SEARCHCROSS-SECTIONALepidemiology, public health

cross-sectional·epidemiology, public health, geriatrics, internal medicine, family medicine·PMC10069553

Sex differences in non-communicable disease multimorbidity among adults aged 45 years or older in India

BMJ Open · 3 authors, 3 centres

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TL;DR

The study also identified specific risk factors and outcomes that differed by sex.

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The study found a significantly higher overall prevalence of NCD-MM in women (42.7%) compared to men (38.9%), with the gap widening with age. Sex differences were noted in the association of certain risk factors, such as overweight/obesity and a prior history of chewing tobacco, with NCD-MM. The impact of multimorbidity on adverse health outcomes also varied by sex: the effect on limitations in activities of daily living (ADL) and instrumental ADL (IADL) was greater in men, while the association with hospitalization was greater in women. The findings highlight significant sex disparities in NCD multimorbidity among older adults in India, which require targeted research and health system responses.

STUDY TYPE

cross-sectional

SPECIALTY

epidemiology

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ORIGINAL PAPER

PMC10069553

Sex differences in non-communicable disease multimorbidity among adults aged 45 years or older in India

BMJ Open

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ABSTRACT

Objective Older male and female adults differ in key characteristics such as disease-specific life expectancy, health behaviours and clinical presentations and non-communicable disease multimorbidity (NCD-MM). Therefore, examining the sex differences in NCD-MM among older adults is vital, as this issue is understudied in low-income and middle-income country (LMIC) contexts such as India, and has been growing in the past few decades. Design Large scale nationally representative cross-sectional study. Settings and participants Longitudinal Ageing Study in India (LASI 2017–2018) had data on 27 343 men and 31 730 women aged 45+, drawn from a sample of 59 073 individuals across India. Primary and secondary outcomes measures We operationalised NCD-MM based on prevalence of the presence of two or more long-term chronic NCD morbidities. Descriptive statistics and bivariate analysis along with multivariate statistics were used. Results Women aged 75+ had a higher prevalence of multimorbidity as compared with men (52.1% vs 45.17%). NCD-MM was more common among widows (48.5%) than widowers (44.8%). The female-to-male ratios of ORs (RORs) for NCD-MM associated with overweight/obesity and prior history of chewing tobacco were 1.10 (95% CI: 1.01 to 1.20) and 1.42 (95% CI: 1.12 to 1.80), respectively. The female-to-male RORs show that the odds of NCD-MM were greater in formerly working women (1.24 (95% CI: 1.06 to 1.44)) relative to formerly working men. The effect of increasing NCD-MM on limitations in activities of daily living and instrumental ADL was greater in men than women but reversed for the hospitalisation. Conclusions We found significant sex differences in NCD-MM prevalence among older Indian adults, with various associated risk factors. The patterns underlying these differences warrant greater study, given existing evidence on differential longevity, health burdens and health-seeking patterns all of which operate in a larger structural context of patriarchy. Health systems in turn must respond to NCD-MM mindful of these patterns and aim to redress some of the larger inequities they reflect.

CITATION EXPORT

Santosh Kumar Sharma, Devaki Nambiar, Arpita Ghosh. Sex differences in non-communicable disease multimorbidity among adults aged 45 years or older in India. BMJ Open. (2023). https://doi.org/10.1136/bmjopen-2022-067994

AUTHORS

3 · 3 CENTRES

Santosh Kumar Sharma, Devaki Nambiar, Arpita Ghosh

1 The George Institute for Global Health India, New Delhi, India
2 Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
3 Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India