Prevalence, patterns and associated behavioural risk factors of multimorbidity in rural India: Cross-sectional analysis from the Andhra Pradesh Children and Parents Study (APCAPS)

The prevalence of multimorbidity is projected to increase substantially in India. Previous studies have focused on urban populations and older adults, who do not represent the majority of those at risk. We aimed to estimate the prevalence and investigate patterns of multimorbidity in a rural population in India and examine their associations with four common behavioural risk factors (BRFs): daily drinking, tobacco consumption, physical inactivity, and poor sleep. This cross-sectional analysis used data of all adult participants (aged ≥18 years, mean age of 35.5 years) from the third follow-up of Andhra Pradesh Children and Parents Study (APCAPS), 2010-12. We used binary logistic regression to examine the associations between BRFs, ascertained through validated questionnaires, and the prevalence of multimorbidity, defined as having two or more of 13 common chronic conditions. We used latent class analysis (LCA) to investigate common patterns of multimorbidity, followed by multinomial logistic regression to examine their associations with BRFs (categorised as binary), adjusted for age, sex, and household socioeconomic status. Of 5332 adult participants (mean age 35.5 years, standard deviation 13.8 years) included in the analysis, 14.2% had multimorbidity, the prevalence of which increased steeply with age. Current tobacco consumption (adjusted odds ratio (aOR) = 1.23 [95% confidence interval (CI): 1.01-1.50]), physical inactivity (aOR: 1.66 [95% CI: 1.38-1.99]), and poor sleep (aOR: 1.86 [95% CI: 1.35-2.57]) were associated with higher odds of having multimorbidity. We found one multimorbidity pattern of "anaemia and hypertension" (n = 220, 4.1%). Physical inactivity (aOR: 2.07 [95% CI: 1.52-2.82]) was associated with higher odds of having this multimorbidity pattern, with no associations found for the other BRFs. The BRFs identified, notably physical activity, could present important opportunities for intervention to reduce the burden of multimorbidity in India. Longitudinal studies are needed to confirm these relationships.