hypertension, musculoskeletal disorder, gastrointestinal disorder, diabetes mellitus, and skin diseases were reported as the most recurrent diseases. 'Hypertension-musculoskeletal disorder', 'diabetes mellitus-hypertension', 'gastrointestinal disorders-hypertension' and 'gastrointestinal disorders- musculoskeletal disorder' were recurrent disease combinations among the multimorbid individuals. The study generated compelling evidence to establish that there are statistically significant differences between the prevalence of diseases and how they interact with each other between women and men. These findings further accentuate that disease networks are slightly more complex among women. In totality, the study visualizes disease association, identifies the most influential diseases to the network, and those which acts as a bridge between other diseases, causing multimorbidity among the older adult population in India.
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Affiliation(s)
- Parul Puri
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Shri Kant Singh
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, Maharashtra, India
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Bazalar-Palacios J, Jaime Miranda J, Carrillo-Larco RM, Gilman RH, Smeeth L, Bernabe-Ortiz A. Aggregation and combination of cardiovascular risk factors and their association with 10-year all-cause mortality: the PERU MIGRANT Study. BMC Cardiovasc Disord 2021; 21:582. [PMID: 34876013 PMCID: PMC8650245 DOI: 10.1186/s12872-021-02405-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/22/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To estimate the association between the aggregation and pair-wise combination of selected cardiovascular risk factors (CVRF) and 10-year all-cause mortality. METHODS Secondary data analysis of the PERU MIGRANT study, a prospective population-based cohort. Ten-year all-cause mortality was determined for participants originally enrolled in the PERU MIGRANT Study (baseline in 2007) through the National Registry of Identification and Civil Status. The CVRF included hypertension, type 2 diabetes mellitus, hypercholesterolemia, and overweight/obesity. Exposures were composed of both the aggregation of the selected CVRF (one, two, and three or more CVRF) and pair-wise combinations of CVRF. Cox regression models were used to calculate hazard ratios (HR) and 95% confidence intervals (95% CI). FINDINGS Of the 989 participants evaluated at baseline, 976 (98.8%) had information about vital status at 10 years of follow-up (9992.63 person-years), and 63 deaths were recorded. In the multivariable model, adjusting for sociodemographic and lifestyle variables, participants with two CVRF (HR: 2.48, 95% CI: 1.03-5.99), and those with three or more CVRF (HR: 3.93, 95% CI: 1.21-12.74) had higher all-cause mortality risk, compared to those without any CVRF. The pair-wise combinations associated with the highest risk of all-cause mortality, compared to those without such comorbidities, were hypertension with type 2 diabetes (HR: 11.67, 95% CI: 3.67-37.10), and hypertension with overweight/obesity (HR: 2.76, 95% CI: 1.18-6.71). CONCLUSIONS The aggregation of two or more CVRF and the combination of hypertension with type 2 diabetes or overweight/obesity were associated with an increased risk of 10-year all-cause mortality. These risk profiles will inform primary and secondary prevention strategies to delay mortality from cardiovascular risk factors.
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Affiliation(s)
- Janina Bazalar-Palacios
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 445, Miraflores, Lima 18, Peru
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 445, Miraflores, Lima 18, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Rodrigo M Carrillo-Larco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 445, Miraflores, Lima 18, Peru
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Robert H Gilman
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 445, Miraflores, Lima 18, Peru.
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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Cezard G, McHale CT, Sullivan F, Bowles JKF, Keenan K. Studying trajectories of multimorbidity: a systematic scoping review of longitudinal approaches and evidence. BMJ Open 2021; 11:e048485. [PMID: 34810182 PMCID: PMC8609933 DOI: 10.1136/bmjopen-2020-048485] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 10/20/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Multimorbidity-the co-occurrence of at least two chronic diseases in an individual-is an important public health challenge in ageing societies. The vast majority of multimorbidity research takes a cross-sectional approach, but longitudinal approaches to understanding multimorbidity are an emerging research area, being encouraged by multiple funders. To support development in this research area, the aim of this study is to scope the methodological approaches and substantive findings of studies that have investigated longitudinal multimorbidity trajectories. DESIGN We conducted a systematic search for relevant studies in four online databases (Medline, Scopus, Web of Science and Embase) in May 2020 using predefined search terms and inclusion and exclusion criteria. The search was complemented by searching reference lists of relevant papers. From the selected studies, we systematically extracted data on study methodology and findings and summarised them in a narrative synthesis. RESULTS We identified 35 studies investigating multimorbidity longitudinally, all published in the last decade, and predominantly in high-income countries from the Global North. Longitudinal approaches employed included constructing change variables, multilevel regression analysis (eg, growth curve modelling), longitudinal group-based methodologies (eg, latent class modelling), analysing disease transitions and visualisation techniques. Commonly identified risk factors for multimorbidity onset and progression were older age, higher socioeconomic and area-level deprivation, overweight and poorer health behaviours. CONCLUSION The nascent research area employs a diverse range of longitudinal approaches that characterise accumulation and disease combinations and to a lesser extent disease sequencing and progression. Gaps include understanding the long-term, life course determinants of different multimorbidity trajectories, and doing so across diverse populations, including those from low-income and middle-income countries. This can provide a detailed picture of morbidity development, with important implications from a clinical and intervention perspective.
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Affiliation(s)
- Genevieve Cezard
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | | | - Frank Sullivan
- School of Medicine, University of St Andrews, St Andrews, UK
| | | | - Katherine Keenan
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
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Hossain B, Govil D, Sk MIK. Persistence of Multimorbidity Among Women Aged 15-49 Years in India: An Analysis of Prevalence, Patterns and Correlation. Int J Public Health 2021; 66:601591. [PMID: 34744567 PMCID: PMC8565281 DOI: 10.3389/ijph.2021.601591] [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] [Received: 09/01/2020] [Accepted: 02/02/2021] [Indexed: 02/01/2023] Open
Abstract
Objectives: The present study has examined the patterns and possible correlates of coexisting morbidities among women aged 15–49 years based on biomarker measurement data at the national level in India. Methods: National Family Health Survey conducted during 2015–16 used in the present study. Simple disease count approach was used to calculate the multimorbidity among women. Multinomial logistic regression was applied to analyze the predictors of multimorbidity among women. Results: Almost 30% of the women had any of the selected morbidity and 9% of them had two or more morbidities. Hypertension and overweight combination (3%) was the most prevalent among women. The risk of having two or more morbidities was predominantly high among women aged above 30 years, low educated women, women from the wealthier group, ever-married women and women who were consuming tobacco as compared to their counterparts. Conclusions: From the policy perspective, the identification of groups of women vulnerable to multimorbidity will help in the selection of programmatic focus and preventive public health intervention in adult phase to reduce the multimorbidity burden among women in old ages.
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Affiliation(s)
- Babul Hossain
- International Institute for Population Sciences, Mumbai, India
| | - Dipti Govil
- International Institute for Population Sciences, Mumbai, India
| | - Md Illias K Sk
- International Institute for Population Sciences, Mumbai, India
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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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Kshatri JS, Bhoi T, Barik SR, Palo SK, Pati S. Is multimorbidity associated with risk of elder abuse? Findings from the AHSETS study. BMC Geriatr 2021; 21:413. [PMID: 34217225 PMCID: PMC8255025 DOI: 10.1186/s12877-021-02347-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With an increasing number of older adults in low- and middle-income countries (LMIC), the burden of multimorbidity and functional dependence is on the rise. At the same time, a higher prevalence of elder abuse is observed in these populations. There is scarce evidence on the interplay between elder abuse and multimorbidity with no reports from LMIC settings yet. Present study examined the association of multimorbidity with the risk of elder abuse and its correlates in a rural elderly population of Odisha, India. METHODS The data for this study was collected as a part of our AHSETS study comprising of 725 older adults residing in rural Odisha, India. Multimorbidity was assessed by the MAQ PC tool while Hwalek-Sengstock elder abuse screening test (HS-EAST) was used to assess the risk of elder abuse. Functional dependence was measured by the Lawton IADL questionnaire. We used ordinal logistic regression models to identify the correlates of elder abuse and test for mediation by functional dependence. RESULTS Around 48.8 % (95 % CI:45.13-52.53 %) older adults had multimorbidity while 33.8 % (95 % CI:30.35-37.35 %) had some form of dependence. Out of 725, 56.6 % (CI 52.85-60.19 %) were found to be at low-risk elder abuse and 15.9 % (CI 13.27-18.72 %) being at high-risk. The prevalence of higher risk of elder abuse was greater among females, non-literates, widowed persons, those not currently working and those belonging to lower socio-economic strata. The risk of elder abuse was significantly associated with multimorbidity (AOR = 1.68; 95 %CI: 1.11-2.57) and functional dependence (AOR = 2.08; 95 %CI: 1.41-3.06). Additionally, we found a partial mediation mechanism of functional dependency between the pathway of multimorbidity and elder abuse. CONCLUSIONS Elder abuse and multimorbidity are emerging as issues of significant concern among rural elderly in Odisha, India. Multimorbidity and functional dependence are associated with significantly higher odds of elder abuse among rural older adults. Further, we report the role of functional dependence as a partial mediator between multimorbidity and elder abuse. Therefore, potential interventions on reducing the economic, physical and care dependence among multimorbid patients may reduce the risk of elder abuse.
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Affiliation(s)
- Jaya Singh Kshatri
- Department of Health Research, ICMR-Regional Medical Research Center, Bhubaneswar, Odisha, 751023, India
| | - Trilochan Bhoi
- Department of Health Research, ICMR-Regional Medical Research Center, Bhubaneswar, Odisha, 751023, India
| | - Shakti Ranjan Barik
- Department of Health Research, ICMR-Regional Medical Research Center, Bhubaneswar, Odisha, 751023, India
| | - Subrata Kumar Palo
- Department of Health Research, ICMR-Regional Medical Research Center, Bhubaneswar, Odisha, 751023, India
| | - Sanghamitra Pati
- Department of Health Research, ICMR-Regional Medical Research Center, Bhubaneswar, Odisha, 751023, 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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Lazar Neto F, Mendes TB, Matos PMPG, de Oliveira JC, Favarato MHS, Lin CA, Martins MA. External validity of type 2 diabetes clinical trials on cardiovascular outcomes for a multimorbid population. Diabetes Obes Metab 2021; 23:971-979. [PMID: 33336870 DOI: 10.1111/dom.14303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/27/2020] [Accepted: 12/13/2020] [Indexed: 01/14/2023]
Abstract
AIM To investigate the external validity of recent antihyperglycaemic trials evaluating cardiovascular outcomes in a multimorbid population. MATERIALS AND METHODS Selection criteria of 15 randomized controlled trials from the 2020 American Diabetes Association Standard of Care statement were applied in a stepwise manner to tertiary care patients with type 2 diabetes. Primary outcomes were the number of patients eligible per individual trial and for the aggregate of trials. Secondary outcomes included patient predictors of trial eligibility. RESULTS Of 1059 patients, the mean (SD) age was 66 (10.74) years, the median (IQR) Charlson index was 2 (2, 3) and 458 (43%) had documented cardiovascular disease. The median (IQR) number of patients included in individual trials was 263 (174.25-308.75) and 795 (75.1%) of them were eligible for at least one trial. Among those 264 ineligible, 127 (48.1%) had an HbA1c level of 7% or less and no cardiovascular disease; 53.5% and 34.4% of the patients were eligible for two and three different classes of drugs, respectively. The strongest predictor of trial eligibility was cardiovascular disease (risk ratio 2.17, 95% CI 2.01-2.35). CONCLUSIONS A considerable proportion of multimorbid patients would be eligible for recent antihyperglycaemic trials. This positive finding can be attributed to development guidance in diabetes trials and the different approach we took, in which we evaluated inclusion by trials as an aggregate.
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Affiliation(s)
- Felippe Lazar Neto
- Department of Internal Medicin, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Thiago Bosco Mendes
- Department of Internal Medicine, Faculdade de Medicina da Universidade Estadual de São Paulo (UNESP), São Paulo, Brazil
| | | | - Julio César de Oliveira
- Department of Internal Medicin, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | | | - Chin An Lin
- Department of Internal Medicin, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Milton Arruda Martins
- Department of Internal Medicin, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
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Pati S, Sinha R, Mahapatra P, Sahu SP, Nallala S. Management of geriatric multimorbidity in old age home residents: An emerging issue in India. Geriatr Gerontol Int 2021; 21:338-339. [PMID: 33543545 DOI: 10.1111/ggi.14137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 01/14/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Sanghamitra Pati
- ICMR Regional Medical Research Centre Bhubaneswar, Bhubaneswar, India
| | | | | | - Siba Prasad Sahu
- Indian Institute of Public Health Bhubaneswar, Bhubaneswar, India
| | - Srinivas Nallala
- Indian Institute of Public Health Bhubaneswar, Bhubaneswar, India
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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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Puri P, Singh SK, Pati S. Temporal dynamics, patterns and correlates of single and multimorbidity in India, 1994-2018. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2021; 11:26335565211062756. [PMID: 35004339 PMCID: PMC8728765 DOI: 10.1177/26335565211062756] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 11/08/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE As a consequence of the epidemiological transition, multimorbidity has been identified as a critical public health challenge in India. The majority of the studies in the domain are grounded on hospital-based data or are based on small sample size, findings from which can only be generalized to a specific sub-group. These studies recommend exploring multimorbidity holistically at a national level to ensure adequate healthcare management in the country. Therefore, the present study examines the pattern and correlates of single and multimorbidity over the past two decades in India. METHODS The study utilized data on 397901, 257519, and 399705 individuals from 52nd (1994-1995), 60th (2004-2005), and 75th (2018) rounds of cross-sectional data from the National Sample Survey (NSS). Univariate, bivariate, and multivariable statistical methods were applied to draw inferences from the data. The findings depict an increase in single and multimorbidity burden over individuals' age and NSS rounds. RESULTS Hypertension and diabetes were the fastest-growing morbidities over time. Higher education, urban residence, and belonging to an affluent class were significantly associated with both single and multimorbidity occurrence over time. CONCLUSION The burden of single and multimorbidity increases over time among India's older adults. Therefore, there is an urgent need to recuperate chronic disease management strategies for older adults in the Indian healthcare infrastructure.
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Affiliation(s)
- Parul Puri
- Department of Survey
Research and Data Analytics, International Institute for
Population Sciences, Mumbai
| | - Shri Kant Singh
- Department of Survey
Research and Data Analytics, International Institute for
Population Sciences, Mumbai
| | - Sanghamitra Pati
- Department of Health Research, ICMR Regional Medical Research
Centre, Bhubaneswar, India
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Prathapan S, Fernando GVMC, Matthias AT, Bentota Mallawa Arachchige Charuni Y, Abeygunawardhana HMG, Somathilake BGGK. The rising complexity and burden of multimorbidity in a middle-income country. PLoS One 2020; 15:e0243614. [PMID: 33306724 PMCID: PMC7732070 DOI: 10.1371/journal.pone.0243614] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 11/24/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The limited knowledge on aetiology, epidemiology and risk factors for multimorbidity especially evident from low and middle-income countries curtail the development and implementation of sustainable healthcare models. Sri Lanka, boasting for one of South Asia's most efficient public health systems that is accessible free-of-charge by the citizens is presently transitioning from lower-middle to upper-middle-income tier. Faced with the triple burden of disease, it is imperative for Sri Lanka to incorporate an integrated model to manage multimorbidity. METHODS A descriptive cross-sectional study was carried out in medical clinics of a tertiary care hospital and a University primary care department. Data were extracted on to a form from the clinical records of patients over the age of 20 years with at least one non-communicable disease (NCD) and analysed. RESULTS Multimorbidity was present among 64.1% of patients (n = 1600). Nearly 44.44% of the patients aged 20-35 years have a minimum of two disorders, and by the time they reach 50 years, nearly 64% of the patients have two or more non-communicable diseases. Nearly 7% of those aged over 65 years were diagnosed with four or more disorders. A fourth of the sample was affected by co-morbid diabetes mellitus and hypertension, whereas the combinations of coronary heart disease with hypertension and diabetes mellitus were also found to be significantly prevalent. A salient revelation of the binomial logistic regression analysis was that the number of disorders was positively correlated to the presence of mental disorders 7.25 (95% CI = 5.82-8.68). CONCLUSION Multimorbidity is highly prevalent among this population and seemingly has a detrimental effect on the psychological wellbeing of those affected. Therefore, the need for horizontal integration of all primary to tertiary care disciplines, including mental health, to manage multimorbidity by policymakers is emphasized as a priority task.
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Affiliation(s)
- Shamini Prathapan
- Department of Community Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Gunasekara Vidana Mestrige Chamath Fernando
- National Centre for Primary Care and Allergy Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
- Department of Family Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Anne Thushara Matthias
- Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
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