1
|
Zanwar PP, Taylor R, Hill-Jarrett TG, Tsoy E, Flatt JD, Mirza Z, Hill CV, Perianayagam A. Characterizing Multimorbidity Prevalence and Adverse Outcomes in Ethnically and Culturally Diverse Sub-Populations in India: Gaps, Opportunities, and Future Directions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:327. [PMID: 38541326 PMCID: PMC10970139 DOI: 10.3390/ijerph21030327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/14/2024] [Accepted: 02/29/2024] [Indexed: 04/28/2024]
Abstract
India is a large middle-income country and has surpassed China in overall population, comprising 20% of the global population (over 1.43 billion people). India is experiencing a major demographic shift in its aging population. Chronic diseases are common among older adults and can be persistent over the life course, lead to the onset of disability, and be costly. Among older adults in India, the existence of multiple comorbid chronic conditions (i.e., multimorbidity) is rapidly growing and represents a burgeoning public health burden. Prior research identified greater rates of multimorbidity (e.g., overweight/obesity diabetes, hypertension, cardiovascular disease, stroke, and malignancies) in minority populations in the United States (U.S.); however, limited studies have attempted to characterize multimorbidity among older adult sub-populations residing in India. To address this gap, we conducted a narrative review of studies on multimorbidity using the data from the Longitudinal Aging Study of India (LASI), the largest nationally representative longitudinal survey study of adults in India. Our definition of multimorbidity was the presence of more than two conditions in the same person. Our findings, based on 15 reviewed studies, aim to (1) characterize the definition and measurement of multimorbidity and to ascertain its prevalence in ethnically and culturally diverse sub-populations in India; (2) identify adverse outcomes associated with multimorbidity in the Indian adult population; and (3) identify gaps, opportunities, and future directions.
Collapse
Affiliation(s)
- Preeti Pushpalata Zanwar
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA 19107, USA
- Irma Lerma Rangel College of Pharmacy, Texas A&M University, Kingsville, TX 78363, USA
- Jie Du Center for Innovation and Excellence for Drug Development, University of Pacific, Stockton, CA 95211, USA
- The National Institutes on Aging (NIA) Funded Network on Education, Biosocial Pathways, and Dementia in Diverse Populations (EBDDP), College Park, MD 20742, USA
| | - Robyn Taylor
- National Association of Chronic Disease Directors, Decatur, GA 30030, USA; (R.T.); (Z.M.)
| | - Tanisha G. Hill-Jarrett
- Memory and Aging Center, University of California, San Francisco, CA 94143, USA; (T.G.H.-J.); (E.T.)
- Global Brain Health Institute, University of California San Francisco & Trinity College Dublin, San Francisco, CA 94158, USA
| | - Elena Tsoy
- Memory and Aging Center, University of California, San Francisco, CA 94143, USA; (T.G.H.-J.); (E.T.)
- Global Brain Health Institute, University of California San Francisco & Trinity College Dublin, San Francisco, CA 94158, USA
| | - Jason D. Flatt
- School of Public Health, University of Nevada, Las Vegas, NV 89119, USA;
| | - Zunera Mirza
- National Association of Chronic Disease Directors, Decatur, GA 30030, USA; (R.T.); (Z.M.)
| | | | | |
Collapse
|
2
|
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
|
3
|
Varanasi R, Sinha A, Nayak D, Manchanda RK, Janardhanan R, Tandon S, Pati S. Prevalence and correlates of multimorbidity among patients attending AYUSH primary care settings in Delhi-National Capital Region, India. BMC Complement Med Ther 2023; 23:429. [PMID: 38031066 PMCID: PMC10685658 DOI: 10.1186/s12906-023-04158-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 09/07/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION India has a multifaceted healthcare system and recognizes complementary and alternative systems of medicine (AYUSH) that cater to the healthcare needs of people. Multimorbidity requires frequent visits to physicians and long-term use of medications, due to which people tend to prefer AYUSH systems as they provide holistic patient-centered treatment. Hence, we aimed to estimate the prevalence of multimorbidity and assess its correlates among patients attending AYUSH primary care clinics in Delhi. METHODS A cross-sectional study was conducted among 943 patients aged ≥ 18 years attending various AYUSH primary care clinics in Delhi from September 2021 to February 2022, employing a stratified random sampling technique. Descriptive statistics such as frequency and proportion were used to report the prevalence of multimorbidity (two or more chronic conditions in an individual out of the 33 conditions listed as per the Multimorbidity Assessment Questionnaire for Primary Care). A multivariable logistic regression assessed the association between various socio-demographic characteristics and multimorbidity, presented as an adjusted odds ratio (AOR) with a 95% confidence interval (CI). RESULTS The prevalence of diabetes (14.7%) was found to be the highest (out of all included chronic conditions) among the patients attending various AYUSH primary care settings. The overall prevalence of multimorbidity was observed to be around 39.4%. We observed a higher likelihood of having multimorbidity among participants aged ≥ 70 years [AOR: 9.19 (95% CI: 3.75-22.54)], females [AOR: 1.57 (95% CI: 1.04-2.37)], and middle class [AOR: 2.23 (95% CI: 1.45-3.43)]. CONCLUSION Multimorbidity was evidently prevalent across AYUSH primary care settings, which cannot be overlooked. The results suggest behavioral change communication may be aimed at older individuals, females, and the middle class.
Collapse
Affiliation(s)
- Roja Varanasi
- Amity Institute of Public Health, Amity University, Noida, India.
- Central Council for Research in Homoeopathy, Ministry of AYUSH, New Delhi, India.
| | - Abhinav Sinha
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Debadatta Nayak
- Amity Institute of Public Health, Amity University, Noida, India
- Central Council for Research in Homoeopathy, Ministry of AYUSH, New Delhi, India
| | | | - Rajiv Janardhanan
- Amity Institute of Public Health, Amity University, Noida, India
- SRM Institute of Science & Technology, Chennai, Tamil Nadu, India
| | - Simran Tandon
- Amity School of Health Sciences, Amity University, Mohali, Punjab, India
| | - Sanghamitra Pati
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India.
| |
Collapse
|
4
|
Sinha A, Kanungo S, Bhattacharya D, Kaur H, Pati S. Non-communicable disease multimorbidity among tribal older adults in India: evidence from Study on Global AGEing and adult health, 2015. Front Public Health 2023; 11:1217753. [PMID: 37693702 PMCID: PMC10488702 DOI: 10.3389/fpubh.2023.1217753] [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: 05/05/2023] [Accepted: 07/27/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction Multimorbidity defined as the simultaneous presence of two or more chronic conditions in an individual is on the rise in low- and middle-income countries such as India. With India aiming to achieve universal health coverage, it is imperative to address the inequalities in accessing healthcare, especially among vulnerable groups such as tribal. Moreover, changing lifestyle has led to the emergence of multimorbidity among tribals in India. We aimed to estimate the prevalence and assess the correlates of multimorbidity among tribal older adults in India. Methods We employed nationally representative data from the World Health Organization's Study on Global AGEing and Adult Health conducted in 2015. We included 522 participants aged ≥50 years who reported their caste to be 'Scheduled Tribe' in the survey. A multivariable regression model assessed the association between multimorbidity and various attributes. Results Arthritis, cataract, and hypertension were the most common chronic conditions. The overall prevalence of multimorbidity was ~22.61%. We observed a higher likelihood of having multimorbidity among respondents aged ≥80 years [AOR: 4.08 (1.17-14.18)] than the younger age groups, and among the most affluent group [AOR: 2.64 (1.06-6.56)] than the most deprived class. Conclusion The prevalence of multimorbidity among tribal older adults is emerging which cannot be overlooked. Health and wellness centers may be a window of opportunity to provide egalitarian and quality preventive and curative services to achieve universal health coverage. Future studies should explore the outcomes of multimorbidity in terms of healthcare utilization, expenditure, and quality of life in this group.
Collapse
Affiliation(s)
- Abhinav Sinha
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Srikanta Kanungo
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | | | - Harpreet Kaur
- Indian Council of Medical Research, New Delhi, India
| | - Sanghamitra Pati
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| |
Collapse
|
5
|
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: 94] [Impact Index Per Article: 94.0] [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
|
6
|
Nayak S, Nayak SR, Alice A, Sahoo D, Kanungo S, Rehman T, Pati S, Palo SK. Factors associated with poor self-rated health among chronic kidney disease patients and their health care utilization: Insights from LASI wave-1, 2017-18. FRONTIERS IN NEPHROLOGY 2023; 2:968285. [PMID: 37675030 PMCID: PMC10479761 DOI: 10.3389/fneph.2022.968285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 12/12/2022] [Indexed: 09/08/2023]
Abstract
Background Chronic kidney disease (CKD), associated with other chronic conditions affects the physical, behavioral, and psychological aspects of an individual, leading to poor self-rated health. Hence, we aimed to assess the factors associated with poor self-rated health (SRH) in CKD patients. Additionally, we assessed their health care utilization. Methods This is an observational study consisting of 527 CKD patients from Longitudinal Aging Study in India (LASI), 2017-2018. A descriptive statistic computed prevalence. Regression analysis assessed the association between poor SRH and socio-demographic variables presented as adjusted odds ratio with a confidence interval of 95%. Health care utilization among CKD patients was graphically presented. Results Around 64% of CKD patients had poor SRH. Aged 75 years and above (AOR=1.8, 95% CI= 0.5-6.8), rural residents (AOR= AOR 1.8, 95% CI =1.0 -3.1) and those with other chronic conditions (AOR=5.1, 95% CI= 2.3-11.0) were associated with poor SRH. Overall 79% of the CKD patients availed health care facility, most (44.8%) of those visit private facility. Conclusion We observed older adults, females, rural residents, and having other chronic conditions were associated with poor SRH among CKD patients which highlights the need for equitable and strengthened health care system. There is an urgent need to provide accessible, affordable and quality healthcare services for these individuals so as to maintain continuity of care.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Subrat Kumar Palo
- Department of Health Research (ICMR)-Regional Medical Research Center, Bhubaneswar, India
| |
Collapse
|
7
|
Ghosal S, Sinha A, Kerketta S, Acharya AS, Kanungo S, Pati S. Oral health among adults aged ≥45 years in India: Exploring prevalence, correlates and patterns of oral morbidity from LASI wave-1. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
8
|
Shigli K, Nayak SS, Lagali-Jirge V, Kusurkar RA, Nerali JT, Oginni FO. Inclusion of gerodontology in dental curriculum: An urgent case for India. GERONTOLOGY & GERIATRICS EDUCATION 2022; 43:468-481. [PMID: 35422199 DOI: 10.1080/02701960.2022.2058936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The proportion of older adults is on the rise. Management of dental problems in this group is different from the general population, and hence requires special training. Gerodontology is yet to find its place in the Indian dental curriculum. A lack of training would result in inadequate care delivery. In this article, we share our views on the need for inclusion of the subject, potential challenges, and a guide for incorporation of gerodontology in undergraduate and postgraduate curriculum in the Indian dental institutes. We propose a framework based on the salient features of Kern's 6-step approach for curriculum development and Kotter's 8-step change management model. Some features are common to both the models. A combination of these models includes the following salient features: Problem identification and general needs assessment, beginning with a sense of urgency and targeted needs assessment, communication of the vision for change, working in guided coalitions and defining clear goals and objectives, adopting the relevant educational strategies, implementation strategies to enable change and generating short-term wins, evaluating the effectiveness of the curricular reform and sustaining and anchoring the change. The proposed framework may also be useful for countries where gerodontology is yet to be implemented.
Collapse
Affiliation(s)
- Kamal Shigli
- Department of Prosthodontics, DY Patil Dental School, Pune, India
| | | | - Vasanti Lagali-Jirge
- Department of Oral Medicine and Radiology, KLEVK Institute of Dental Sciences, KAHER Belagavi, India
| | - Rashmi A Kusurkar
- Amsterdam UMC location Vrije Universiteit Amsterdam, Research in Education, Boelelaan, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam The Netherlands
| | | | | |
Collapse
|
9
|
Pati S, Sinha A, Ghosal S, Kerketta S, Lee JT, Kanungo S. Family-Level Multimorbidity among Older Adults in India: Looking through a Syndemic Lens. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9850. [PMID: 36011486 PMCID: PMC9408391 DOI: 10.3390/ijerph19169850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/02/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
Most evidence on multimorbidity is drawn from an individual level assessment despite the fact that multimorbidity is modulated by shared risk factors prevailing within the household environment. Our study reports the magnitude of family-level multimorbidity, its correlates, and healthcare expenditure among older adults using data from the Longitudinal Ageing Study in India (LASI), wave-1. LASI is a nationwide survey amongst older adults aged ≥45 years conducted in 2017-2018. We included (n = 22,526) families defined as two or more members coresiding in the same household. We propose a new term, "family-level multimorbidity", defined as two or more members of a family having multimorbidity. Multivariable logistic regression was used to assess correlates, expressed as adjusted odds ratios with a 95% confidence interval. Family-level multimorbidity was prevalent among 44.46% families, whereas 41.8% had conjugal multimorbidity. Amongst siblings, 42.86% reported multimorbidity and intergenerational (three generations) was 46.07%. Family-level multimorbidity was predominantly associated with the urban and affluent class. Healthcare expenditure increased with more multimorbid individuals in a family. Our findings depict family-centred interventions that may be considered to mitigate multimorbidity. Future studies should explore family-level multimorbidity to help inform programs and policies in strategising preventive as well as curative services with the family as a unit.
Collapse
Affiliation(s)
- Sanghamitra Pati
- ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India
| | - Abhinav Sinha
- ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India
| | | | | | - John Tayu Lee
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London SW7 2AZ, UK
| | - Srikanta Kanungo
- ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India
| |
Collapse
|
10
|
Sinha A, Kerketta S, Ghosal S, Kanungo S, Lee JT, Pati S. Multimorbidity and Complex Multimorbidity in India: Findings from the 2017-2018 Longitudinal Ageing Study in India (LASI). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159091. [PMID: 35897461 PMCID: PMC9332385 DOI: 10.3390/ijerph19159091] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/18/2022] [Accepted: 07/24/2022] [Indexed: 12/18/2022]
Abstract
Complex multimorbidity refers to the co-occurrence of three or more chronic illnesses across >2 body systems, which may identify persons in need of additional medical support and treatment. There is a scarcity of evidence on the differences in patient outcomes between non-complex (≥2 conditions) and complex multimorbidity groups. We evaluated the prevalence and patient outcomes of complex multimorbidity and compared them to non-complex multimorbidity. We included 30,489 multimorbid individuals aged ≥45 years from the Longitudinal Ageing Study in India (LASI) from wave-1 conducted in 2017−2018. We employed a log link in generalised linear models (GLM) to identify possible risk factors presenting the adjusted prevalence−risk ratio (APRR) and adjusted prevalence−risk difference (APRD) with 95% confidence interval. The prevalence of complex multimorbidity was 34.5% among multimorbid individuals. Participants residing in urban areas [APRR: 1.10 (1.02, 1.20)], [APRD: 0.04 (0.006, 0.07)] were more likely to report complex multimorbidity. Participants with complex multimorbidity availed significantly higher inpatient department services and had higher expenditure as compared to the non-complex multimorbidity group. Our findings have major implications for healthcare systems in terms of meeting the requirements of people with complicated multimorbidity, as they have significantly higher inpatient health service utilisation, higher medical costs, and poorer self-rated health.
Collapse
Affiliation(s)
- Abhinav Sinha
- ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India; (A.S.); (S.K.); (S.G.)
| | - Sushmita Kerketta
- ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India; (A.S.); (S.K.); (S.G.)
| | - Shishirendu Ghosal
- ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India; (A.S.); (S.K.); (S.G.)
| | - Srikanta Kanungo
- ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India; (A.S.); (S.K.); (S.G.)
- Correspondence: (S.K.); (S.P.)
| | - John Tayu Lee
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia;
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London SW7 2AZ, UK
| | - Sanghamitra Pati
- ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India; (A.S.); (S.K.); (S.G.)
- Correspondence: (S.K.); (S.P.)
| |
Collapse
|
11
|
Sinha A, Kerketta S, Ghosal S, Kanungo S, Pati S. Multimorbidity Among Urban Poor in India: Findings From LASI, Wave-1. Front Public Health 2022; 10:881967. [PMID: 35719649 PMCID: PMC9201724 DOI: 10.3389/fpubh.2022.881967] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/06/2022] [Indexed: 12/17/2022] Open
Abstract
Background Multimorbidity has become a norm in low-and middle-income countries such as India requiring notable health system improvements to combat. Urban population is a heterogeneous group where poor are at a risk of facing inequity in accessing healthcare services which can jeopardize our efforts to attain universal health coverage (UHC). We aimed to estimate the prevalence, assess correlates and patterns of multimorbidity among urban poor. Further, we assessed the outcomes of multimorbidity such as healthcare utilization, expenditure and self-rated health. Methods Longitudinal Aging Study in India (LASI), wave-1 is a nationally representative survey conducted amongst participants aged ≥45 years in 2017–18. We included 9,327 participants residing in urban areas, categorized as poor based on monthly per capita expenditure. Descriptive statistics computed prevalence with 95% uncertainty interval. Multivariable logistic regression was executed to assess the association between multimorbidity and various correlates, expressed as adjusted odds ratio. An ordinal regression model was run between self-rated health and number of chronic conditions. Results The prevalence of multimorbidity was 45.26% among the urban poor. Hypertension and oral morbidities were the most commonly observed dyad. Respondents who were poorer [AOR: 1.27 (1.06–1.51)] had higher chances of having multimorbidity than the poorest. Respondents with a health insurance [AOR: 1.40 (1.14–1.70)] had a higher risk of having multimorbidity. In-patient admission was significantly higher among participants having multimorbidity. Out of pocket expenditure increased while self-rated health deteriorated with each additional morbid condition. Conclusion Multimorbidity is found to be increasingly prevalent among urban poor and individuals having health insurance which demonstrates the need to expand healthcare insurance schemes such as Ayushman Bharat for urban poor to achieve UHC.
Collapse
Affiliation(s)
- Abhinav Sinha
- Department of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar, India
| | - Sushmita Kerketta
- Department of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar, India
| | - Shishirendu Ghosal
- Department of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar, India
| | - Srikanta Kanungo
- Department of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar, India
| | - Sanghamitra Pati
- Department of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar, India
| |
Collapse
|
12
|
Barik M, Panda SN, Tripathy SS, Sinha A, Ghosal S, Acharya AS, Kanungo S, Pati S. Is multimorbidity associated with higher risk of falls among older adults in India? BMC Geriatr 2022; 22:486. [PMID: 35658840 PMCID: PMC9167508 DOI: 10.1186/s12877-022-03158-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 05/16/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Fall, a multifaceted health condition, is one of the major causes of mortality among older adults. Rapid ageing and increased multimorbidity in low-and middle-income countries (LMICs), including India, might elevate the risk of fall. Although, fall is associated with significant healthcare utilization, it still remains an under-recognized public health issue. This accentuates a need for evidence on fall to integrate it into existing healthcare programs, a gap in geriatric care. The present study aimed to assess the association of fall with multimorbidity among older adults in India. METHODS We included 28,567 participants aged ≥ 60 years from Longitudinal Ageing Study in India (LASI), wave-1 conducted during 2017-19. Descriptive statistics were used to compute the prevalence of self-reported falls along with 95% confidence interval as a measure of uncertainty. The association between falls and multimorbidity was assessed by multivariable logistic regression and presented as an adjusted odds ratio (AOR). RESULTS The prevalence of falls was 12.5%, being higher among women (13.6% vs. 11.4%) than men. The major determinants of fall were females, rural residents and smokeless tobacco use. We observed multimorbidity [AOR: 1.29 (1.14-1.46)] to be significantly associated with falls. CONCLUSION Falls are commonly prevalent among older adults having multimorbidity as its important predictor. Existing health programs should incorporate falls as an important part of geriatric care. Additionally, primary health care facilities should be strengthened to provide comprehensive care for injuries sustained due to falls.
Collapse
Affiliation(s)
- Manish Barik
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha India
| | | | | | - Abhinav Sinha
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha India
| | | | | | - Srikanta Kanungo
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha India
| | - Sanghamitra Pati
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha India
| |
Collapse
|
13
|
Oral Health of Elderly People in Institutionalized Care and Three-Month Rehabilitation Programme in Southern Poland: A Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19094994. [PMID: 35564391 PMCID: PMC9105158 DOI: 10.3390/ijerph19094994] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/12/2022] [Accepted: 04/15/2022] [Indexed: 01/01/2023]
Abstract
Demographic ageing is a global growing process and the quality of ageing is an important parameter in this process. The aim of the study was to analyse the distribution of remaining dentition in relation to oral hygiene indicators among elderly people remaining in institutional care and those who participated in a 3-month rehabilitation program, aimed at increasing time of independent functioning, in southern Poland. The patients underwent a questionnaire and clinical examination. An analysis of missing teeth was performed, plaque index, and gingival index were measured. Residents of the Municipal Health Centre for Older and Dependent People (n = 50) had a higher incidence of missing teeth in the maxilla (88.4%), mandible (77.6%), as well as in the maxilla and mandible combined (83%) than residents of the Daily Medical Care House (n = 30). The distribution of the remaining teeth, in both groups, corresponds to the outlets of the large salivary glands. The group of 53.8% of patients with dry mouth had PI scored 3. Residents with dry mouth were more likely to have plaque deposits and gingival inflammation. It is necessary to develop and implement an oral care program for patients with reduced saliva secretion, with a particular focus on dependents.
Collapse
|