Characterizing Multimorbidity Prevalence and Adverse Outcomes in Ethnically and Culturally Diverse Sub-Populations in India: Gaps, Opportunities, and Future Directions

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[18] LASI, 2017–2018, ages ≥ 45 years and above, n = 65,336 “Cooccurrence of ≥2 chronic health conditions in an individual that persists long-term (i.e., physical NCD, mental health condition or infectious illness). A score was calculated from 12 morbidities that were self-reported by survey respondents”. “Age group: Overall (27.93), 45–59 (22.63), 60–74 (31.57), 75+ (34.05); Gender: Female (28.93), Male (25.57); Residence: Rural (23.27), Urban (36.43); Social Group: Other Backward Class (28.14), Scheduled Castes (23.76), Scheduled Tribes (13.51); Wealth Index: Richest (38.45), Rich (30.87), Middle (26.21), Poorer (24.43), Poorest (18.79); Marital status: Widowed/Divorced/Separated (30.44), Currently Married (26.53), Never married (16.71); Religion: Other (30.03), Muslim (34.76), Hindu (26.17); Education level: No education (24.55), Primary education (30.36), Secondary education (35.28), Higher secondary (32.71); Living Status: Living alone (29.66), Living with spouse and others (26.56), Living without spouse and others (29.56)” [21] LASI, 2017–2018, across all 35 states (excluding Sikkim) and union territories in India, ≥60 years, n = 31,373 “Chronic morbidity was assessed using the question: Has any health professional ever diagnosed you with the following chronic conditions or diseases? Presence of ≥2 of any of the following conditions: Hypertension, diabetes; cancer or a malignant tumor; chronic lung diseases or chronic lung problems (e.g., asthma, chronic obstructive pulmonary disease/bronchitis); chronic heart diseases or other chronic heart problems (e.g., coronary heart disease, heart attack or myocardial infarction, congestive heart failure); stroke; arthritis or rheumatism, osteoporosis or other bone/joint diseases; any neurological or psychiatric conditions (e.g., depression, Alzheimer’s/dementia, unipolar/bipolar disorders, or convulsions; Parkinson’s); and high cholesterol”. “Age group: Overall (24.1), 60–69 (22.8), 70+ (25.8); Gender: Female (25.5), Male (22.5); Residence: Rural (19.1), Urban (36); Wealth Index: Richest (35.9), Richer (27.9), Middle (22.7), Poorer (20.3), Poorest (16.7); Marital status: Widowed/Divorced/Separated (30.44), Currently Married (23.4), Never married (16); Education level: No education (18.4), Below Primary (26.4), Primary (30.2), Secondary (35), Higher (34.7); Living Status: Living alone (23.5), with spouse (23.3), with others (25.5)” [14] LASI, 2017–2018, ages ≥ 60, n = 31,464 older adults (rural—20,725 and urban—10,739) “Chronic morbidity was assessed using the question: Has any health professional ever diagnosed you with the following chronic conditions or diseases? Presence of ≥2 of any of the following conditions: Hypertension, diabetes; cancer or a malignant tumor; chronic lung diseases or chronic lung problems (e.g., asthma, chronic obstructive pulmonary disease/bronchitis); chronic heart diseases or other chronic heart problems (e.g., coronary heart disease, heart attack or myocardial infarction, congestive heart failure); stroke; arthritis or rheumatism, osteoporosis or other bone/joint diseases; any neurological or psychiatric conditions (e.g., depression, Alzheimer’s/dementia, unipolar/bipolar disorders, or convulsions; Parkinson’s); and high cholesterol”. “The prevalence of multimorbidity was higher in urban vs. rural areas in each sub-category for the following factors: Obesity/Overweight (48.6 vs. 36.6), High-risk waiste circumference (49.6 vs. 35.1), High risk waiste to hip ratio (36.9 vs. 21.0), Physical Activity (Never, 36.9 vs. 22.4), Tobacco Consumption (29.9 vs. 17.1), Alcohol Consumption (32.9 vs. 15.9), Age group (70–79 years, 38.3 vs. 20.4), Gender (Female, 37.8 vs. 19.9), Education (Higher than Secondary, 38.5 vs. 28.7), Marital Status (Widowed, 37.1 vs. 20.3), Working Status (Not Working, 42.2 vs. 23.3), Household Wealth (Richer, 43.3 vs. 21.2), Caste (Other Backward Class, 36.3 vs. 19.9) Religion (Christian, 47.9 vs. 25.4)” [22] LASI, 2017–2018, ages ≥ 45 years, n = 22,526 families “Family was referred ≥2 members residing in the same household. Conjugal multimorbidity was defined as presence of multimorbidity among the household head and their spouse; multimorbidity between siblings, or presence of multimorbidity between generations”. “Family-level multimorbidity (44.46); conjugal multimorbidity (41.8); Siblings multimorbidity (42.86); intergenerational multimorbidity, three generations (46.07). Family-level multimorbidity was largely associated with those residing in urban regions and belonging to affluent class”. [23] LASI, 2017–2019, women ages 45–65 years, n = 23,951 “Presence of ≥2 simultaneously. NCD’s included asthma, musculoskeletal disorders, cancer, chronic bronchitis, chronic renal disease, chronic obstructive pulmonary disease, diabetes mellitus, gastrointestinal disorders, chronic heart disease, high cholesterol, hypertension, neurological and psychiatric disorders, obesity, skin disorder, stroke, thyroid disorder, and urinary incontinence”. “Multimorbidity (29.8) among women in midlife. Chandigarh (PR—54.8 per 100 women) and Punjab (PR—52.8 per 100 women) reported the highest prevalence of multimorbidity”. [19] LASI, 2017–2018, ages ≥ 45 years and above, n = 59,764 “Self-reported chronic NCDs were collected in response to the question “Has any health professional ever diagnosed you with the following chronic conditions or diseases?” Multimorbidity scores were then generated as one of the simultaneous occurrences of ≥2 chronic diseases. The 16 NCD’s—included asthma, musculoskeletal disorders, cancer, chronic bronchitis, chronic renal failure, chronic obstructive pulmonary disease, diabetes, gastrointestinal disorders, chronic heart disease, high cholesterol, hypertension, urinary incontinence, neurological and psychiatric disorders, skin disease, stroke, and thyroid disease”. “Age: Overall (28%), 45–49 (17.99), 50–54 (21.82), 55–59 (29.56), 60–64 (30.12), 65–69 (33.67), 70–74 (35.37), 75–79 (35.93), 80+ (34.22); Gender: Female (29.62), Male (26.07); Residence: Rural (24.30), Urban (36.55); Social Group: Other (34.31), Other Backward Class (28.51), Scheduled Castes (24.03), Scheduled Tribes (14.47); Wealth Index: Richest (38.22), Rich (31.87), Middle (26.80), Poorer (25.27), Poorest (19.76); Current marital status: Not in Union (30.92), In Union (26.97); Religion: Muslim (33.38), Christian (28.75), Hindu (27.06), Others (32.43)”. [10] 2017–2018 LASI, n = 30,489, urban poor, age ≥ 45 years “Co-occurrence of—≥2 chronic conditions within an individual, without defining an index disease; 17 self-reported chronic conditions—included hypertension, diabetes, cancer, chronic lung disease, chronic heart disease, stroke, arthritis or bone/joint conditions, psychological or neurological conditions, hypercholesterolemia, thyroid disorder, gastrointestinal problems, skin disease, chronic kidney disease, urine incontinence, oral morbidities, visual impairment, and hearing impairment”. “Overall: 45.26; Age: ≥75 years (64.14), 60–74 years (53.41), 45–59 years (33.83); Gender: Female (47.31), Male (41.06); Caste: Other backward class (43.30), Scheduled Caste (43.07), Scheduled Tribe (38.16); Monthly Per Capita Expenditure: Poorest (47.88), Poorer (41.44)”. [9] 2017–2018 LASI, n = 30,489, age ≥ 45 years “Complex multimorbidity was defined as ≥3 chronic conditions among >2 body systems. These chronic conditions were further catalogued into 11 system-
-specific chapters (e.g., neoplasms; endocrine/nutritional/metabolic; mental/behavioral; eye-cataract; glaucoma; ear/mastoid; circulatory system; the digestive system, which includes reflux; oral conditions; respiratory system; skin/subcutaneous tissue; musculoskeletal/connective tissue; and genitourinary system)”. “Age: Overall (63.25), 60–74 years (47.9); Gender: Female (59.6), Male (40.4); Residence: Rural (59.7), Urban (44.3); Social Group: Other Backward Class (40.4), Other Caste (34.0), Scheduled Castes (15.7), Scheduled Tribes (9.9); Wealth Index: Richest (23.7), Rich (22.1), Middle Class (19.9), Poorer (18.6), Poorest (15.7)”.

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