title: Prevalence, correlates, and outcomes of multimorbidity among patients attending primary care in Odisha, India.
abstract: OBJECTIVE
  Little information is available on multimorbidity in primary care in India. Because primary care is the first contact of health care for most of the population and important for coordinating chronic care, we wanted to examine the prevalence and correlates of multimorbidity in India and its association with health care utilization.
  
  
  METHODS
  Using a structured multimorbidity assessment protocol, we conducted a cross-sectional study, collecting information on 22 self-reported chronic conditions in a representative sample of 1,649 adult primary care patients in Odisha, India.
  
  
  RESULTS
  The overall age- and sex-adjusted prevalence of multimorbidity was 28.3% (95% CI, 24.3-28.6) ranging from 5.8% in patients aged 18 to 29 years to 45% in those aged older than 70 years. Older age, female sex, higher education, and high income were associated with significantly higher odds of multimorbidity. After adjusting for age, sex, socioeconomic status (SES), education, and ethnicity, the addition of each chronic condition, as well as consultation at private hospitals, was associated with significant increase in the number of medicines intake per person per day. Increasing age and higher education status significantly raised the number of hospital visits per person per year for patients with multiple chronic conditions.
  
  
  CONCLUSIONS
  Our findings of higher prevalence of multimorbidity and hospitalizations in higher SES individuals contrast with findings in Western countries, where lower SES is associated with a greater morbidity burden.
authors.affiliation: Public Health Foundation of India, Indian Institute of Public Health, Bhubaneswar, Odisha, India sanghamitra.pati@iiphb.org.
authors.forename: Sanghamitra
authors.initials: S
authors.lastname: Pati
authors.affiliation: Public Health Foundation of India, Indian Institute of Public Health, Bhubaneswar, Odisha, India.
authors.forename: Subhashisa
authors.initials: S
authors.lastname: Swain
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, The University of Queensland, Brisbane, Australia.
authors.forename: Mohammad Akhtar
authors.initials: MA
authors.lastname: Hussain
authors.affiliation: Public Health Foundation of India, Indian Institute of Public Health, Bhubaneswar, Odisha, India.
authors.forename: Shridhar
authors.initials: S
authors.lastname: Kadam
authors.affiliation: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
authors.forename: Chris
authors.initials: C
authors.lastname: Salisbury
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care / Q000458:organization & administration*; D017678:Sex Distribution; D012923:Social Class; D055815:Young Adult
keywords: India; chronic disease; health care utilization; multimorbidity; prevalence; primary health care