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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.
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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.)
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Varanasi R, Sinha A, Bhatia M, Nayak D, Manchanda RK, Janardhanan R, Lee JT, Tandon S, Pati S. Epidemiology and impact of chronic disease multimorbidity in India: a systematic review and meta-analysis. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2024; 14:26335565241258851. [PMID: 38846927 PMCID: PMC11155324 DOI: 10.1177/26335565241258851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/16/2024] [Indexed: 06/09/2024]
Abstract
Objectives This is the first systematic review and meta-analysis of the prevalence of multimorbidity, its risk factors including socioeconomic factors, and the consequences of multimorbidity on health systems and broader society in India. Methods A systematic review of both published and grey literature from five databases (Medline, Embase, EBSCO, Scopus, and ProQuest) was conducted including original studies documenting prevalence or patient outcomes associated with multimorbidity among adults in India. We excluded studies that did not explicitly mention multimorbidity. Three independent reviewers did primary screening based on titles and abstracts followed by full-text review for potential eligibility. The risk of bias was independently assessed by two reviewers following the Appraisal Tool for Cross-Sectional Studies. We presented both qualitative and quantitative (through meta-analysis) summaries of the evidence. The protocol for this study was prospectively registered with PROSPERO (CRD42021257281). Results The review identified 5442 articles out of which 35 articles were finally included in this study. Twenty-three studies were based on the primary data while 12 used secondary data. Eleven studies were conducted in hospital/primary care setting while 24 were community-based. The pooled prevalence of multimorbidity based on (n=19) studies included for meta-analysis was 20% (95% CI: 19% to 20%). The most frequent outcomes were increased healthcare utilization, reduced health-related quality of life, physical and mental functioning. Conclusion We identified a wide variance in the magnitude of multimorbidity across age groups and regions with most of the studies from eastern India. Nation-wide studies, studies on vulnerable populations and interventions are warranted.
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Affiliation(s)
- Roja Varanasi
- Amity Institute of Public Health, Noida, India
- Central Council for Research in Homoeopathy, New Delhi, India
| | - Abhinav Sinha
- ICMR-Regional Medical Research Centre, Bhubaneswar, India
| | | | - Debadatta Nayak
- Amity Institute of Public Health, Noida, India
- Central Council for Research in Homoeopathy, New Delhi, India
| | - Raj K Manchanda
- Homoeopathic Sectional Committee, AYUSH Department, Bureau of Indian Standards, Government of India, New Delhi, India
| | - Rajeev Janardhanan
- Amity Institute of Public Health, Noida, India
- SRM Institute of Science & Technology, Kattankulathur, India
| | - John Tayu Lee
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Simran Tandon
- Amity School of Health Sciences, Amity University, Mohali, India
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Varanasi R, Sinha A, Nayak D, Manchanda RK, Janardhanan R, Tandon S, Pati S. Prevalence and correlates of multimorbidity among patients attending AYUSH primary care settings in Delhi-National Capital Region, India. BMC Complement Med Ther 2023; 23:429. [PMID: 38031066 PMCID: PMC10685658 DOI: 10.1186/s12906-023-04158-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 09/07/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION India has a multifaceted healthcare system and recognizes complementary and alternative systems of medicine (AYUSH) that cater to the healthcare needs of people. Multimorbidity requires frequent visits to physicians and long-term use of medications, due to which people tend to prefer AYUSH systems as they provide holistic patient-centered treatment. Hence, we aimed to estimate the prevalence of multimorbidity and assess its correlates among patients attending AYUSH primary care clinics in Delhi. METHODS A cross-sectional study was conducted among 943 patients aged ≥ 18 years attending various AYUSH primary care clinics in Delhi from September 2021 to February 2022, employing a stratified random sampling technique. Descriptive statistics such as frequency and proportion were used to report the prevalence of multimorbidity (two or more chronic conditions in an individual out of the 33 conditions listed as per the Multimorbidity Assessment Questionnaire for Primary Care). A multivariable logistic regression assessed the association between various socio-demographic characteristics and multimorbidity, presented as an adjusted odds ratio (AOR) with a 95% confidence interval (CI). RESULTS The prevalence of diabetes (14.7%) was found to be the highest (out of all included chronic conditions) among the patients attending various AYUSH primary care settings. The overall prevalence of multimorbidity was observed to be around 39.4%. We observed a higher likelihood of having multimorbidity among participants aged ≥ 70 years [AOR: 9.19 (95% CI: 3.75-22.54)], females [AOR: 1.57 (95% CI: 1.04-2.37)], and middle class [AOR: 2.23 (95% CI: 1.45-3.43)]. CONCLUSION Multimorbidity was evidently prevalent across AYUSH primary care settings, which cannot be overlooked. The results suggest behavioral change communication may be aimed at older individuals, females, and the middle class.
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Affiliation(s)
- Roja Varanasi
- Amity Institute of Public Health, Amity University, Noida, India.
- Central Council for Research in Homoeopathy, Ministry of AYUSH, New Delhi, India.
| | - Abhinav Sinha
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Debadatta Nayak
- Amity Institute of Public Health, Amity University, Noida, India
- Central Council for Research in Homoeopathy, Ministry of AYUSH, New Delhi, India
| | | | - Rajiv Janardhanan
- Amity Institute of Public Health, Amity University, Noida, India
- SRM Institute of Science & Technology, Chennai, Tamil Nadu, India
| | - Simran Tandon
- Amity School of Health Sciences, Amity University, Mohali, Punjab, India
| | - Sanghamitra Pati
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India.
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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.
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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
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Eyowas FA, Schneider M, Alemu S, Getahun FA. Experience of living with multimorbidity and health workers perspectives on the organization of health services for people living with multiple chronic conditions in Bahir Dar, northwest Ethiopia: a qualitative study. BMC Health Serv Res 2023; 23:232. [PMID: 36890489 PMCID: PMC9995260 DOI: 10.1186/s12913-023-09250-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 03/06/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Multimorbidity-the simultaneous occurrence of two or more chronic Non-Communicable Diseases) in an individual is increasing globally and challenging health systems. Although individuals living with multimorbidity face a range of adverse consequences and difficulty in getting optimal health care, the evidence base in understanding the burden and capacity of the health system in managing multimorbidity is sparse in low-and middle-income countries (LMICs). This study aimed at understanding the lived experiences of patients with multimorbidity and perspective of service providers on multimorbidity and its care provision, and perceived capacity of the health system for managing multimorbidity in Bahir Dar City, northwest Ethiopia. METHODS A facility-based phenomenological study design was conducted in three public and three private health facilities rendering chronic outpatient Non-Communicable Diseases (NCDs) care in Bahir Dar City, Ethiopia. Nineteen patient participants with two or more chronic NCDs and nine health care providers (six medical doctors and three nurses) were purposively selected and interviewed using semi-structured in-depth interview guides. Data were collected by trained researchers. Interviews were audio-recorded using digital recorders, stored and transferred to computers, transcribed verbatim by the data collectors, translated into English and then imported into NVivo V.12 software for data analysis. We employed a six-step inductive thematic framework analysis approach to construct meaning and interpret experiences and perceptions of individual patients and service providers. Codes were identified and categorized into sub-themes, organizing themes and main themes iteratively to identify similarities and differences across themes, and to interpret them accordingly. RESULTS A total of 19 patient participants (5 Females) and nine health workers (2 females) responded to the interviews. Participants' age ranged from 39 to 79 years for patients and 30 to 50 years for health professionals. About half (n = 9) of the participants had three or more chronic conditions. The key themes produced were feeling dependency, social rejection, psychological distress, poor medication adherence and poor quality of care. Living with multimorbidity poses a huge burden on the physical, psychological, social and sexual health of patients. In addition, patients with multimorbidity are facing financial hardship to access optimal multimorbidity care. On the other hand, the health system is not appropriately prepared to provide integrated, person-centered and coordinated care for people living with multiple chronic conditions. CONCLUSION AND RECOMMENDATIONS Living with multimorbidity poses huge impact on physical, psychological, social and sexual health of patients. Patients seeking multimorbidity care are facing challenges to access care attributable to either financial constraints or the lack of integrated, respectful and compassionate health care. It is recommended that the health system must understand and respond to the complex care needs of the patients with multimorbidity.
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Affiliation(s)
- Fantu Abebe Eyowas
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Marguerite Schneider
- Department of Psychiatry and Mental Health University of Cape Town, Alan J Flisher Centre for Public Mental Health, Cape Town, South Africa
| | - Shitaye Alemu
- School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fentie Ambaw Getahun
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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