Multimorbidity: a growing concern in India

India is experiencing an epidemiological transition, marked by a shift in the disease burden from acute infectious diseases into chronic conditions. Chronic diseases are often interlinked, with shared risk factors Consequently, a person with one condition is at increased risk of developing additional ones if they have underlying factors that contribute to these diseases. This growing complexity often results in individuals living with more than one condition at the same time, a situation referred to as multimorbidity. This can severely impact a person’s life as managing multiple chronic conditions means dealing with a range of symptoms, medications, procedures, lifestyle modifications and dietary adjustments. This not only places immense strain on the individual but also burdens the caregiver and society.

Existing evidence suggests that around 20 percent of Indian adults are now dealing with more than one long-term health issue. Despite this, multimorbidity research is still in its early stages in the country. Studies in this area use different definitions and varying lists of conditions to measure multimorbidity. Additionally, most of these studies rely on cross-sectional datasets, which do not allow for the study of trajectories and impact. Another issue is the reduction of multimorbidity to simple disease counts and focus on common disease combinations.

 

Proposed Solution

To address the issue, using approaches that can comprehensively measure multimorbidity are needed. Keeping this in mind,  in January 2023, we started working on Identifying Multimorbidity Patterns and Events among Indians (IMPEND) - a project aimed at answering the research question: how can we group Indian adults with multiple chronic conditions into clusters based on their disease profile, produce reliable and replicable clusters, characterize the clusters with respect to individuals’ characteristics, identify clusters that are likely to have the greatest health burden, and identify clusters that could benefit most from targeted health interventions?  

 

Funded by the DBT/Wellcome Trust India Alliance, this five-year project addresses this knowledge gap, by leveraging on multiple datasets and statistical methodologies to fully understand the complexity and impact of multimorbidity. The study will comprise of four sub-studies. First, a review of existing statistical methodologies and datasets. The second will focus on using national surveys to identify multimorbidity sub-groups across India. The third will utilize hospital medical records to study disease patterns and identify high-cost high-needs patient sub-groups. Lastly, we will leverage two patients’ cohorts (diabetes and chronic kidney disease) to investigate patterns and disease outcomes. After combining each part of the project, a comprehensive view of India's multimorbidity landscape can be seen.

 

Potential implications of the work

The IMPEND project aims to enhance the understanding of multimorbidity, by classifying individuals with multiple chronic conditions into well-characterized clusters using multiple data sources and statistical methodologies. This approach will not only improve the quality of multimorbidity measurement but also pave the way for more effective solutions tailored to the patient specific needs.

We want to hear from you

What are your thoughts on multimorbidity? Please feel free to reach out to Dr Arpita Ghosh at aghosh@georgeinstitute.org.in or Dr Parul Puri at ppuri@georgeinstitute.org.in.

First published: 5 August 2024

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