The Burden Beyond Disease Count: Multimorbidity Clusters and Their Health Consequences in Indigenous Geriatric Populations of Eastern India
1
1 ICMR- Regional Medical Research Centre, Bhubaneswar, India
2
2 Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, Netherlands
3
3 Barwon South-West Public Health Unit, Barwon Health, Geelong, Australia
4
4 Deakin University, IMPACT–Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Australia
5
5 Indian Council of Medical Research, New Delhi, India
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Multimorbidity is an increasing public health concern among older adults in low- and middle-income countries, yet evidence from Indigenous populations in India remains limited. Tribal older adults experience compounded social and health disadvantages, underscoring the need to understand the burden, patterns, and functional consequences of multimorbidity in these settings.
METHODS:
We analysed cross-sectional data from the Odisha Tribal Family Health Survey (OTFHS, 2022–2023), a population-based survey covering 53 tribal groups. The study included 3,471 Indigenous adults aged ≥60 years. Multimorbidity was defined as the presence of two or more chronic conditions assessed using validated questionnaire and clinical measurements. Health outcomes included self-rated health (SRH), quality of life (QoL), activities of daily living (ADL), instrumental activities of daily living (IADL), and healthcare access. Weighted analyses accounted for the complex survey design and multivariable logistic regression was used to examine associations between multimorbidity and health outcomes. Disease co-occurrence and the distribution of poor health outcomes across multimorbidity clusters were assessed using UpSet plots and pattern analysis.
RESULTS:
Overall, 44.0% of the population had multimorbidity. After adjustment for socio-demographic and health-related covariates, multimorbidity was strongly associated with adverse health outcomes. Multimorbidity patterns showed a steep increase in poor health outcomes with increasing numbers of coexisting conditions, with the highest burden among individuals with four or more conditions. Hypertension was the most common single condition (24.2%) and frequently clustered with kidney disease and visual difficulty. Higher-order triads and tetrads commonly involved combinations of hypertension, arthritis, back pain, and sensory impairments, and were associated with particularly poor self-rated health, reduced quality of life, functional disability, and poorer healthcare access.
CONCLUSIONS:
Multimorbidity among Indigenous older adults is highly prevalent and patterned, driving functional dependence and poor wellbeing and highlighting the need for integrated, culturally responsive primary healthcare in tribal settings.
Multimorbidity is an increasing public health concern among older adults in low- and middle-income countries, yet evidence from Indigenous populations in India remains limited. Tribal older adults experience compounded social and health disadvantages, underscoring the need to understand the burden, patterns, and functional consequences of multimorbidity in these settings.
METHODS:
We analysed cross-sectional data from the Odisha Tribal Family Health Survey (OTFHS, 2022–2023), a population-based survey covering 53 tribal groups. The study included 3,471 Indigenous adults aged ≥60 years. Multimorbidity was defined as the presence of two or more chronic conditions assessed using validated questionnaire and clinical measurements. Health outcomes included self-rated health (SRH), quality of life (QoL), activities of daily living (ADL), instrumental activities of daily living (IADL), and healthcare access. Weighted analyses accounted for the complex survey design and multivariable logistic regression was used to examine associations between multimorbidity and health outcomes. Disease co-occurrence and the distribution of poor health outcomes across multimorbidity clusters were assessed using UpSet plots and pattern analysis.
RESULTS:
Overall, 44.0% of the population had multimorbidity. After adjustment for socio-demographic and health-related covariates, multimorbidity was strongly associated with adverse health outcomes. Multimorbidity patterns showed a steep increase in poor health outcomes with increasing numbers of coexisting conditions, with the highest burden among individuals with four or more conditions. Hypertension was the most common single condition (24.2%) and frequently clustered with kidney disease and visual difficulty. Higher-order triads and tetrads commonly involved combinations of hypertension, arthritis, back pain, and sensory impairments, and were associated with particularly poor self-rated health, reduced quality of life, functional disability, and poorer healthcare access.
CONCLUSIONS:
Multimorbidity among Indigenous older adults is highly prevalent and patterned, driving functional dependence and poor wellbeing and highlighting the need for integrated, culturally responsive primary healthcare in tribal settings.
| eISSN: | 2654-1459 |
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