Prevalence and Patterns of Coexistence of Multiple Chronic Conditions: A Study from Indian Urban Outpatient Setting

BACKGROUND: Chronic diseases are a common cause for seeking care in a hospital, however little is known about prevalence and spectrum of multiple chronic conditions (MCC) in Indian context. Estimates for coexistence of MCC range from one-fourth of all primary care attendees in Spain to two-thirds of all medicare attendees in the United States. This study was designed to estimate the similar prevalence and patterns in an Indian outpatient setting. MATERIALS AND METHODS: This study was performed at All India Institute of Medical Sciences Bhopal between May and June 2013, a hospital which had just started outpatient services in this period. All consecutive patients that presented to Medicine, Neurology, and Orthopedics clinics were sought to be included in the study, and information about their current diagnoses was abstracted from their outpatient records. All patients with one or more chronic disease diagnosis were asked about their monthly out-of-pocket expenditure. We performed a descriptive analysis of the demographic, medical diagnoses, and out-of-pocket expenditure variables. RESULTS: A total of 785 patients were included in the study, and 286 (36%) of them had one or more chronic disease diagnosis. Of these, 103 (13%) had a single chronic disease, while 183 (23%) had more than one chronic disease diagnosis. Among those with MCCs, chronic vascular diseases in combination, followed by combinations of chronic vascular and immunological diseases were common patterns. There was a significant rising trend in average out-of-pocket expenditure with increasing number of chronic disease diagnoses. CONCLUSION: Co-existence of multiple chronic diseases is common in those who seek hospital-based care. This fact has important implications for education and clinical decision making in primary care.