Student S Journal of Health Research Africa · Jun 30, 2026
Burden, Patterns, and Economic Impact of Multimorbidity among Older Adults in India: Evidence from a Community-Based Mixed-Methods Study
By Ujjwal S, Bharti SK, Nidhi
Background: Multimorbidity, defined as the coexistence of two or more chronic conditions, is increasingly prevalent among the elderly in India. It significantly impacts healthcare utilization and financial burden, yet remains underexplored in integrated frameworks combining epidemiology, health economics, and patient perspectives. Objectives: To estimate the prevalence and patterns of multimorbidity, assess out-of-pocket expenditure (OOPE), evaluate healthcare utilization, and explore patient experiences among elderly individuals in rural and urban settings. Methods: A community-based mixed-methods study was conducted among 600 elderly participants (≥60 years) selected through multistage stratified sampling in Rural and Urban field practice area of Mahabodhi medical college Gaya ji. Quantitative data included socio-demographic characteristics, morbidity profile, healthcare utilization, and expenditure. Multimorbidity patterns were analyzed using cluster analysis. Logistic regression identified predictors. Catastrophic health expenditure was defined as OOPE ≥10% of household income. Qualitative data were obtained through in-depth interviews and analyzed thematically. Results: The prevalence of multimorbidity was 48.5% (95% CI: 44.5–52.5), higher in urban (54.2%) than rural areas (42.8%). The most common conditions were hypertension (58%), diabetes (42%), and osteoarthritis (37%). Three dominant clusters emerged: cardiometabolic, musculoskeletal, and respiratory. Multimorbidity was significantly associated with age ≥70 years (AOR 2.1), female gender (AOR 1.6), and low physical activity (AOR 1.9). Mean annual OOPE was ₹18,600, with 32% experiencing catastrophic expenditure. Private sector utilization was higher (61%), especially in urban areas. Qualitative findings highlighted financial distress, fragmented care, and lack of geriatric-friendly services. Conclusion: Multimorbidity poses a substantial clinical and economic burden among the elderly, with inequities across rural–urban settings. Strengthening primary care and financial risk protection is essential.