Patterns of multimorbidity in India: A nationally representative cross-sectional study of individuals aged 15 to 49 years

There is a dearth of evidence on the epidemiology of multimorbidity in low- and middle- income countries. This study aimed to determine the prevalence of multimorbidity in India and its variation among states and population groups. We analyzed data from a nationally representative household survey conducted in 2015-2016 among individuals aged 15 to 49 years. Multimorbidity was defined as having two or more conditions out of five common chronic morbidities in India: anemia, asthma, diabetes, hypertension, and obesity. We disaggregated multimorbidity prevalence by condition, state, rural versus urban areas, district- level wealth, and individual-level sociodemographic characteristics. 712,822 individuals were included in the analysis. The prevalence of multimorbidity was 7.2% (95% CI, 7.1%- 7.4%), and was higher in urban (9.7% [95% CI, 9.4%- 10.1%]) than in rural (5.8% [95% CI, 5.7%- 6.0%]) areas. The three most prevalent morbidity combinations were hypertension with obesity (2.9% [95% CI, 2.8%- 3.1%]), hypertension with anemia (2.2% [95% CI, 2.1%- 2.3%]), and obesity with anemia (1.2% [95% CI, 1.1%- 1.2%]). The age-standardized multi- morbidity prevalence varied from 3.4% (95% CI: 3.0%- 3.8%) in Chhattisgarh to 16.9% (95% CI: 13.2%- 21.5%) in Puducherry. Being a woman, being married, not currently smoking, greater household wealth, and living in urban areas were all associated with a higher risk of multimorbidity. Multimorbidity is common among young and middle-aged adults in India. This study can inform screening guidelines for chronic conditions and the targeting of relevant policies and interventions to those most in need.