Life course rural-urban residence and multimorbidity among older adults in India

We examine the associations between rural-urban dwelling at different life stages, transitions across these settings, and multimorbidity among older adults in India. Data are from the first wave of the Longitudinal Aging Study in India (LASI), with a sample of 28,427 older adults aged 60+ with complete information on life course rural-urban residential status. Multivariable logistic regression models are used to examine the association between rural-urban residence during childhood, adulthood, and later life, as well as life course transitions across these settings and multimorbidity. Majority of older Indians (69.35%) were consistent rural dwellers, while 18.22% always lived in urban areas. Overall, 24.83% reported multimorbidity. In the fully adjusted models, older men with urban residence in childhood, adulthood, or later life had higher odds of multimorbidity than rural peers; these associations were largely insignificant for women, except for those currently living in urban areas. After adjusting for age, sex, education, and work, those with urban-urban-rural and rural-urban-urban transitions reported higher odds of multimorbidity than consistent rural dwellers, though these became insignificant when further covariates were considered. However, consistent urban dwellers and those with rural-rural-urban transitions continued to show significantly higher odds of multimorbidity than counterparts who only ever lived in rural settings. Older Indians with consistent urban residence and later-life rural-to-urban transitions were more likely to report multimorbidity than rural dwellers. Moreover, this association varied by gender, with childhood and adulthood urban residence linked to higher risk of multimorbidity only among men.