Multimorbidity among midlife women in India: well-being beyond reproductive age

Association between reproductive lifespan and multimorbidity among Chinese postmenopausal women

OBJECTIVE

Although menopause is considered a risk factor for multimorbidity, few studies have explored the association between reproductive lifespan and multimorbidity. This study aimed to explore the association between reproductive lifespan and multimorbidity in postmenopausal Chinese women.

METHODS

This cross-sectional study selected postmenopausal women as study participants. The reproductive lifespan refers to the interval between menarche and menopause. Multimorbidity refers to having two or more self-reported chronic diseases. We used a logistic regression model to explore potential associations based on the adjustment of a set of covariates.

RESULTS

In total, 1,310 postmenopausal women with an average reproductive lifespan of 34 years were included in this study. The prevalence of multimorbidity was 22.2% (291/1,310) in postmenopausal women. Our findings showed that compared with postmenopausal women with the Q1 of reproductive lifespan (≤32 reproductive years), those with Q3 (35-37 reproductive years) and Q4 (≥38 reproductive years) were less likely to have multimorbidity (OR Q3 = 0.529, 95% CI Q3 = 0.347-0.805, OR Q4 = 0.510, 95% CI Q4 = 0.308-0.842), whereas those with Q2 (33-34 reproductive years) were not (OR = 0.700, 95% CI = 0.446-1.098). This study also revealed a linear trend in the association between the reproductive lifespan and multimorbidity; that is, the longer the reproductive lifespan, the lower the risk of multimorbidity.

CONCLUSIONS

In postmenopausal Chinese women, a longer reproductive lifespan was associated with a lower prevalence of multimorbidity. This study suggests that for the prevention and intervention of multimorbidity in postmenopausal women, healthcare professionals should screen and assess reproductive factors to identify high-risk individuals.

Characterizing Multimorbidity Prevalence and Adverse Outcomes in Ethnically and Culturally Diverse Sub-Populations in India: Gaps, Opportunities, and Future Directions

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.

Knowledge, practices and barriers to access sexual health of women in the menopausal stages: a cross-sectional study with Brazilian gynecologists

BACKGROUND

Sexual health access and care for women in the menopausal stages face significant barriers, presenting deficits in relation to diagnosis and treatment. Although epidemiological data indicate high prevalence of problems related to sexual health in this population, traditionally, the theme is not discussed in health care settings. This study aimed to analyze knowledge, practices and barriers to access sexual health of women in the menopausal stages in the context of women's health care in Brazil.

METHODS

With a cross-sectional design, a questionnaire was distributed electronically, encompassing variables related to knowledge; practices; and barriers to access sexual health of women in the menopausal stages. The data obtained were subjected to analysis using both descriptive and inferential statistics. Specifically, we employed multivariate analysis, employing multiple linear regression models, to discern potential factors associated with outcomes concerning the level of knowledge and the frequency of addressing the topic in professional practice.

RESULTS

The sample included 70 physicians with specialization in obstetrician/gynecologists who work in health care with women in the menopausal transition or postmenopausal women. A high level of self-reported knowledge about sexual health was identified. Regarding the practices, most of them reported directly proposing the subject and not using instruments. Although they reported frequently addressing the topic in general, topics related to vaginal lubrication, dyspareunia, and sexual dysfunction have been more present in the clinic compared to sexual orientation and women's relationship with themselves. The main barriers were time limitation and patient discomfort with the topic. The multivariate models indicated that female gynecologists and professionals with higher levels of knowledge on the subject had a higher frequency of addressing sexual health in clinical practice with women in menopausal stages.

CONCLUSIONS

Sexual health access and care for brazilian women in the menopausal stages presents discrepancies in the frequency of approach between the various topics, in addition to the predictive character of technical knowledge in the practices of professionals. To ensure universal access to sexual health services for this population, an active approach through specific instruments is important, as well as the reinforcement of strategies to improve the level of knowledge of professionals.

Epidemiology and impact of chronic disease multimorbidity in India: a systematic review and meta-analysis

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.

Epidemiology of multimorbidity in Nepal: A systematic review and meta-analysis

Background

Multimorbidity is rising in low-and middle-income countries such as Nepal, yet the research has not gained pace in this field. We aimed to systematically review the existing multimorbidity literature in Nepal and estimate the prevalence and map its risk factors and consequences.

Methods

We reviewed data collated from PubMed, Embase and CINAHL by including original studies that reported prevalence of multimorbidity in Nepal. The quality of included studies was assessed using the Appraisal Tool for Cross-sectional Studies. The summary of the review is presented both qualitatively as well as through meta-analysis to give pooled prevalence. We prospectively registered in PROSPERO (CRD42024499598).

Results

We identified 423 studies out of which seven were included in this review. All studies were conducted in a community setting except one which was hospital based. The prevalence reported across various studies ranged from 13.96% to 70.1%. The pooled prevalence of multimorbidity was observed to be 25.05% (95% CI: 16.99 to 34.09). The number of conditions used to assess multimorbidity ranged from four to nine. The major risk factors identified were increasing age, urban residence, and lower literacy rates.

Conclusion

A wide variance in the prevalence of multimorbidity was observed. Moreover, multimorbidity assessment tool/conditions considered for assessing multimorbidity were heterogeneous.

Prevalence and correlates of multimorbidity among patients attending AYUSH primary care settings in Delhi-National Capital Region, India

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.

Prevalence and determinants of hysterectomy in India

Increase in the prevalence of hysterectomy among low-and middle-income countries (LMICs) such as India has become a significant concern. Reports based on either a particular group or region show an increasing trend in hysterectomy, but there is a dearth of national-level data in this domain. Hence, there seems to be an urgent need to garner evidence on the prevalence and determinants of hysterectomy, which could pave the way for future programs and policies. We aimed to estimate the prevalence of hysterectomy and assess its determinants using a nationally representative sample. An observational analysis was conducted using data from Longitudinal Aging Study in India (LASI), 2017-2018. 38,154 women aged > 18 years were included. A multivariable logistic regression, presented as an adjusted odds ratio (AOR) with a 95% confidence interval (CI), was used to predict the association between various socio-demographic characteristics and hysterectomy. A separate multivariable logistic regression model was executed to determine the association between selected non-communicable diseases (NCDs) and hysterectomy. Survey weights compensated the complex study design. The overall prevalence of hysterectomy was around 11.35%. Excessive menstrual bleeding followed by fibroids emerged as the leading causes of hysterectomy. The various determinants of hysterectomy were urban residents [AOR: 1.54 (1.21-1.96)], other backward class [AOR: 2.19 (1.72-2.78], working women [AOR: 1.19(1-1.42)] and the most affluent (rich) group [AOR: 2.06 (1.62-2.63)]. Hysterectomy was associated with cancer [AOR: 4.83 (2.51-9.29)], diabetes [AOR: 1.79 (1.25-2.57)], hypertension [AOR: 1.48 (1.27-1.71)] and joint diseases [AOR: 1.43 (1.09-1.88)]. Hysterectomy is considerably prevalent in India, which cannot be overlooked. Health promotion regarding hysterectomy and its implications is needed especially among urban residents, affluent groups and those with a higher body mass index. Health programmes aimed at women should follow a life course approach by prioritizing health and overall well-being even after reproductive years.

Non-communicable disease multimorbidity among tribal older adults in India: evidence from Study on Global AGEing and adult health, 2015

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.

Obesogenic diet and metabolic syndrome among adolescents in India: data-driven cluster analysis

BACKGROUND

Metabolic syndrome is on the rise in India and is primarily linked to obesogenic dietary habits. The synergy of both is a prominent risk factor for cardiovascular diseases (CVDs). Hence, the present study aims to unveil clusters at high risk of metabolic syndrome and ascertain cluster characteristics based on dietary patterns among adolescents aged 10-19 years.

DATA AND METHODS

The study utilizes secondary data, i.e., Comprehensive National Nutrition Survey conducted in 2016-18. The study sample includes children and adolescents aged 10-19 years. An unsupervised learning algorithm was used to ascertain possible clusters in the data based on individuals' dietary patterns. The k-means were used to cluster the data according to their dietary patterns. To determine the number of clusters elbow method was used, and appropriate validation indices were also obtained for the final k. Further, to ascertain the distribution of the obesogenic dietary patterns and metabolic conditions in each cluster was analysed. Bivariate descriptive analysis was used to draw further inferences.

RESULTS

The k-means clusters identified five optimum clusters based on 12,318 adolescents (6333 males (mean age:14.2 ± 2.8) and 5985 females (mean age:14.3 ± 2.8)) 17 dietary patterns. Clusters were named based on how prudent these were in terms of consuming a healthy diet. Cluster phenotypic characteristics were defined as follows: a cluster of obesogenic diets (24%) constituted the highest proportion of the total sample and was significantly suffering from obesity (p < 0.001), and greater proportions of lipid anomalies (p = 0.51) and hypertension (p = 0.44) but not statistically significant. In contrast, 21% of the sample comprised a plant-based diet cluster and suffered from all deficiencies but folate (p = 0.625), zinc (p = 0.132), and greater proportion from obesity (p = 0.19; not significant), and diabetes (p < 0.001). A cluster of "convenient" (20%) mainly suffered from lipid anomalies (p = 0.00), diabetes (p = 0.03), and a greater proportion from hypertension (p = 0.56) with deficiencies of all the essential vitamins and minerals but significantly from vitamin A (p < 0.001), folate (p < 0.001), and iron (p = 0.017). Lastly, the cluster of those who follow a "Western diet" (17%) was found to have lipid anomalies (p = 0.003), diabetes (p = 0.016), greater proportion of vitamin B12 (p = 0.136), D (p = 0.002), folate (p < 0.001), and iron deficiencies (p = 0.013).

CONCLUSIONS AND RELEVANCE

Adolescents in India show a strong association between obesogenic diet and metabolic syndrome. Therefore, the burden of metabolic syndrome at early ages can be prevented by controlling obesogenic dietary practices and addressing micronutrient deficiencies. This may be done by targeted health promotional campaigns in schools and college-going populations in India.

Gynecological morbidity and treatment-seeking among older adult (aged 45-59) women in India

BACKGROUND

Women's gynecological health needs are not limited to the reproductive years of their life. Women are at risk of hormonal changes, gynecological malignancies, and various genitourinary conditions as they move toward menopause and beyond. Concerns about older women's sexual and reproductive health and rights (SRHR) continue to be taboo in many countries, of little interest to researchers and professionals in the field of healthcare, and a "blind spot" in discussions about policy as a whole. Despite the widespread agreement, the life course approach to addressing SRHR concerns has received minimal attention. The study estimates the prevalence, assesses the correlates, and treatment-seeking of gynecological morbidity (GM) among older adult women aged 45-59 years (N = 18,547) in India.

METHOD

The analysis was based on the nationally representative Longitudinal Ageing Study (2016-2017) data that adopted a multistage stratified area probability cluster sampling to select respondents. The outcome variables used in this analysis were 'had any GM' and 'sought treatment for any GM.' Women with any morbidity such as per vaginal bleeding, foul-smelling vaginal discharge, uterus prolapses, mood swings/irritability, fibroid/cyst, and dry vagina causing painful intercourse were considered to have any GM. Of the respondents with GM, who sought a doctor's consultation or treatment were considered 'sought treatment for any GM.' Binary logistic regression was conducted to examine the adjusted effect of socioeconomic and demographic predictors of GM and treatment-seeking. Stata (V 16) was used for statistical analyses with a 5% significance level.

RESULTS

Fifteen percent of the women had any GM, and only 41% of them sought treatment. Age, marital status, education, number of pregnancies, hysterectomy, involvement in household decision-making, social group, religion, wealth status, and region were significantly associated with GM. The odds of treatment-seeking were higher among women with 10+ years of schooling (OR 1.66, CI 1.23, 2.23), with hysterectomy (OR 7.36, CI 5.92, 9.14), with five-plus pregnancies (OR 1.25, CI 0.96, 1.64), and those from the richest (OR 1.91, CI 1.40, 2.60) households than their respective counterparts.

CONCLUSION

Many older adult women experience GM, and treatment-seeking is inadequate. The GM prevalence and treatment-seeking vary considerably by socioeconomic and demographic characteristics. Results suggest community-level awareness generation and the inclusion of this otherwise ignored group in programs targeting better health and wellbeing of women.

Sex differences in non-communicable disease multimorbidity among adults aged 45 years or older in India

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.

The burden of disease-specific multimorbidity among older adults in India and its states: evidence from LASI

BACKGROUND

Around the world, advances in public health and changes in clinical interventions have resulted in increased life expectancy. Multimorbidity is becoming more of an issue, particularly in countries where the population is rapidly ageing. We aimed to determine the prevalence of multimorbidity and disease-specific multimorbidity and examine its association with demographic and socioeconomic characteristics among older adults in India and its states.

METHODS

The individual data from the longitudinal ageing study in India (LASI) were used for this study, with 11 common chronic conditions among older adults aged 60 and above years (N = 31,464). Descriptive statistics were used to report the overall prevalence of multimorbidity and disease-specific burden of multimorbidity. Multinomial logistic regression has been used to explore the factors associated with multimorbidity.

RESULTS

Prevalence of single morbidity was 30.3%, and multimorbidity was 32.1% among older people in India. Multimorbidity was higher among females and in urban areas and increased with age and among those living alone. Hypertension, arthritis and thyroid were highly prevalent among females and chronic lung diseases and stroke were highly prevalent among males. The older people in the state of Kerala had a high prevalence of multimorbidity (59.2%). Multimorbidity was found to be more likely in older age groups of 75-79 years (RR-1.69; CI: 1.53-1.87) and 80 years and above (RR-1.40; CI: 1.27-1.56) and in the Western (RR-2.16; CI: 1.90-2.44) and Southern regions (RR-2.89; CI: 2.57-3.24). Those who were living with a spouse (RR-1.60; CI: 1.15-2.23) were more likely to have multimorbidity. Disease-specific multimorbidity was high in chronic heart disease (91%) and low in angina (64.8%).

CONCLUSIONS

The findings suggest that multimorbidity has a positive relationship with advancing age, and disease-specific burden of multimorbidity is higher among chronic heart patients. Comorbidity, especially among those who already have chronic heart disease, stroke, cholesterol or thyroid disorder can have severe consequences on physical functioning, therefore, disease-specific health management needs to be enhanced.

Chronic non-communicable disease burden among reproductive-age women in India: evidence from recent demographic and health survey

BACKGROUND

Chronic disease burden among women leads to various detrimental consequences, impacting women's health throughout their life course and off-springs. The present study explores the chronic disease profile among reproductive-aged women and analyzes the effects of various covariates on multimorbidity among reproductive-aged women in India. Here, multimorbidity is defined as an individual suffering from two or more chronic conditions.

METHODS

The present study employed the most recent National Family Health Survey round, 2019-2021. The study utilized information on 695,707 non-pregnant women aged 15-49 years. The study used descriptive, bivariate, and multivariable ordered logistic regression analysis to explore the burden of chronic non-communicable diseases and multimorbidity.

RESULTS

The mean age of women with single chronic condition-related morbidity is 30 years, whereas it was 35 years for those with multimorbidity. Approximately 28% of urban women suffered from multimorbidity. Further, significant factors that affect multimorbidity include age, educational attainment, working status, marital status, parity, menopause, religion, region, wealth index, tobacco use, alcohol consumption, and dietary patterns.

CONCLUSIONS

The present study hints that women in the reproductive age group are at very high risk of developing multimorbidity in India. Most of the programs and policies are focused on the elderly population in terms of awareness and facilitating them with better health services. However, right now, one should also prioritize the emerging chronic condition related to chronic conditions other than hypertension, diabetes, and cancer among the study population, which is escalating as soon as women reach 30 years of age.

Patterns of multimorbidity among a community-based cohort in rural India

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.

Life-course fertility and multimorbidity among middle-aged and elderly women in China: Evidence from China health and retirement longitudinal study

Background

Multimorbidity has become an important public health problem in China, especially among middle-aged and elderly women. Few studies have been reported on the association between multimorbidity and female fertility, which is an important stage in the life course. This study aimed to explore the association between multimorbidity and fertility history among middle-aged and elderly women in China.

Methods

Data from 10,182 middle-aged and elderly female participants in the China Health and Retirement Longitudinal Study (CHARLS) in 2018 were used in this study. Multimorbidity was defined as the presence of at least two or more chronic conditions. Logistic regression analysis, negative binomial regression analysis, and restrictive cubic splines (RCSs) were used to analyze the relationship between female fertility history and multimorbidity or the number of chronic conditions. Multivariable linear regression was used to analyze the relationship between female fertility history and multimorbidity pattern factor scores.

Results

The results of this study showed that high parity and early childbearing were significantly associated with an increased risk of multimorbidity and an increased number of chronic conditions among middle-aged and elderly women in China. Late childbearing was significantly associated with reduced risk of multimorbidity and lessened diseases. Parity and age of first childbirth were significantly correlated with the odds of multimorbidity. The association between fertility history and multimorbidity was found to be influenced by age and urban-rural dual structure. Women with high parity tend to have higher factor scores of cardiac-metabolic, visceral-arthritic, and respiratory-psychiatric patterns. Women with early childbearing tended to have higher factor scores of the visceral-arthritic pattern and those with late childbearing tended to have lower factor scores of the cardiac-metabolic pattern.

Conclusion

Fertility history has a significant effect on multimorbidity in the middle and later lives of Chinese women. This study is of great importance for reducing the prevalence of multimorbidity among Chinese women through their life course and promoting health during their middle and later lives.

Association of the number of teeth and self-rated mastication with self-rated health in community-dwelling Japanese aged 40 years and older: the Yamagata cohort study

Self-rated health (SRH) is a predictive factor for health-related prognoses such as mortality. This study aimed to comprehensively investigate the risk factors for poor SRH in the general population of Japan, focusing on the combination of the number of teeth and self-rated mastication. Individuals aged at least 40 years in Yamagata Prefecture, Japan, were surveyed from 2017 to 2021. The participants answered a self-administered postal survey on lifestyle factors, medical history, physical and mental conditions, oral health, and dietary intake, and 6739 participants were included. Multivariate logistic regression analysis showed that individuals with less than 20 teeth and who bite tightly on one side or neither side were at a 1.422- and 1.952-fold significantly higher risk, respectively, of poor SRH than individuals with at least 20 teeth and who bite tightly on both sides. Moreover, individuals who had less than 20 teeth but could bite tightly on both sides did not have a significant risk compared to those who had at least 20 teeth and could bite tightly on both sides. Regarding individuals with more than 20 teeth, there was no difference between those who could and could not bite tightly on both sides, although the odds ratios for poor SRH tended to increase for those who could bite on one side or neither side. Our results emphasize the importance of having at least 20 teeth without periodontal disease and oral rehabilitation using a type of prosthesis for SRH, even with less than 20 teeth.

Family-Level Multimorbidity among Older Adults in India: Looking through a Syndemic Lens

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.

Multimorbidity and Complex Multimorbidity in India: Findings from the 2017-2018 Longitudinal Ageing Study in India (LASI)

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.

Multimorbidity Among Urban Poor in India: Findings From LASI, Wave-1

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.

Is multimorbidity associated with higher risk of falls among older adults in India?

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.