Multimorbidity, Health Literacy, and Quality of Life Among Older Adults in an Urban Slum in India: A Community-Based Cross-Sectional Study

Abstract

Abstract Background: India is experiencing a rising burden of multimorbidity due to an aging population and epidemiological transition. Older adults residing in urban slums are especially vulnerable due to challenges in managing multiple comorbidities amid deprived living conditions. This study aimed to assess the prevalence of multimorbidity, associated health literacy, and quality of life impact in this marginalized population. Methods and Materials: A community-based cross-sectional study was conducted among 800 adults aged ≥65 years in an urban slum in Gujarat, India. Participants were selected through multistage random sampling. Data on sociodemographics, chronic conditions, health literacy (HLS-SF-47 scale), quality of life (SF-12 scale), physical activity, social support, smoking, alcohol use, diet, and healthcare access were collected. and were collected. Multimorbidity was defined as the presence of ≥2 conditions. Categorical variables are presented as the frequency and percentage, and numerical variables are presented as the mean ± SD. Logistic regression analyses were applied to test the relationship between categorized independent and dependent variables, and all tests were two-tailed, with statistical significance set at the probability value (P <0.05). Results: The prevalence of multimorbidity was 62.5% (500/800). Multimorbidity was significantly associated with lower physical component summary (PCS) and mental component summary (MCS) scores on the SF-12 (p<0.001). Nearly half (48%) of the older adults with multimorbidity had inadequate health literacy, compared to 20% of those without multimorbidity. After adjustment, inadequate health literacy increased the likelihood of having multimorbidity by more than 4 times (AOR 4.2, 95% CI 2.1-8.5). Older age (AOR 1.05, 95% CI 1.02-1.09; p=0.002), female sex (AOR 1.86, 95% CI 1.12-3.08; p=0.016), widowhood (AOR 2.05, 95% CI 1.15-3.65; p=0.015), no formal education (AOR 3.12, 95% CI 1.52-6.41; p=0.002), low socioeconomic status (AOR 2.35, 95% CI 1.22-4.52; p=0.011), being physically inactive (AOR 1.68, 95% CI 1.02-2.77), and lacking social support (AOR 1.57, 95% CI 1.01-2.45) were associated with greater odds of multimorbidity. Conclusion: There is a high burden of multimorbidity among urban slum dwellers aged ≥65 years in India, which is strongly linked to inadequate health literacy, physical inactivity, and poor social support. Improving health literacy and addressing modifiable social determinants of health are essential to reducing multimorbidity prevalence in this marginalized population.