1
|
Santhosh R, Kakade SV, Durgawale PM. Determinants of multimorbidity among elderly population in maharashtra, India: Logistic regression analysis. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:270. [PMID: 39310010 PMCID: PMC11414868 DOI: 10.4103/jehp.jehp_1481_23] [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: 09/15/2023] [Accepted: 12/04/2023] [Indexed: 09/25/2024]
Abstract
BACKGROUND Population aging is an emerging global trend. Because of decreasing fertility rates and improved healthcare, the lifespan of elderly population increased. Consequently, proportion of elderly population is increasing at an alarming rate. This is accompanied by an increased recognition of the occurrence of multimorbidity and associated mortality risks. So, the purpose of this study was to determine the prevalence and predictors of multimorbidity among elderly population in Maharashtra with its variation among socio-demographic spectrum, functional health and health behaviors. MATERIALS AND METHODS Sample of elderly population aged > 60 years were selected to examine multimorbidity and its associated risk factors. Statistical methods such as Chi-square test were used to show the association between multimorbidity and other covariates. Binary logistic regression analysis was used to understand the effects of predictor variables on multimorbidity. Receiver Operating Characteristic (ROC) Curve Analysis was carried out to improve the performance of the classification model by using a modified cut-off probability value. Z scores were calculated to compare model performance in training data and test data. RESULTS The prevalence of multimorbidity in Maharashtra in training data and test data was found to be 32.8% and 32.9%. Residence, living arrangement, MPCE Quintile, marital status, work status, education, tobacco consumption, physical activity, Instrumental Activities of Daily Living (IADL), Activities of Daily Living (ADL) and self-rated health of elderly population were important determinants that exert a significant adverse effect on multimorbidity. CONCLUSION Prediction percentages indicate that appropriate actions should be undertaken to ensure good quality of life for all the elderly in Maharashtra.
Collapse
Affiliation(s)
- Reshma Santhosh
- Department of Community Medicine, Krishna Vishwa Vidyapeeth “Deemed To Be University”, Karad, Maharashtra, India
| | - Satish V. Kakade
- Department of Community Medicine, Krishna Vishwa Vidyapeeth “Deemed To Be University”, Karad, Maharashtra, India
| | - PM Durgawale
- Department of Community Medicine, Krishna Vishwa Vidyapeeth “Deemed To Be University”, Karad, Maharashtra, India
| |
Collapse
|
2
|
Anindya K, Zhao Y, Hoang T, Lee JT, Juvekar S, Krishnan A, Mbuma V, Sharma T, Ng N. Interrelationships between physical multimorbidity, depressive symptoms and cognitive function among older adults in China, India and Indonesia: A four-way decomposition analysis. Arch Gerontol Geriatr 2024; 122:105386. [PMID: 38640878 DOI: 10.1016/j.archger.2024.105386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 02/07/2024] [Accepted: 02/23/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVE This paper explores the role of depressive symptoms (mediator/moderator) in the association between physical multimorbidity (exposure) and cognitive function (outcome) among older adults in the three most populous middle-income countries. METHODS This study used cross-sectional data from China (2015 China Health and Retirement Longitudinal Study), India (2017/2018 Longitudinal Ageing Study in India), and Indonesia (2014/2015 Indonesian Family Life Survey), with a total sample of 73,199 respondents aged ≥ 45 years. Three domains of cognitive tests were harmonised across surveys, including time orientation, word recall, and numeracy. The four-way decomposition analysis assessed the mediation and interaction effects between exposure, mediator/moderator, and outcome, adjusted for covariates. RESULTS The mean age of the respondents (in years) was slightly younger in Indonesia (56.0, SD = 8.8) than in China (59.5, SD = 9.3) and India (60.0, SD = 10.5). The proportion of male respondents was 49.3 % in China, 47.3 % in India, and 47.5 % in Indonesia. Respondents in China had the highest mean cognitive function z scores (54.7, SD = 19.9), followed by India (51.1, SD = 20.0) and Indonesia (51.0, SD = 18.4). Physical multimorbidity was associated with lower cognitive function in China and India (p < 0.0001), with 48.4 % and 40.0 % of the association explained by the mediating effect of depressive symptoms ('overall proportion due to mediation'). The association was not found in Indonesia. CONCLUSION Cognitive functions were lower among individuals with physical multimorbidity, and depressive symptoms mainly explained the association. Addressing depressive symptoms among persons with physical multimorbidity is likely to have not only an impact on their mental health but could prevent cognitive decline.
Collapse
Affiliation(s)
- Kanya Anindya
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Yang Zhao
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Thanh Hoang
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - John Tayu Lee
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia; Department of Primary Care and Public Health, School of Public Health, Imperial College London, United Kingdom; College of Health and Medicine, Australian National University, Canberra, Australia
| | - Sanjay Juvekar
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vanessa Mbuma
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tarishi Sharma
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nawi Ng
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
3
|
de Oliveira-Figueiredo DST, Silva MPGPC, Feitosa PYDO, Leite BC, Rocha FL, de Andrade LDF. What is the burden of multimorbidity and the factors associated with its occurrence in elderly Brazilians? Rev Bras Enferm 2024; 77:e20220809. [PMID: 38716903 PMCID: PMC11067935 DOI: 10.1590/0034-7167-2022-0809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 11/25/2023] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE To estimate the prevalence of multimorbidity in elderly people and its association with sociodemographic characteristics, lifestyle, and anthropometry. METHODS This was a cross-sectional study using data from the National Health Survey, 2019. A total of 22,728 elderly individuals from all 27 Brazilian states were randomly selected. Poisson regression models with robust variance were employed, and a significance level of 5% was adopted. RESULTS The prevalence of multimorbidity was 51.6% (95% CI: 50.4-52.7), with the highest estimates observed in the South and Southeast. Multimorbidity was associated with being female (aPR = 1.33; 95% CI: 1.27-1.39), being 80 years old or older (aPR = 1.12; 95% CI: 1.05-1.19), having low education (aPR = 1.16; 95% CI: 1.07-1.25), past cigarette use (aPR = 1.16; 95% CI: 1.11-1.21), insufficient physical activity (aPR = 1.13; 95% CI: 1.06-1.21), and screen use for 3 hours or more per day (aPR = 1.13; 95% CI: 1.08-1.18). CONCLUSION Multimorbidity affects more than half of the elderly population in Brazil and is associated with social, demographic, and behavioral factors.
Collapse
|
4
|
Zeng H, Miao C, Wang R, Zhao W, Wang W, Liu Y, Wei S, Liu A, Jia H, Li G, Zhou J, Chen X, Tian Q. Influence of comorbidity of chronic diseases on basic activities of daily living among older adults in China: a propensity score-matched study. Front Public Health 2024; 12:1292289. [PMID: 38638478 PMCID: PMC11024351 DOI: 10.3389/fpubh.2024.1292289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 03/14/2024] [Indexed: 04/20/2024] Open
Abstract
Rationale With the accelerating process of population aging, the comorbidity of chronic disease (CCD) has become a major public health problem that threatens the health of older adults. Objective This study aimed to assess whether CCD is associated with basic activities of daily living (BADL) and explore the factors influencing BADL in older adults. Method A cross-sectional community health survey with stratified random sampling among older residents (≥60 years old) was conducted in 2022. A questionnaire was used to collect information on BADL, chronic diseases, and other relevant aspects. Propensity score matching (PSM) was used to match the older adults with and without CCD. Univariate and multivariate logistic regression analyses were used to explore the factors influencing BADL. PSM was used to match participants with single-chronic disease (SCD) and CCD. Results Among the 47,720 participants, those with CCD showed a higher prevalence of BADL disability (13.07%) than those with no CCD (6.33%) and SCD (7.39%). After adjusting for potential confounders with PSM, 6,513 pairs of cases with and without CCD were matched. The univariate analysis found that the older adults with CCD had a significantly higher prevalence of BADL disability (13.07%, 851 of 6,513) than those without CCD (9.83%, 640 of 6,513, P < 0.05). The multivariate logistic regression analysis revealed that CCD was a risk factor for BADL in older adults [OR = 1.496, 95% CI: 1.393-1.750, P < 0.001]. In addition, age, educational level, alcohol intake, social interaction, annual physical examination, retirement benefits, depression, weekly amount of exercise, and years of exercise were related to BADL disability (P < 0.05). PSM matching was performed on participants with CCD and SCD and showed that the older adults with CCD had a significantly higher prevalence of BADL disability (13.07%, 851 of 6,513) than those with SCD (11.39%, 742 of 6,513, P < 0.05). Conclusion The older adults with CCD are at a higher risk of BADL disability than their counterparts with no CCD or SCD. Therefore, we advocate paying attention to and taking measures to improve the health and quality of life of these individuals.
Collapse
Affiliation(s)
- Hongji Zeng
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Chen Miao
- Henan Medical College, Zhengzhou, China
| | - Rui Wang
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Weijia Zhao
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Wenjuan Wang
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yahui Liu
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Shufan Wei
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Anqi Liu
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Huibing Jia
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Guoxin Li
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Junge Zhou
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xuejiao Chen
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Qingfeng Tian
- School of Public Health, Zhengzhou University, Zhengzhou, China
| |
Collapse
|
5
|
Goel N, Biswas I, Chattopadhyay K. Risk factors of multimorbidity among older adults in India: A systematic review and meta-analysis. Health Sci Rep 2024; 7:e1915. [PMID: 38420204 PMCID: PMC10900089 DOI: 10.1002/hsr2.1915] [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: 02/24/2023] [Revised: 12/18/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
Background Multimorbidity among older adults is a growing concern in India. Multimorbidity is defined as the coexistence of two or more chronic health conditions in an individual. Primary studies have been conducted on risk factors of multimorbidity in India, but no systematic review has been conducted on this topic. This systematic review aimed to synthesize the existing evidence on risk factors of multimorbidity among older adults in India. Methods The JBI and Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. Several databases were searched for published and unpublished studies until August 03, 2022. The screening of titles and abstracts and full texts, data extraction, and quality assessment were conducted by two independent reviewers. Any disagreements were resolved through discussion or by involving a third reviewer. Data synthesis was conducted using narrative synthesis and random effects meta-analysis, where appropriate. Results Out of 8781 records identified from the literature search, 16 and 15 studies were included in the systematic review and meta-analysis, respectively. All included studies were cross-sectional, and 10 met a critical appraisal score of more than 70%. Broadly, sociodemographic, lifestyle, and health conditions-related factors were explored in these studies. The pooled odds of multimorbidity were higher in people aged ≥70 years compared to 60-69 years (odds ratio (OR) 1.51; 95% confidence interval (CI) 1.20-1.91), females compared to males (1.38; 1.09-1.75), single, divorced, separated, and widowed compared to married (1.29; 1.11-1.49), economically dependent compared to economically independent (1.54; 1.21-1.97), and smokers compared to non-smokers (1.33; 1.16-1.52) and were lower in working compared to not working (0.51; 0.36-0.72). Conclusion This systematic review and meta-analysis provided a comprehensive picture of the problem by synthesizing the existing evidence on risk factors of multimorbidity among older adults in India. These synthesized sociodemographic and lifestyle factors should be taken into consideration when developing health interventions for addressing multimorbidity among older adults in India.
Collapse
Affiliation(s)
- Nikita Goel
- Lifespan and Population Health, School of MedicineUniversity of NottinghamNottinghamUK
| | - Isha Biswas
- Lifespan and Population Health, School of MedicineUniversity of NottinghamNottinghamUK
| | - Kaushik Chattopadhyay
- Lifespan and Population Health, School of MedicineUniversity of NottinghamNottinghamUK
- The Nottingham Centre for Evidence‐Based Healthcare: A JBI Centre of ExcellenceNottinghamUK
| |
Collapse
|
6
|
Musa IR, Hassan AA, Adam I. Multimorbidity and its associated risk factors among adults in northern Sudan: a community-based cross-sectional study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:13. [PMID: 38281058 PMCID: PMC10822146 DOI: 10.1186/s41043-024-00513-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/25/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Multimorbidity (having two or more coexisting long-term conditions) is a growing global challenge. However, data on multimorbidity among adults in Africa, including Sudan, are scarce. Thus, this study aimed to investigate the prevalence of multimorbidity and its associated risk factors among adults in Sudan. METHODS A community-based cross-sectional study was conducted in northern Sudan from March 2022 to May 2022. Participants' sociodemographic characteristics were assessed using a questionnaire. Multimorbidity was defined as having two or more coexisting long-term conditions, including diabetes mellitus (DM), hypertension, obesity, anaemia and depression-anxiety. Multivariate logistic regression analyses were performed to determine the associated factors. RESULTS The participants included 250 adults: 119 (47.6%) males and 131(52.4%) females. The median interquartile range (IQR) of the enrolled adults of the age was 43.0 (30.0‒55.0) years. Of the 250 adults, 82(32.8%), 17(6.8%), 84(33.6%), and 67(26.8%) were normal weight, underweight, overweight, and obese, respectively; 148(59.2%), 72(28.8%), 63(25.2%), 67(26.8%), and 98(39.2%) had hypertension, DM, anaemia, obesity, and depression-anxiety, respectively. A total of 154 adults (61.6%) had multimorbidity: 97(38.8%), 49(19.6%), and 8(3.2%) had two, three, and four morbidities, respectively. The remaining 21 (8.4%), and 75 (30.0%) adults had no morbidity, and one morbidity, respectively. In amultivariate logistic regression analysis, increasing age (adjusted odd ratio [AOR] = 1.03, 95% CI = 1.01‒1.05), and female sex (AOR = 2.17, 95% CI = 1.16‒4.06) were associated with multimorbidity. CONCLUSIONS The high prevalence of multimorbidity revealed in this study uncovers a major public health problem among Sudanese adults. Our results show that increasing age and female sex are associated with multimorbidity. Additional extensive studies are necessary to evaluate the magnitude of multimorbidity for improved future planning and establishing effective health systems.
Collapse
Affiliation(s)
- Imad R Musa
- Royal Commission Hospital at AL Jubail Industrial City, Al Jubail, Kingdom of Saudi Arabia
| | | | - Ishag Adam
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, 51911, Unaizah, Kingdom of Saudi Arabia
| |
Collapse
|
7
|
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.
Collapse
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
| | | |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Geigl C, Loss J, Leitzmann M, Janssen C. Social factors of health-related quality of life in older adults: a multivariable analysis. Qual Life Res 2023; 32:3257-3268. [PMID: 37458960 PMCID: PMC10522508 DOI: 10.1007/s11136-023-03472-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE The objective of the analysis was to examine the relationships between sociodemographic, socioeconomic, psychosocial, and behavioural factors and both physical and mental health-related quality of life (HRQOL) in older adults. METHODS The analysis was based on recent cross-sectional data of 1687 community residents from a whole population postal survey of German adults aged 65 years and older (33% response rate, 52% female, mean age 76 years). HRQOL was assessed using the 36-Item Short Form Survey (SF-36v2). For a differentiated analysis, hierarchical multiple linear regressions were performed. RESULTS An internal health locus of control, physical activity, social support, and income were positively associated with physical HRQOL (Adj. R2 = 0.34; p < 0.001) and mental HRQOL (Adj. R2 = 0.18; p < 0.001), whereas an external health locus of control and age were negatively associated with both. Alcohol use and educational level were positively associated only with physical HRQOL, whilst female gender was negatively associated only with mental HRQOL. CONCLUSION Sociodemographic, socioeconomic, psychosocial, and behavioural factors were associated with physical and mental HRQOL. These results highlight the importance of social factors in HRQOL and provide approaches for policy and practice to develop and implement tailored health interventions for older adults. Our findings may be transferable to municipalities in metropolitan areas of high-income European countries. CLINICAL TRIAL REGISTRATION Not applicable.
Collapse
Affiliation(s)
- Christoph Geigl
- Department of Applied Social Sciences, Munich University of Applied Sciences, 81243, Munich, Germany.
- Department of Epidemiology and Preventive Medicine, University of Regensburg, 93053, Regensburg, Germany.
| | - Julika Loss
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, 13353, Berlin, Germany
| | - Michael Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, 93053, Regensburg, Germany
| | - Christian Janssen
- Department of Applied Social Sciences, Munich University of Applied Sciences, 81243, Munich, Germany
| |
Collapse
|
10
|
Pati S, Sinha A, Verma P, Kshatri J, Kanungo S, Sahoo KC, Mahapatra P, Pati S, Delpino FM, Krolow A, Teixeira DSDC, Batista S, Nunes BP, Weller D, Mercer SW. Childhood health and educational disadvantage are associated with adult multimorbidity in the global south: findings from a cross-sectional analysis of nationally representative surveys in India and Brazil. J Epidemiol Community Health 2023; 77:617-624. [PMID: 37541775 PMCID: PMC10511991 DOI: 10.1136/jech-2022-219507] [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: 07/05/2022] [Accepted: 05/21/2023] [Indexed: 08/06/2023]
Abstract
INTRODUCTION Multimorbidity has emerged as a major healthcare challenge in low/middle-income countries (LMICs) such as India and Brazil. Life course epidemiology suggests that adverse events in early life contribute to an individual's later health in adulthood. However, little is known about the influence of early life health and social factors on the development of multimorbidity in adulthood in LMICs. We aimed to explore the association of adult multimorbidity with childhood health and social disadvantages among two LMICs, India and Brazil. METHODS We conducted a secondary data analysis of older adults aged ≥50 years using nationally representative surveys from Longitudinal Ageing Study in India, 2017-2018 (n=51 481) and 'Estudo Longitudinal da Saude e Bem-Estar dos Idosos Brasileirous', 2015-2016 (n=8730). We estimated the prevalence of multimorbidity along with 95% CI as a measure of uncertainty for all weighted proportions. Log link in generalised linear model was used to assess the association between childhood health and disadvantages with multimorbidity, reported as adjusted prevalence ratio (APR). RESULTS The prevalence of multimorbidity was 25.53% and 55.24% in India and Brazil, respectively. Participants who perceived their childhood health as poor and missed school for a month or more due to illness had the highest level of multimorbidity across both countries. After adjusting for age and gender, a significant association between adult multimorbidity and poor self-rated childhood health (APR: (India: 1.38, 1.16 to 1.65) and (Brazil: 1.19, 1.09 to 1.30)); and missed school for a month due to illness (AOR: (India: 1.73, 1.49 to 2.01) and (Brazil: 1.16, 1.08 to 1.25)) was observed. CONCLUSION Early life health, educational and economic disadvantages are associated with adult multimorbidity and appear to contribute to the later course of life. A life course approach to the prevention of multimorbidity in adulthood in LMICs may be useful in health programmes and policies.
Collapse
Affiliation(s)
- Sanghamitra Pati
- Division of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Abhinav Sinha
- Division of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Priyanka Verma
- Division of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Jayasingh Kshatri
- Division of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Srikanta Kanungo
- Division of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Krushna Chandra Sahoo
- Division of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Pranab Mahapatra
- Department of Psychiatry, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
- Lown Fellow, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Sandipana Pati
- Department of Health & Family Welfare, Odisha State Institute of Health and Family Welfare, Bhubaneswar, Odisha, India
| | | | - Andria Krolow
- Department of Nursing, Federal University of Pelotas, Pelotas, Brazil
| | | | - Sandro Batista
- School of Medicine, Federal University of Goias, Goiania, Brazil
| | - Bruno P Nunes
- Department of Nursing, Federal University of Pelotas, Pelotas, Brazil
| | - David Weller
- College of Medicine, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Stewart W Mercer
- College of Medicine, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| |
Collapse
|
11
|
Liu P, Wang Z, Liu N, Peres MA. A scoping review of the clinical application of machine learning in data-driven population segmentation analysis. J Am Med Inform Assoc 2023; 30:1573-1582. [PMID: 37369006 PMCID: PMC10436153 DOI: 10.1093/jamia/ocad111] [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: 03/29/2023] [Revised: 06/08/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE Data-driven population segmentation is commonly used in clinical settings to separate the heterogeneous population into multiple relatively homogenous groups with similar healthcare features. In recent years, machine learning (ML) based segmentation algorithms have garnered interest for their potential to speed up and improve algorithm development across many phenotypes and healthcare situations. This study evaluates ML-based segmentation with respect to (1) the populations applied, (2) the segmentation details, and (3) the outcome evaluations. MATERIALS AND METHODS MEDLINE, Embase, Web of Science, and Scopus were used following the PRISMA-ScR criteria. Peer-reviewed studies in the English language that used data-driven population segmentation analysis on structured data from January 2000 to October 2022 were included. RESULTS We identified 6077 articles and included 79 for the final analysis. Data-driven population segmentation analysis was employed in various clinical settings. K-means clustering is the most prevalent unsupervised ML paradigm. The most common settings were healthcare institutions. The most common targeted population was the general population. DISCUSSION Although all the studies did internal validation, only 11 papers (13.9%) did external validation, and 23 papers (29.1%) conducted methods comparison. The existing papers discussed little validating the robustness of ML modeling. CONCLUSION Existing ML applications on population segmentation need more evaluations regarding giving tailored, efficient integrated healthcare solutions compared to traditional segmentation analysis. Future ML applications in the field should emphasize methods' comparisons and external validation and investigate approaches to evaluate individual consistency using different methods.
Collapse
Affiliation(s)
- Pinyan Liu
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Ziwen Wang
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Nan Liu
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Institute of Data Science, National University of Singapore, Singapore, Singapore
| | - Marco Aurélio Peres
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore, Singapore
| |
Collapse
|
12
|
K J, Rao M, YN S, Thunga G, N R, Sudhakar C, Sanatombi Devi E. Determinants of Medication Non-Adherence Among the Elderly with Co-Existing Hypertension and Type 2 Diabetes Mellitus in Rural Areas of Udupi District in Karnataka, India. Patient Prefer Adherence 2023; 17:1641-1656. [PMID: 37465058 PMCID: PMC10351531 DOI: 10.2147/ppa.s380784] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/08/2023] [Indexed: 07/20/2023] Open
Abstract
Purpose Medication adherence is a crucial component in the management of elderly with co-morbid chronic conditions. Hence, this study aimed to investigate the determinants of medication non-adherence among rural elderly with co-morbid chronic conditions of hypertension (HTN) and type 2 diabetes mellitus (T2DM) in India. Patients and Methods This cross-sectional study adopted the probability proportional to size (PPS) sampling technique to find the determinants of medication non-adherence among elderly residing in rural coverage areas of five randomly selected primary health centres (PHC) in Udupi district, Karnataka, India. A total of 360 elderly (72 samples from each cluster) who met the inclusion criteria and consented were interviewed using predesigned prevalidated and standardized or reliable tools. The data were coded and entered in SPSS version 16.0 and analyzed using both descriptive and inferential statistics. Results The study found that 55.6% (n=200) of rural elderly with co-morbid conditions HTN and T2DM were non-adherent to their medications and established Spearman correlation coefficient rank (r) value between undesirable person-related factors (r=-0.444); good family support (including financial support) (r=0.185); poor accessibility to healthcare facility (r=-0.209); detrimental medication-related factors including high cost of medication (r=-0.237) were found to be significant at 0.05 level of confidence (p < 0.05). Further, the study depicted that the chi-square test (χ2) was identified to be significantly associated (p<0.05) with a variable such as education, knowledge, number of illnesses and impairments, vision, memory, and physical impairments. Conclusion Medication adherence could be improved among rural elderly with co-morbid conditions by identifying and addressing the determinants at the earliest. Further, it is vital to identify the suitable intervention program to address these avoidable problems.
Collapse
Affiliation(s)
- Jeyalakshmi K
- Department of Community Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Mahadev Rao
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shashidhara YN
- Department of Community Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Girish Thunga
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ravishankar N
- Department of Biostatistics, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Christopher Sudhakar
- Department of Mental Health Nursing & Director - Quality, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Elsa Sanatombi Devi
- Department of Medical Surgical Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India
| |
Collapse
|
13
|
Manirajan P, Sivanandy P. Drug Utilisation Review among Geriatric Patients with Noncommunicable Diseases in a Primary Care Setting in Malaysia. Healthcare (Basel) 2023; 11:1665. [PMID: 37372782 DOI: 10.3390/healthcare11121665] [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: 04/26/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
A prospective cross-sectional study was conducted to analyse the drugs prescribed to the elderly population with noncommunicable diseases and to determine the polypharmacy at a primary care clinic in Negeri Sembilan, Malaysia. The study was conducted for 6 months at the primary care clinic of Gemas. Geriatric patients above the age of 65 and diagnosed with noncommunicable diseases were included upon providing written informed consent. The majority of the geriatric patients were between 65 and 69 years (mean: 69.72 ± 2.85) and prescribed 4 or more medications (mean: 5.18 ± 0.64, p = 0.007). More than 95% (n = 295) of the geriatrics were found to have multimorbidity, in which around 45% (n = 139) had type-2 diabetes together with hypertension and dyslipidaemia. Combination therapy was prescribed to more than 97% (n = 302) of the elderly, whereas cardiovascular and endocrine medications were the most commonly prescribed. Ten prescriptions were found to have drug-related problems, prescribing cascade (80%), lack of medicine optimisation (10%), and inappropriate prescription (10%). In this study, the majority of the elderly had multimorbidity; polypharmacy was commonly seen among geriatric patients. Polypharmacy is the biggest threat to the elderly population, as it increases the chances of falls and fall-related injuries. Medicine optimisation and deprescribing will reduce the chances of drug-related problems and morbidity and mortality associated with polypharmacy and over-consumption of medications. Hence, the study recommends the health fraternity look for medication optimisation and deprescribing to reduce the future complications associated with polypharmacy.
Collapse
Affiliation(s)
- Priya Manirajan
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Palanisamy Sivanandy
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia
| |
Collapse
|
14
|
Mahapatra P, Sahoo KC, Desaraju S, Nath B, Pati S. Managing dementia care during COVID-19 pandemic: caregivers' experiences in Odisha, India. Prim Health Care Res Dev 2023; 24:e41. [PMID: 37226696 PMCID: PMC10227469 DOI: 10.1017/s1463423622000664] [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: 12/28/2020] [Revised: 05/04/2021] [Accepted: 10/17/2022] [Indexed: 05/26/2023] Open
Abstract
AIM The present study explored the family caregivers' perspectives and elicited their experience while managing dementia care during the COVID-19 pandemic in Odisha, India. BACKGROUND The onset of the COVID-19 pandemic has diverted the attention of health systems away from chronic disease management and health services delivery. Psychiatric care particularly for dementia and the elderly is found to be more compromised in such situation. METHODS We adopted an inductive phenomenological approach to garner key insights into the care continuity for people living with dementia in the context of the COVID-19 pandemic. Telephonic in-depth interviews (IDIs) were carried out with 17 immediate caregivers. All IDIs were digitally recorded, transcribed, and analysed using a thematic approach. FINDINGS Caregivers did not perceive dementia as an overwhelming challenge; instead viewed it as a part of the ageing process. Caring for dementia was being done by family members as a collective responsibility with task-sharing. The caregivers primarily relied on their usual physician for the continuity of dementia care and took utmost precautions to prevent exposure to COVID-19 risk. However, they found it more challenging to ensure adequate care for the multiple illnesses (multimorbidity) coexisting with dementia. Towards this, they adopted all possible measures to keep the chronic conditions under control, lest the vulnerability to COVID-19 infection might heighten. The fear of visiting a hospital, prevailing restrictions in mobility, and diverted attention of health systems to pandemic containment created impediments towards maintaining multimorbidity care. The support of local administration, neighbourhood pharmacy and diagnostic laboratories and teleconsultation with the physicians were vital for care continuity. Caregivers adapted by reducing or deferring physical consultation and seeking treatment via telephonic advice of the treating physicians. Our findings suggest leveraging digitally enabled health care technology and augmenting caregiver activation for home-based dementia care to cruise through any similar catastrophic situations.
Collapse
Affiliation(s)
- Pranab Mahapatra
- Department of Psychiatry, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha751024, India
| | - Krushna Chandra Sahoo
- Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, Odisha751023, India
| | - Shyama Desaraju
- Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, Odisha751023, India
| | - Binapani Nath
- Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, Odisha751023, India
| | - Sanghamitra Pati
- Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, Odisha751023, India
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Chowdhury SR, Chandra Das D, Sunna TC, Beyene J, Hossain A. Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis. EClinicalMedicine 2023; 57:101860. [PMID: 36864977 PMCID: PMC9971315 DOI: 10.1016/j.eclinm.2023.101860] [Citation(s) in RCA: 120] [Impact Index Per Article: 120.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Knowing the prevalence of multimorbidity among adults across continents is a crucial piece of information for achieving Sustainable Development Goal 3.4, which calls for reducing premature death due to non-communicable diseases. A high prevalence of multimorbidity indicates high mortality and increased healthcare utilization. We aimed to understand the prevalence of multimorbidity across WHO geographic regions among adults. METHODS We performed a systematic review and meta-analysis of surveys designed to estimate the prevalence of multimorbidity among adults in community settings. We searched PubMed, ScienceDirect, Embase and Google Scholar databases for studies published between January 1, 2000, and December 31, 2021. The random-effects model estimated the pooled proportion of multimorbidity in adults. Heterogeneity was quantified using I2 statistics. We performed subgroup analyses and sensitivity analyses based on continents, age, gender, multimorbidity definition, study periods and sample size. The study protocol was registered with PROSPERO (CRD42020150945). FINDINGS We analyzed data from 126 peer-reviewed studies that included nearly 15.4 million people (32.1% were male) with a weighted mean age of 56.94 years (standard deviation of 10.84 years) from 54 countries around the world. The overall global prevalence of multimorbidity was 37.2% (95% CI = 34.9-39.4%). South America (45.7%, 95% CI = 39.0-52.5) had the highest prevalence of multimorbidity, followed by North America (43.1%, 95% CI = 32.3-53.8%), Europe (39.2%, 95% CI = 33.2-45.2%), and Asia (35%, 95% CI = 31.4-38.5%). The subgroup study highlights that multimorbidity is more prevalent in females (39.4%, 95% CI = 36.4-42.4%) than males (32.8%, 95% CI = 30.0-35.6%). More than half of the adult population worldwide above 60 years of age had multimorbid conditions (51.0%, 95% CI = 44.1-58.0%). Multimorbidity has become increasingly prevalent in the last two decades, while the prevalence appears to have stayed stable in the recent decade among adults globally. INTERPRETATION The multimorbidity patterns by geographic regions, time, age, and gender suggest noticeable demographic and regional differences in the burden of multimorbidity. According to insights about prevalence among adults, priority is required for effective and integrative interventions for older adults from South America, Europe, and North America. A high prevalence of multimorbidity among adults from South America suggests immediate interventions are needed to reduce the burden of morbidity. Furthermore, the high prevalence trend in the last two decades indicates that the global burden of multimorbidity continues at the same pace. The low prevalence in Africa suggests that there may be many undiagnosed chronic illness patients in Africa. FUNDING None.
Collapse
Affiliation(s)
- Saifur Rahman Chowdhury
- Department of Public Health, North South University, Dhaka, Bangladesh
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Dipak Chandra Das
- Department of Public Health, North South University, Dhaka, Bangladesh
| | | | - Joseph Beyene
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Ahmed Hossain
- College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Global Health Institute, North South University, Dhaka, Bangladesh
- Corresponding author.
| |
Collapse
|
17
|
Bandhu K, Rao A, Nehra A, Dwivedi SN, Chakrawarty A, Dey AB. Recurrent syncope in long survivors and its association with geriatric syndromes. Aging Med (Milton) 2023; 6:49-55. [PMID: 36911095 PMCID: PMC10000258 DOI: 10.1002/agm2.12240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 12/25/2022] [Accepted: 12/29/2022] [Indexed: 01/12/2023] Open
Abstract
Objective Syncope is a common clinical condition in the elderly, associated with significant morbidity and risk of recurrence. Recurrent syncope causing a repeated reduction in the cerebral blood flow can predispose to progressive neurodegeneration, a decline in overall health and functionality. Hence, this study was conducted to study the common causes of recurrent syncope and its association with various geriatric syndromes. Methodology This case-control study recruited 50 cases of recurrent syncope and 50 controls, aged 75 years and older. A detailed history and sequential evaluation for aetiologies of recurrent syncope were done. Cognition, frailty, activities of daily living, depression, and nutrition were assessed using various scales. Results Most (80%, 80/100) of the participants were males and the mean age was 80.04 ± 4.3 years. In the syncope group, 42% (21/50) of patients had arrhythmia, and 30% (15/30) had valvular heart disease. Recurrent syncope was significantly associated with lower scores on Montreal cognitive assessment scale (OR: 6.47 P < 0.001), four or more comorbidities (OR: 6.29 P < 0.001), and hearing impairment (OR: 6.21 P < 0.004) on multivariate logistic regression analysis. Conclusion Recurrent syncope is significantly associated with cognitive impairment, the presence of four or more comorbidities, and hearing impairment. Conduction abnormality was the most common etiology of recurrent cardiovascular syncope. Structured evaluation and appropriate management of recurrent syncope might reduce the decline in physical, cognitive, and psychological reserve. A follow-up longitudinal study is needed to establish this.
Collapse
Affiliation(s)
- Kamal Bandhu
- Department of Geriatric Medicine All India Institute of Medical SciencesNew DelhiIndia
| | - Akshata Rao
- Department of Geriatric Medicine All India Institute of Medical SciencesNew DelhiIndia
| | - Ashima Nehra
- Neuropsychology, Neurosciences CentreAll India Institute of Medical SciencesNew DelhiIndia
| | - Sada Nand Dwivedi
- Department of BiostatisticsAll India Institute of Medical SciencesNew DelhiIndia
| | - Avinash Chakrawarty
- Department of Geriatric Medicine All India Institute of Medical SciencesNew DelhiIndia
| | - Aparajit Ballav Dey
- Department of Geriatric Medicine All India Institute of Medical SciencesNew DelhiIndia
- Venu Geriatric Care CenterNew DelhiIndia
| |
Collapse
|
18
|
Kumar M, Kumari N, Chanda S, Dwivedi LK. Multimorbidity combinations and their association with functional disabilities among Indian older adults: evidence from Longitudinal Ageing Study in India (LASI). BMJ Open 2023; 13:e062554. [PMID: 36746539 PMCID: PMC9906171 DOI: 10.1136/bmjopen-2022-062554] [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: 02/08/2023] Open
Abstract
OBJECTIVE This study aims to identify the unique multimorbidity combinations (MMCs) and their associations with the functional disability of Indian older adults. Moreover, the population attributable fractions (PAFs) were calculated to assess the potential impact of additional diseases in the nested groups on disability. DESIGN A cross-sectional data were analysed in this study. SETTING AND PARTICIPANTS The present study uses data from the first wave of the Longitudinal Ageing Study in India (2017-2018). The sample for the study consists of 27 753 aged 60 years and over. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome variable was functional disability, measured by the combined activities of daily living (ADL)-instrumental activities of daily living (IADL) index. RESULTS Out of 197 uniquely identified MMCs, the combination of hypertension and high depressive symptoms (HDS) was the most prevalent (10.3%). Overall, all MMCs were associated with increased functional limitation. Specifically, the combination of hypertension, arthritis and HDS was associated with greater ADL-IADL disability than any other MMC. The addition of HDS in group 3 (hypertension and arthritis) (incidence rate ratios (IRR)=1.44; 95% CI 1.26 to 1.64) and the addition of arthritis in group 1 (hypertension, HDS) (IRR=1.48; 95% CI 1.28 to 1.71) and group 2 (hypertension, diabetes) (IRR=1.49; 95% CI 1.22 to 1.82) significantly increases the rates of ADL-IADL disability. The estimated PAFs of the group 1 (hypertension and HDS), group 3 (hypertension and arthritis) and group 4 (arthritis and HDS) for ADL-IADL disability were 22.5% (19.2-25.5), 21.6% (18.7-24.4) and 23.5% (20.6-26.3), respectively. CONCLUSION The findings from this study underscore the importance of addressing the morbidity combinations which are more disabling than the others in older adults. Understanding the somatic and psychological relevance of the morbidities in functional health is necessary and can help reduce disabilities among older adults.
Collapse
Affiliation(s)
- Manish Kumar
- Population Research Centre, Dharwad, Karnataka, India
| | - Neha Kumari
- International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Srei Chanda
- International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Laxmi Kant Dwivedi
- International Institute for Population Sciences, Mumbai, Maharashtra, India
| |
Collapse
|
19
|
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: 4] [Impact Index Per Article: 4.0] [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.
Collapse
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.
| |
Collapse
|
20
|
Liu X, Song F, Liu F, Mao Z, Qu S. Multiple chronic conditions among older adults in China: differences in socio-demographic characteristics. Heliyon 2022; 8:e11129. [PMID: 36281412 PMCID: PMC9586908 DOI: 10.1016/j.heliyon.2022.e11129] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/21/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022] Open
Abstract
Objective There are relatively few studies on multiple chronic conditions (MCC) among older adults in China. This study sought to assess the potential differences in the risk of MCC among different elderly populations, and thus to identify the most vulnerable populations at higher risk of developing the MCC. Methods A sample of 5320 adults aged 60 years or above from the China's Health-Related Quality of Life Survey for Older Adults 2018 (CHRQLS-OA 2018) were included in this study. Descriptive statistics frequencies and proportions were used to summarize the sample characteristics, and logistic regression models were conducted to identify the differences in the risk of having MCC among different populations. Results Overall, 52.6% of respondents had been clearly diagnosed with at least one chronic disease with 25.3% having MCC. The males ((adjusted odds ratio [AOR] = 0.84; 95% confidence interval [CI] = 0.73-0.98) were less likely to have MCC. This was also true among female elderly with a non-agricultural hukou (AOR = 0.75; 95% CI = 0.57-0.99). The elderly with a non-agricultural hukou aged 60-64 (AOR = 0.55; 95% CI = 0.34-0.88) had a lower risk of having MCC. Those whose average annual household income per capita were 15,000-30,000 RMB (AOR = 1.42; 95% CI = 1.03-1.96) were more likely to suffer from MCC. The odds ratios of having MCC were smaller as the personal savings increases in total samples (all P < 0.05). Conclusions The findings suggest that different policies or approaches should target these specific populations who are most in need and are most likely to suffer from MCC.
Collapse
Affiliation(s)
- Xiaojun Liu
- Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Fang Song
- Editorial Department of Medicine and Society, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fengyu Liu
- Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Zongfu Mao
- Department of Global Health, School of Health Sciences, Wuhan University, Wuhan, China
| | - Shuming Qu
- Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou, China,Corresponding author.
| |
Collapse
|
21
|
Vaishnav LM, Joshi SH, Joshi AU, Mehendale AM. The National Programme for Health Care of the Elderly: A Review of its Achievements and Challenges in India. Ann Geriatr Med Res 2022; 26:183-195. [PMID: 36039665 PMCID: PMC9535372 DOI: 10.4235/agmr.22.0062] [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: 06/16/2022] [Accepted: 08/22/2022] [Indexed: 11/18/2022] Open
Abstract
Aging care is critical. Projections for 2020 indicate that India’s older population will comprise 6.57% of the overall population. The best-known newly developed technologies must be provided to the older population. Non-governmental organizations and private institutions are increasingly providing more door-to-door guidance and help. This study evaluated the impact of the National Programme for Health Care of the Elderly (NPHCE) in India and analyzed its achievements and challenges. The program’s key strategies include providing preventive and promotional care and sickness management, empowering geriatric services, and guaranteeing optimal rehabilitation. The NPHCE is an excellent project for caring for a rapidly aging population. This study described the existing programs and schemes related to older people in India, with a focus on the NPHCE and an analysis of the program’s achievements and challenges.
Collapse
Affiliation(s)
- Lokesh Mukut Vaishnav
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), India
| | - Shiv Hiren Joshi
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), India
| | - Abhishek Upendra Joshi
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), India
- Corresponding Author: Shiv Hiren Joshi, MD Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), 442001, India E-mail:
| | - Ashok Madhukar Mehendale
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), India
| |
Collapse
|
22
|
Asenjo-Alarcón JA. Diagnóstico clínico integral de adultos mayores atendidos en Perú. REVISTA CUIDARTE 2022. [DOI: 10.15649/cuidarte.2485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introducción: Los adultos mayores constituyen el grupo poblacional más vulnerable y el menos favorecido por los sistemas de salud, transitan por un proceso de involución progresiva que puede repercutir en su salud; por tanto, se torna relevante el diagnóstico clínico oportuno y adecuado para identificar eventuales alteraciones. Objetivo: Establecer el diagnóstico clínico integral según sexo y edad de adultos mayores atendidos a nivel nacional en el Perú. Materiales y métodos: Se realizó un estudio descriptivo, transversal y retrospectivo, durante marzo y abril del 2021, en 60698 adultos mayores atendidos en todos los departamentos del Perú. La valoración física, funcional, mental y social de los adultos mayores se realizó mediante la Historia Clínica de Atención Integral de Salud del Adulto Mayor y se interpretó con su guía técnica. Se describieron frecuencias absolutas, relativas, intervalos de confianza para proporciones al 95% y el chi cuadrado de homogeneidad. Resultados: El 49,4% de adultos mayores estaban enfermos, de los cuales el 50,8% fueron mujeres y el 47,4% varones, el 50,0% tenían de 60 a 69 años, el 50,6% de 70 a 79 años y el 46,1% de 80 a más años. Se encontraron diferencias estadísticamente significativas entre el diagnóstico clínico integral por sexo y edad (p = 0,000). Discusión: Independientemente del número de participantes en todos los contextos estudiados, al menos una enfermedad crónica coexiste medianamente en los adultos mayores, sin ser determinante el lugar donde viven, pues el proceso de envejecimiento solo puede ser distinto en su velocidad de progresión y en las condiciones en que se presenta. Conclusión: Los adultos mayores en su mayoría estaban enfermos, fueron mujeres y tenían de 70 a 79 años, las diferencias por sexo y edad en el diagnóstico clínico integral fueron significativas. Las intervenciones en etapas previas contribuirían de manera importante en un envejecimiento saludable. Como citar este artículo: Asenjo-Alarcón José Ander. Diagnóstico clínico integral de adultos mayores atendidos en Perú. Revista Cuidarte. 2022;13(2): e2485. http://dx.doi.org/10.15649/cuidarte.2485
Collapse
|
23
|
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.
Collapse
|
24
|
Reddy MM, Zaman K, Yadav R, Yadav P, Kumar K, Kant R. Prevalence, Associated Factors, and Health Expenditures of Noncommunicable Disease Multimorbidity-Findings From Gorakhpur Health and Demographic Surveillance System. Front Public Health 2022; 10:842561. [PMID: 35462842 PMCID: PMC9019118 DOI: 10.3389/fpubh.2022.842561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Noncommunicable disease (NCD) multimorbidity throws a unique challenge to healthcare systems globally in terms of not only management of disease, but also familial, social, and economic implications associated with it. Objective To assess the prevalence of NCD multimorbidity and its associated risk factors along with health expenditures among adults (≥18 years) living in a rural area. Methods A secondary data analysis of the first-round survey done as part of the Gorakhpur Health and Demographic Surveillance Site (GHDSS) was done. Information related to self-reported morbidity and other variables related to sociodemographics and out-of-pocket expenditure (OOPE) was captured using a pretested questionnaire. Multivariable cluster adjusted binomial regression analysis was done to identify factors associated with multimorbidity. Results The overall prevalence of NCD multimorbidity was found to be 1.8% (95% CI: 1.7-1.9%). The prevalence of NCD multimorbidity was highest among elderly (≥60 years) [6.0% (95% CI: 5.5-6.5%)] and among women [2.4% (95% CI: 2.3-2.6%)]. Sociodemographic factors, such as age, gender, occupation, education, marital status, religion, caste, and household wealth, were all found to be independently associated with NCD multimorbidity. The median annual OOPE was found to be significantly higher among those with NCD multimorbidity (INR 20,000) compared with those with no NCD (INR 5,000) or having only one NCD (INR 8,000). Conclusion Among the adults in GHDSS, about 13 in every 100 were suffering from at least one NCD and around two in 100 were having NCD multimorbidity. Those with NCD multimorbidity spent almost four times higher annual OOPE compared with those without NCDs.
Collapse
Affiliation(s)
- Mahendra M Reddy
- Indian Council of Medical Research-Regional Medical Research Centre (ICMR-RMRC), Gorakhpur, India
| | - Kamran Zaman
- Indian Council of Medical Research-Regional Medical Research Centre (ICMR-RMRC), Gorakhpur, India
| | - Rajaram Yadav
- Indian Council of Medical Research-Regional Medical Research Centre (ICMR-RMRC), Gorakhpur, India
| | - Priyanka Yadav
- Indian Council of Medical Research-Regional Medical Research Centre (ICMR-RMRC), Gorakhpur, India
| | - Kaushik Kumar
- Indian Council of Medical Research-Regional Medical Research Centre (ICMR-RMRC), Gorakhpur, India
| | - Rajni Kant
- Indian Council of Medical Research-Regional Medical Research Centre (ICMR-RMRC), Gorakhpur, India
| |
Collapse
|
25
|
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.
Collapse
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
| | | |
Collapse
|
26
|
Khan MR, Malik MA, Akhtar SN, Yadav S, Patel R. Multimorbidity and its associated risk factors among older adults in India. BMC Public Health 2022; 22:746. [PMID: 35422020 PMCID: PMC9008964 DOI: 10.1186/s12889-022-13181-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/07/2022] [Indexed: 02/08/2023] Open
Abstract
Abstract
Background
Health at older ages is a key public health challenge especially among the developing countries. Older adults are at greater risk of vulnerability due to their physical and functional health risks. With rapidly rising ageing population and increasing burden of non-communicable diseases older adults in India are at a greater risk for multimorbidities. Therefore, to understand this multimorbidity transition and its determinants we used a sample of older Indian adults to examine multimorbidity and its associated risk factors among the Indian older-adults aged 45 and above.
Methods
Using the sample of 72,250 older adults, this study employed the multiple regression analysis to study the risk factors of multimorbidity. Multimorbidity was computed based on the assumption of older-adults having one or more than one disease risks.
Results
Our results confirm the emerging diseases burden among the older adults in India. One of the significant findings of the study was the contrasting prevalence of multimorbidity among the wealthiest groups (AOR = 1.932; 95% CI = 1.824- 2.032). Similarly women were more likely to have a multimorbidity (AOR = 1.34; 95% CI = 1.282—1.401) as compared to men among the older adults in India.
Conclusion
Our results confirm an immediate need for proper policy measures and health system strengthening to ensure the better health of older adults in India.
Collapse
|
27
|
Chauhan S, Patel R, Kumar S. Prevalence, factors and inequalities in chronic disease multimorbidity among older adults in India: analysis of cross-sectional data from the nationally representative Longitudinal Aging Study in India (LASI). BMJ Open 2022; 12:e053953. [PMID: 35351706 PMCID: PMC8961109 DOI: 10.1136/bmjopen-2021-053953] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE This study examines the prevalence, patterns and factors of chronic disease-related multimorbidity. Also, this study examines the inequality in the prevalence of multimorbidity among older adults in India. DESIGN Cross-sectional study; large nationally representative survey data. SETTING AND PARTICIPANTS We have used the first wave of a Longitudinal Ageing Study in India conducted in 2017-2018 across all the 35 states (excluded Sikkim) and union territories in India. This study used information from 31 373 older people aged 60+years in India. PRIMARY AND SECONDARY OUTCOME MEASURES The outcome variable for this study is multimorbidity. The study used multinomial logistic regression to examine the risk factors for multimorbidity among older adults. To measure the inequality in multimorbidity, the slope of index inequality and relative index of inequality have been used to understand the ranked-based inequality. RESULTS Almost one-fourth (24.1%) reported multimorbidity. The relative risk ratio (RRR) of multimorbidity (RRR=2.12; 95% CI=1.49 to 3.04) was higher among higher educated older adults than uneducated older adults. Furthermore, the RRR of multimorbidity (RRR=2.35; 95% CI=2.02 to 2.74) was higher among urban older adults than their rural counterparts. Older adults in the richest wealth quintile were more likely to report multimorbidities (RRR=2.86; 95% CI=2.29 to 3.55) than the poorest older adults. Good self-rated health and no activities of daily living disability were associated with a lower risk of multimorbidities. CONCLUSIONS This study contributes to the comprehensive knowledge of the prevalence, factors and inequality of the chronic disease-related multimorbidity among older adults in India. Considering India's ageing population and high prevalence of multimorbidity, the older adults must be preferred in disease prevention and health programmes, however, without compromising other subpopulations in the country. There is a need to develop geriatric healthcare services in India. Additionally, there is a need to disseminate awareness and management of multimorbidity among urban and highly educated older adults.
Collapse
Affiliation(s)
- Shekhar Chauhan
- International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Ratna Patel
- International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Shubham Kumar
- International Institute for Population Sciences, Mumbai, Maharashtra, India
| |
Collapse
|
28
|
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.
Collapse
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.
| |
Collapse
|
29
|
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.
Collapse
Affiliation(s)
- Parul Puri
- International Institute for Population Sciences (IIPS), Mumbai, India
| | - Sanghamitra Pati
- Regional Medical Research Center (ICMR), Bhubaneswar, India
- *Correspondence: Sanghamitra Pati,
| |
Collapse
|
30
|
Nguyen VC, Park J. Relationships between Demographic Factors and Chronic Conditions with Disease Severities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111469. [PMID: 34769985 PMCID: PMC8583414 DOI: 10.3390/ijerph182111469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/15/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022]
Abstract
Disease severities are the outcomes of an inpatient visit classification that assigns a diagnostic related group, including risk of mortality and severity of illness. Although widely used in healthcare, the analysis of factors affecting disease severities has not been adequately studied. In this study, we analyze the relationships between demographics and chronic conditions and specify their influence on disease severities. Descriptive statistics are used to investigate the relationships and the prevalence of chronic conditions. To evaluate the influence of demographic factors and chronic conditions on disease severities, several multinomial logistic regression models are performed and prediction models for disease severities are conducted based on National Inpatient Sample data for 2016 provided by the Healthcare Cost and Utilization Project database in the United States. The rate of patients with a chronic illness is 88.9% and the rate of patients with more than two chronic conditions is 67.6%; further, the rate is 62.7% for females, 73.9% for males, and 90% for the elderly. A high level of disease severity commonly appears in patients with more than two chronic conditions, especially in the elderly. For patients without chronic conditions, disease severities show a lower or safe level, even in the elderly.
Collapse
|
31
|
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.
Collapse
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
| |
Collapse
|
32
|
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.
Collapse
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.
| |
Collapse
|
33
|
Lu J, Wang Y, Hou L, Zuo Z, Zhang N, Wei A. Multimorbidity patterns in old adults and their associated multi-layered factors: a cross-sectional study. BMC Geriatr 2021; 21:372. [PMID: 34147073 PMCID: PMC8214251 DOI: 10.1186/s12877-021-02292-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 05/20/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Influenced by various factors such as socio-demographic characteristics, behavioral lifestyles and socio-cultural environment, the multimorbidity patterns in old adults remain complex. This study aims to identify their characteristics and associated multi-layered factors based on health ecological model. METHODS In 2019, we surveyed a total of 7480 participants aged 60+ by using a multi-stage random cluster sampling method in Shanxi province, China. Latent class analysis was used to discriminate the multimorbidity patterns in old adults, and hierarchical regression was performed to determine the multi-layered factors associated with their various multimorbidity patterns. RESULTS The prevalence of multimorbidity was 34.70% among the old patients with chronic disease. Over half (60.59%) of the patients with multimorbidity had two co-existing chronic diseases. "Degenerative/digestive diseases", "metabolic diseases" and "cardiovascular diseases" were three specific multimorbidity patterns. Behavioral lifestyles-layered factors had the most explanatory power for the three patterns, whose proportions of explanatory power were 54.00, 43.90 and 48.15% individually. But the contributions of other multi-layered factors were different in different patterns; balanced diet, medication adherence, the size of family and friendship network, and different types of basic medical insurance might have the opposite effect on the three multimorbidity patterns (p < 0.05). CONCLUSIONS In management of old patients with multimorbidity, we should prioritize both the "lifestyle change"-centered systematic management strategy and group-customized intervention programs.
Collapse
Affiliation(s)
- Jiao Lu
- School of Management, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, Shanxi Province, China.
| | - Yuan Wang
- School of Management, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, Shanxi Province, China
| | - Lihong Hou
- The Second Affiliated Hospital, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi Province, China
| | - Zhenxing Zuo
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Na Zhang
- School of Management, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, Shanxi Province, China
| | - Anle Wei
- School of Management, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, Shanxi Province, China
| |
Collapse
|
34
|
Zhao Y, Zhang P, Lee JT, Oldenburg B, van Heusden A, Haregu TN, Wang H. The Prevalence of Metabolic Disease Multimorbidity and Its Associations With Spending and Health Outcomes in Middle-Aged and Elderly Chinese Adults. Front Public Health 2021; 9:658706. [PMID: 34012951 PMCID: PMC8126686 DOI: 10.3389/fpubh.2021.658706] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/31/2021] [Indexed: 12/28/2022] Open
Abstract
Objective: Metabolic diseases have been a clinical challenge worldwide and a major public health issue. Very few studies from China investigated the impact of metabolic multimorbidity on healthcare and health outcomes at the national level. This study aims to examine the association of metabolic multimorbidity with health service utilization, spending, functional and mental health. Materials and Methods: This is a nationally representative cross-sectional study, utilizing the data from the China Health and Retirement Longitudinal Study in 2015, including 11,377 participants aged 45 years and older. Multivariable regression models were used to assess the association of metabolic multimorbidity with healthcare, out-of-pocket expenditure (OOPE), the activities of daily living (ADL) limitation, the instrumental activities of daily living (IADL) limitation, and depression. Results: Overall, 30.50% of total participants had metabolic multimorbidity in 2015 in China. Compared with single disease, metabolic multimorbidity were associated with the number of outpatient visits [incident rate ratio (IRR) = 1.30, 95% CI = 1.05, 1.62] and days of inpatient care (IRR = 1.52, 95% CI = 1.28, 1.81). Metabolic multimorbidity was positively associated with the OOPE on outpatient care (coefficient = 82.99, 95% CI = 17.70, 148.27) and physical functional difficulties, including ADL limitation (odds ratio = 1.36, 95% CI = 1.18, 1.57). Conclusions: Metabolic multimorbidity is associated with higher levels of health-care service use, greater expenditure for outpatient care, and more difficulties in ADL among Chinese adults. China's health-care systems need to shift from single-disease models to new financing and service delivery models to effectively manage metabolic multimorbidity.
Collapse
Affiliation(s)
- Yang Zhao
- Stroke and Women and Children Health Program, The George Institute for Global Health at Peking University Health Science Center, Beijing, China.,Non-communicable Disease Unit, The Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC, Australia.,WHO Collaborating Centre on Implementation Research for Prevention and Control of Non-communicable Diseases, The University of Melbourne, Melbourne, VIC, Australia
| | - Puhong Zhang
- Stroke and Women and Children Health Program, The George Institute for Global Health at Peking University Health Science Center, Beijing, China.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - John Tayu Lee
- Non-communicable Disease Unit, The Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Brian Oldenburg
- Non-communicable Disease Unit, The Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC, Australia.,WHO Collaborating Centre on Implementation Research for Prevention and Control of Non-communicable Diseases, The University of Melbourne, Melbourne, VIC, Australia
| | - Alexander van Heusden
- Non-communicable Disease Unit, The Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Tilahun Nigatu Haregu
- Non-communicable Disease Unit, The Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC, Australia.,WHO Collaborating Centre on Implementation Research for Prevention and Control of Non-communicable Diseases, The University of Melbourne, Melbourne, VIC, Australia
| | - Haipeng Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, China
| |
Collapse
|