Non communicable disease multimorbidity and associated health care utilization and expenditures in India: cross-sectional study

Pati, Sanghamitra, Agrawal, Sutapa, Swain, Subhashisa, Lee, John Tayu, Vellakkal, Sukumar, Hussain, Mohammad Akhtar and Millett, Christopher (2014) Non communicable disease multimorbidity and associated health care utilization and expenditures in India: cross-sectional study. BMC health services research, 14 1: . doi:10.1186/1472-6963-14-451

Author Pati, Sanghamitra
Agrawal, Sutapa
Swain, Subhashisa
Lee, John Tayu
Vellakkal, Sukumar
Hussain, Mohammad Akhtar
Millett, Christopher
Title Non communicable disease multimorbidity and associated health care utilization and expenditures in India: cross-sectional study
Journal name BMC health services research   Check publisher's open access policy
ISSN 1472-6963
Publication date 2014-10-02
Year available 2014
Sub-type Article (original research)
DOI 10.1186/1472-6963-14-451
Open Access Status DOI
Volume 14
Issue 1
Total pages 9
Place of publication London, United Kingdom
Publisher BioMed Central
Collection year 2015
Language eng
Formatted abstract
Background: Non communicable disease (NCD) multimorbidity is increasingly becoming common in high income
settings but little is known about its epidemiology and associated impacts on citizens and health systems in low
and middle-income countries (LMICs). We aim to examine the socio-demographic distribution of NCD multimorbidity
(≥2 diseases) and its implications for health care utilization and out-of-pocket expenditure (OOPE) in India.

Methods: We analyzed cross-sectional nationally representative data from the World Health Organisaion Study on
Global Ageing and Adult Health (WHO-SAGE), conducted in India during 2007. Multiple logistic regression was used
to determine socio-demographic predictors of self-reported multimorbidity. A two part model was used to assess the
relationship between number of NCDs and health care utilization including OOPE.

Results: 28.5% of the sample population had at least one NCD and 8.9% had NCD multimorbidity. The prevalence of
multimorbidity increased from 1.3% in 18–29 year olds to 30.6% in those aged 70 years and above. Mean outpatient
visits in the preceding 12 months increased from 2.2 to 6.2 and the percentage reporting an overnight hospital stay in
the past 3 years increased from 9% to 29% in those with no NCD and ≥2 NCDs respectively (p <0.001).
OOPE incurred during the last outpatient visit increased from INR 272.1 (95% CI = 249.0-295.2) in respondents with no
NCDs to INR 454.1 (95% CI = 407.8-500.4) in respondents with ≥2 NCDs. However, we did not find an increase in OOPE
during the last inpatient visit with number of NCDs (7865.9 INR for those with zero NCDs compared with 7301.3
for those with ≥2 NCDs). For both outpatient and inpatient OOPE, medicine constitutes the largest proportion of
spending (70.7% for outpatient, 53.6% for inpatient visit), followed by spending for health care provider (14.0% for
outpatient, 12.2% for inpatient visit).

Conclusion: NCD multimorbidity is common in the Indian adult population and is associated with substantially higher
healthcare utilization and OOPE. Strategies to address the growing burden of NCDs in LMICs should include efforts to
improve the management of patients with multimorbidity and reduce associated financial burden to individuals and
Keyword Non-communicable disease (NCD)
Health care utilization
Out-of-pocket expenditure (OOPE)
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Article ID: 14:451

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Public Health Publications
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Citation counts: TR Web of Science Citation Count  Cited 7 times in Thomson Reuters Web of Science Article | Citations
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Created: Sun, 12 Oct 2014, 19:44:41 EST by Mohammad Hussain on behalf of School of Public Health