Non-communicable diseases related multimorbidity, catastrophic health expenditure, and associated factors in Ernakulam district.

BACKGROUND

Multimorbidity, the coexistence of two or more chronic conditions in an individual, has emerged as a significant public health challenge with profound economic implications, exerting substantial strain on healthcare systems and economies worldwide. This study aimed to estimate the prevalence of non-communicable diseases (NCD) related multimorbidity, catastrophic health expenditure (CHE), and associated factors among adults aged ≥40 years in Ernakulam district.

METHODS

A community-based cross-sectional study was conducted among 420 individuals aged ≥40 years using population probability sampling. The tools used were the Multimorbidity Assessment Questionnaire for Primary Care (MAQ-PC), the WHO STEPS Questionnaire, and the Patient Health Questionnaire-9 (PHQ-9), which assessed non-communicable diseases, diet, physical activity, smoking, alcohol consumption, and depression. A pretested semi-structured questionnaire collected data on health and household expenditures. Multimorbidity was defined as having two or more self-reported NCDs, and CHE was identified when health costs exceeded 10% of a household's expenditure in the past month. Multivariable logistic regression was performed to find independent predictors of multimorbidity and CHE.

RESULTS

The mean age of participants was 60.02 ± 10 years. The prevalence of NCD multimorbidity was 42.6% (95% CI: 37.9-47.3%). The most common dyad was diabetes and hypertension (24.5, 95% CI: 20.4-28.6%). Higher odds of multimorbidity were observed in those aged ≥60 years (aOR = 3.03, 95% CI: 1.95-4.73), unmarried/widowed/divorced (aOR = 2.15, 95% CI: 1.28-3.63), unemployed (aOR = 1.81, 95% CI: 1.14-2.87), and tobacco users (aOR = 3.72, 95% CI: 1.85-7.48). Approximately 32.4% (95% CI: 25.5-39.3%) of households incurred catastrophic health expenditure (CHE) by treating adults with multimorbidity. Age ≥ 60 (aOR = 2.39, 95% CI: 1.99-5.77) and use of outpatient services (aOR = 4.09, 95% CI: 2.01-8.32) were independently associated with higher odds of CHE. IP services and each additional morbidity add ₹22,082.37 ( = 0.557,  < 0.001, 95% CI: ₹17,139.88- ₹27,024.86) and ₹1,278.75 ( = 0.128,  = 0.044, 95%CI: ₹35.58-₹2,521.92) to healthcare costs, respectively.

CONCLUSION

The high prevalence of multimorbidity and associated CHE among individuals over 60 years highlights the urgent need for the National Programme for the Prevention and Control of Non-Communicable Diseases to prioritise multimorbidity and its management, especially above 60 years within this age group.