Profile of multimorbidity in outpatients attending public healthcare settings: A descriptive cross-sectional study from Odisha, India

Background: Multimorbidity, the co-occurrence of two or more long-term conditions (LTC) in individuals, is associated with greater healthcare utilization, expenditure, and premature mortality, thus positing a challenge for patients and healthcare providers. Given its sparsely available epidemiological evidence, we aimed to describe the profile of multimorbidity in a representative sample of public healthcare outpatients in India. Methods: A facility-based cross-sectional study was conducted from 1st July to 31st December 2015 in Odisha, India. Fifteen public healthcare facilities were selected by stratified random sampling. Data was collected from 1,870 adult outpatients attending these settings using Multimorbidity Assessment Questionnaire for Primary Care (MAQ-PC) tool. Result: Nearly 3/4th of both women and men outpatients were either obese or overweight. >1/2 had multimorbidity (≥2 LTC) while 1/3rd had ≥3 LTC. Most prevalent condition was hypertension (63%), followed by chronic backache and arthritis. Cancer and psychiatric illness were least reported. Multimorbidity increased with age group, socioeconomic status, and education level. Females across all age groups had higher reported multimorbidity than males. Diabetes--hypertension was frequently occurring dyad. Both physical and mental component of quality of life was reduced in multimorbidity. Conclusion: Multimorbidity is becoming a norm in healthcare practice with high prevalence in females and older adults. Health services for non-communicable diseases need to include commonly occurring dyads along with health promotion. Higher prevalence in females reinforces the need to incorporate gender differences while studying multimorbidity. Analysis of multimorbidity epidemiology through an equity lens could illuminate the underpinning complexities and heterogeneities of this phenomenon