Burden and complexity of multimorbidity: Findings from Dhulikhel Heart Study

Background : Multimorbidity, defined as the coexistence of multiple chronic conditions within an individual, is increasingly recognized as a significant public health concern, particularly as populations age. While the prevalence of multimorbidity has been extensively studied in various global regions, there is limited data from Nepal. This study examines the burden and complexity of multimorbidity within the Dhulikhel Heart Study cohort in central Nepal. Methods : We conducted a community-based cross-sectional study in Dhulikhel Municipality from July 2022 to June 2023, enrolling 1,608 participants aged 18 years and above. Data collection was performed through face-to-face interviews, and multimorbidity was defined as the presence of two or more chronic conditions. The conditions assessed included hypertension, diabetes, obesity, depression, kidney diseases, and several cardiovascular and respiratory disorders, among others. Sociodemographic and health-related behavioral variables were also analyzed. Results : The overall prevalence of multimorbidity in the study population was 26.6%, with 27.0% among females and 26.0% among males. The prevalence of one, two, and three or more chronic conditions was 31.7%, 18.0%, and 8.6%, respectively. The odds of multimorbidity increased significantly with age (p-trend < 0.001). Compared to the 18-29 age group, the odds were 1.82 times higher for ages 30-39 (95% CI: 1.02 - 3.22), 4.27 times higher for ages 40-49 (95% CI: 2.38 - 7.64), 4.48 times higher for ages 50-59 (95% CI: 2.46 - 8.14), 6.68 times higher for ages 60-69 (95% CI: 3.60 - 12.40), and 7.01 times higher for those 70 years and older (95% CI: 3.62 - 13.57). Newar ethnicity had 1.70 times higher odds of multimorbidity (95% CI: 1.28 - 2.26, p < 0.001), and 'Other' ethnic groups (Dalit and Janajati) had 1.48 times higher odds (95% CI: 1.07 - 2.06, p = 0.016). Low physical activity was associated with 1.68 times higher odds of multimorbidity (95% CI: 1.28 - 2.21, p < 0.001). Conclusion : The findings underscore the significant burden of multimorbidity in central Nepal, particularly among older adults. This highlights the need for targeted public health interventions and healthcare strategies to manage multimorbidity effectively, particularly as the population ages. The study provides critical insights into the epidemiology of multimorbidity in Nepal, which could inform future health policy and resource allocation.