Association between chronic morbidity and self-reported disaster-related severe health impacts among older adults in India: Evidence from the Longitudinal Ageing Study in India (LASI), 2017–18

Abstract Background Older adults with chronic diseases are particularly vulnerable to the health consequences of disasters because they rely on continuous healthcare, medications, and social support. Although India is one of the world's most disaster-prone countries, nationally representative evidence on the association between chronic morbidity and disaster exposure among middle-aged and older adults remains limited. This study examined the relationship between chronic morbidity and self-reported severe disaster-related health impacts and assessed whether place of residence modifies this association. Methods This cross-sectional study used data from the Longitudinal Ageing Study in India (LASI) Wave I (2017–18). The analytical sample included 65,652 adults aged 45 years and above after excluding respondents with missing information on disaster exposure. Disaster exposure was defined as self-reported severe health effects from natural or man-made disasters during the previous five years. Chronic morbidity was classified as no chronic disease, one chronic disease, and multimorbidity (two or more chronic diseases). Weighted descriptive statistics and chi-square tests were used to examine sample characteristics. Sequential multivariable logistic regression models estimated adjusted odds ratios (AORs) with 95% confidence intervals (CIs), and an interaction model evaluated whether the association between chronic morbidity and disaster exposure differed by place of residence. Predictive margins were estimated to illustrate the interaction effect. Results Overall, 3.3% of respondents reported experiencing a disaster. The prevalence increased from 3.1% among individuals without chronic disease to 3.9% among those with multimorbidity. In the fully adjusted model, respondents with one chronic disease (AOR = 1.13, 95% CI: 1.02–1.26) and multimorbidity (AOR = 1.45, 95% CI: 1.28–1.64) had significantly higher odds of disaster exposure than those without chronic disease. Urban residence was associated with lower odds of disaster exposure than rural residence (AOR = 0.67, 95% CI: 0.60–0.75). The interaction between chronic morbidity and place of residence was statistically significant (Wald χ 2 = 7.94, p = 0.019). Compared with rural residents, urban older adults with one chronic disease (AOR = 0.75, 95% CI: 0.59–0.96) and those with multimorbidity (AOR = 0.74, 95% CI: 0.58–0.95) had significantly lower odds of disaster exposure, indicating a stronger association between chronic morbidity and disaster exposure in rural settings. Poor self-rated health, alcohol consumption, and residence in the Central, Eastern, North-Eastern, and Western regions were also associated with higher odds of disaster exposure. Conclusions Chronic morbidity, particularly multimorbidity, is independently associated with disaster exposure among middle-aged and older adults in India, with rural older adults experiencing greater vulnerability than their urban counterparts. Integrating chronic disease management into disaster preparedness, strengthening rural health systems, and developing age-sensitive disaster risk reduction strategies are essential to reduce disaster-related health inequalities in an ageing population.