Determinants of Multimorbidity among the Ageing Population in Kurunegala District, Sri Lanka

Abstract

Multimorbidity, the presence of two or more chronic conditions, is a growing public health problem in the context of ageing populations. There is a high level of multimorbidity in Sri Lanka, with a rapid demographic ageing trend, but the community-level evidence on the factors underlying multimorbidity is scarce. The objectives of this study were to estimate the prevalence of multimorbidity and to investigate the demographic and socioeconomic factors of the older people in Kurunegala District, Sri Lanka. The research was conducted by cross-sectional studies on 220 older adults (age ≥ 60) selected by multi-stage cluster sampling, in the community. Structured interviewer-administered questionnaires were used to collect data. Multimorbidity was defined as having ≥ 2 chronic disease conditions, and sensitivity analysis was performed with ≥ 3 chronic disease conditions. Analytical tools, such as Python, were used for descriptive statistics, chi-square tests, and multivariable logistic regression. There was a high prevalence of multimorbidity (57.7%), and 28.6% reported having 3 or more of the chronic conditions. Hypertension, diabetes and arthritis were the most prevalent conditions. Multivariate analysis revealed age and living condition as key independent demographic factors; those aged ≥80 years had greater odds of multimorbidity, and those who lived alone had higher odds. There were no statistically significant associations with socioeconomic status factors such as education, wealth, pension status or place of residence after adjustment. The results were similar in sensitivity analyses based on an alternative definition of multimorbidity (defined as ≥3 conditions). The study suggests that there is a high level of multimorbidity among older adults in Kurunegala District, which is mainly due to their biological ageing and social vulnerability, and not to socioeconomic factors. The results highlight the value of a multi-sector community support network and the importance of primary healthcare being integrated and person-centred, especially for older people who feel socially isolated.