Leaving No One Behind: The Syndemic Impact of Undiagnosed Chronic Conditions on Frailty, Dependence and Quality of Life among India’s Older Indigenous Tribal People
1
Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, India
Popul. Med. 2026;8(Supplement Supplement 1):A90
ABSTRACT
OBJECTIVES:
This study introduces the concept of the "Screening Gap", a disparity between true disease prevalence and diagnosed cases, among older indigenous adults in Odisha, India. We aimed to quantify this gap for five chronic conditions, determine its causal pathway to frailty and dependence, and estimate the Quality-Adjusted Life Years (QALYs) that can be recovered through targeted public health screening.
METHODS:
This was a large-scale sample survey covering over 10,000 households with 3,221 older adults (≥60 years) from 55 tribes in Odisha, eastern India. The study utilised a unique combination of self-reported history and objective laboratory measurements to identify undiagnosed cases of anaemia, hypertension, diabetes, chronic kidney disease (CKD), and chronic liver disease (CLD). Structural Equation Modelling (SEM) was employed to map pathways from screening gaps to Quality of Life (EQ-5D). Markov modelling projected potential QALY gains over a 10-year horizon if these screening gaps were closed.
RESULTS:
The burden of undiagnosed morbidity was profound. While self-reported multimorbidity was 59.3% (95% CI: 57.6%, 61.0%), objective testing revealed massive screening gaps: 80.8% for anaemia, 27.5% for diabetes, and 22.0% for CKD. Only hypertension showed a moderate gap (13.6%). These "invisible" conditions were not benign; SEM analysis (RMSEA=0.025, CFI=0.997) demonstrated that screening gaps directly accelerated the progression of frailty (88.0% prevalence; 95% CI= 86.8%, 89.1%) and functional dependence (7.9%; 95% CI= 7.00%, 8.89%). Crucially, Markov models projected that closing these screening gaps could yield 6.2 to 7.7 additional QALYs per person over a 10-year period. The benefit was most pronounced in the "young-old" (60–70 years), offering a critical window for intervention.
CONCLUSIONS:
The "Screening Gap" is a major, modifiable driver of frailty and lost life years in indigenous populations. Implementing active, community-based screening, particularly for anaemia and diabetes, is a high-yield intervention that could significantly reverse frailty trajectories in the Global South.
This study introduces the concept of the "Screening Gap", a disparity between true disease prevalence and diagnosed cases, among older indigenous adults in Odisha, India. We aimed to quantify this gap for five chronic conditions, determine its causal pathway to frailty and dependence, and estimate the Quality-Adjusted Life Years (QALYs) that can be recovered through targeted public health screening.
METHODS:
This was a large-scale sample survey covering over 10,000 households with 3,221 older adults (≥60 years) from 55 tribes in Odisha, eastern India. The study utilised a unique combination of self-reported history and objective laboratory measurements to identify undiagnosed cases of anaemia, hypertension, diabetes, chronic kidney disease (CKD), and chronic liver disease (CLD). Structural Equation Modelling (SEM) was employed to map pathways from screening gaps to Quality of Life (EQ-5D). Markov modelling projected potential QALY gains over a 10-year horizon if these screening gaps were closed.
RESULTS:
The burden of undiagnosed morbidity was profound. While self-reported multimorbidity was 59.3% (95% CI: 57.6%, 61.0%), objective testing revealed massive screening gaps: 80.8% for anaemia, 27.5% for diabetes, and 22.0% for CKD. Only hypertension showed a moderate gap (13.6%). These "invisible" conditions were not benign; SEM analysis (RMSEA=0.025, CFI=0.997) demonstrated that screening gaps directly accelerated the progression of frailty (88.0% prevalence; 95% CI= 86.8%, 89.1%) and functional dependence (7.9%; 95% CI= 7.00%, 8.89%). Crucially, Markov models projected that closing these screening gaps could yield 6.2 to 7.7 additional QALYs per person over a 10-year period. The benefit was most pronounced in the "young-old" (60–70 years), offering a critical window for intervention.
CONCLUSIONS:
The "Screening Gap" is a major, modifiable driver of frailty and lost life years in indigenous populations. Implementing active, community-based screening, particularly for anaemia and diabetes, is a high-yield intervention that could significantly reverse frailty trajectories in the Global South.
| eISSN: | 2654-1459 |
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