Magnitude and pattern of multimorbidity among adult patients attending a primary care setting in Delhi, India
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20240889Keywords:
Multimorbidity, Dyads, Triads, Quadrads, Delhi, IndiaAbstract
Background: Multimorbidity, “the coexistence of two or more chronic diseases”, is an upcoming & less addressed public health challenge for low and middle-income countries undergoing rapid demographic and epidemiological transition. This study was done to estimate the burden & pattern of multimorbidity in adults (≥18 years) in a primary care setting.
Methods: This cross-sectional study was carried out from January 2021 to March 2022 at a primary health centre in South Delhi. Data was collected by conducting exit interviews with 510 adult patients using a self-designed, pre-tested interview schedule. Data was analyzed using SPSS and Microsoft Excel.
Results: Out of 510 study subjects interviewed, the overall magnitude of multimorbidity was 160 (31.4%). Almost half of the study subjects with multimorbidity had dyads, one-third had triads, and the rest had quadrads multimorbidity patterns. The leading triad was diabetes mellitus+hypertension+heart disease (12.3%), followed by diabetes mellitus+hypertension+chronic lung disease (10.5%). More than half of the study subjects with multimorbidity, 89 (55.6%), suffered from concordant MM.
Conclusions: The study revealed that 31.4% of subjects had multimorbidity, which was almost equally distributed across the age groups. The burden was significantly higher among those aged 18-39 years. Hypertension and Heart disease were found to be the most frequent and the most concordant multimorbidity, respectively, associated with Diabetes mellitus.
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References
Multimorbidity: Technical Series on Safer Primary Care. Available at: https://apps.who.int/iris/bitstream/ handle/10665/252275/9789241511650-eng.pdf. Accessed on 20 November 2023.
Van AD, Buntiux F, Metsemakers J, Roos S, Knottnerus JA. Multimorbidity in general practice: prevalence, incidence and itsdeterminants of co-occurring chronic and recurrent diseases. J Clin Epidemiol. 1998;51:367-75.
Dugravot A, Fayosse A, Dumurgier J, Bouillon K, Rayana TB, Schnitzler A, et al. Social inequalities in multimorbidity, frailty, disability, and transitions to mortality: a 24-year follow-up of the Whitehall II cohort study. Lancet. 2020;1:42-50.
Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, et al. Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev. 2019;10(4):430-9.
Tinetti ME, Fried TR, Boyd CM. Designing health care for the most common chronic condition- multimorbidity. JAMA. 2012;23:2493-4.
Cabral GG, Dantas AC, Barbosa IR, Jerez-Roig J, Souza DLB. Multimorbidity and Its Impact on Workers: A Review of Longitudinal Studies. Saf Health Work. 2019;10:393-9.
Feng, X, Tan X, Riley B, Zheng T, Bias T, Sambamoorthi U. Polypharmacy and Multimorbidity among Medicaid Enrollees: A Multistate Analysis. Popul Health Manag. 2018;21:123-9.
Menditto E, Miguel AG, Juste AM, Plou BP, Pascual-Salcedo MA, Orlando V, et al. Patterns of multimorbidity and polypharmacy in young and adult population: Systematic associations among chronic diseases and drugs using factor analysis. PLoS One. 2019;14:210.
Larranaga A, Vetrano DL, Ferrucci L, Mercer W, Marengoni, A, Onder G, et al. Multimorbidity and functional impairment–bidirectional interplay, synergistic effects and common pathways. J Intern Med. 2019;285:255-71.
Vetrano DL, Palmer K, Marengoni A, Marzetti E, Lattanzio F, Roller WR, et al. Frailty and Multimorbidity: A Systematic Review and Meta-analysis. J Gerontol Ser. 2019;74:659-66.
Makovski TT, Schmitz S, Zeegers MP, Stranges S, Akker MVD. Multimorbidity and quality of life: Systematic literature review and metaanalysis. Ageing Res Rev. 2019;53:100903.
Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, et al. Aging with multimorbidity: A systematic review of the literature. Ageing Res. 2011;10:430-9.
Bahler C, Huber C A, Brungger B, Reich O. Multimorbidity, health care utilization and costs in an elderly community dwelling population: A claims data based observational study. BMC Health Serv Res. 2015;15:23.
Palladino R, Lee JT, Ashworth M, Triassi M, Millett C. Associations between multimorbidity, healthcare utilization and health status: Evidence from 16 European countries. Ageing. 2016;45:431-5.
Wang L, Si L, Cocker F, Palmer AJ, Sanderson K. A systematic review of cost of illness studies of multimorbidity. Appl Health Econ Health Policy. 2018;16:15-29.
Zulman DM, Chee CP, Wagner TH, Yoon J, Cohen DM, Holmes TH, et al. Multimorbidity and healthcare utilization among high-cost patients in the US Veterans Affairs Health Care System. BMJ. 2015;5: 7771.
Nunes BP, Flores TR, Mielke GI, Thume E, Facchini LA. Multimorbidity and mortality in older adults: A systematic review and metaanalysis. Arch Gerontol Geriatr. 2016;67:130-8.
Multimorbidity: a priority for global health research. Available at: https://acmedsci.ac.uk/file-download/ 82222577. Accessed on 20 November 2023.
Pati S, Swain S, Knottnerus JA, Metsemakers JFM, van den AM. Magnitude and determinants of multimorbidity and health care utilization among patients attending public versus private primary care: a cross-sectional study from Odisha, India. Int J Equity Health. 2020;19(1):57.
SPSS for Windows, Version 16.0. Available at: https://www.ibm.com/support/pages/how-cite-ibm-spss-statistics-or-earlier-versions-spss. Accessed on 20 November 2023.
Sood P, Bindra S. Modified Kuppuswamy socioeconomic scale: 2022 update of India. Int J Community Med Public Health. 2022;9(10):3841-4.
Lee Y, Kim H, Jeong H, Noh Y. Patterns of Multimorbidity in Adults: An Association Rules Analysis Using the Korea Health Panel. Int J Environ Res Public Health. 2020;17:2618.
Soji DJ, Lordson J, Mini GK. Multimorbidity patterns among rural adults with Type-2 diabetes mellitus: A cross-sectional study in Kerala, India. WHO South-East Asia J Public Health. 2021;10:32-6.
Verma V, Mishra N. A Study on Multi-morbidity among Geriatric Group in a District of Northern India: A Cross Sectional Study. Int J Med Public Health. 2019;9(4):137-40.
Banjare P, Pradhan J. Socio-Economic Inequalities in the Prevalence of Multi-Morbidity among the Rural Elderly in Bargarh District of Odisha (India). PLoS One. 2014;9(6):97832.
Chakrabarty D, Mandal PK, Manna N, Mallik S, Ghosh P, Chatterjee C, et al. Functional Disability and Associated Chronic Conditions among Geriatric Populations in a Rural Community of India. Ghana Med J. 2010;44(4):150-4.
King DE, Xiang J, Pilkerton CS. Multimorbidity Trends in United States Adults, 1988-2014. J Am Board Fam Med. 2018;31(4):503-13.
Zhang Y, Misra R, Sambamoorthi U. Prevalence of Multimorbidity among Asian Indian, Chinese, and Non-Hispanic White Adults in the United States. Int J Environ Res Public Health. 2020;17:3336.
Lay AAR, Nascimento CF, Burgos FC, Huerta ADCL, Zeballos RER, Silva VP, et al. Gender Differences between Multimorbidity and All-Cause Mortality among Older Adults. Curr Gerontol Geriatr Res. 2020;19:7816785.
