1 Volume 2018; Issue 02 Journal of Tropical Medicine and Health Research Article Muksor A, et al. J Trop Med Health JTMH-121. DOI: 10.29011/JTMH-121.000121 Rural-Urban Differentials in NCD Multimorbidity in Adult Population in India: Prevalence and Cost of Care Alacrity Muksor 1* , Priyanka Dixit 1 , Varun M.R 1 School of Health Systems Studies, Tata Institute of Social Sciences, India * Corresponding author: Alacrity Muksor, School of Health Systems Studies, Tata Institute of Social Sciences, India. Tel: +91- 08413079155; Email: alacritymuksor@gmail.com Citation: Muksor A, Dixit P, Varun MR (2018) Rural-Urban Differentials in NCD Multimorbidity in Adult Population in India: Prevalence and Cost of Care. J Trop Med Health JTMH-121. DOI: 10.29011/JTMH-121.000121 Received Date: 23 February, 2018; Accepted Date: 5 March, 2018; Published Date: 15 March, 2018 Introduction Non-Communicable Diseases (NCDs) have collectively become the leading cause of global disease burden and also major contributors to mortality and morbidity in Low and Middle- Income Countries (LMICs). The Global Status Report released by WHO in 2010 show NCDs as one of the most signifcant causes of mortality worldwide contributing to 80% of mortality occurring in LMICs [1]. In India, chronic diseases are estimated to account for 53% of all deaths and 44% of disability-adjusted-life-years (DALYs) in 2005 alone [2]. Improvements in survival and an aging population are two key factors attributed for the prevalence of chronic disease and the likelihood of living with more than one condition (multimorbidity). These are expected to continue rising in the foreseeable future [3]. The prevalence of multimorbidity is associated with an increased risk of premature mortality, reduced quality of life, substantial societal costs due to increased healthcare utilization, and higher out of pocket expenditure [4]. As the population of a country ages, multimorbidity steadily increases. Clinical management of multimorbidity is complex and hindered essentially by the lack of specifc guidelines. Healthcare delivery systems and medical education even in the present context continues to be addressed only as a single-disease framework. The study of the burden of multimorbidity has largely been confned to developed countries. However, there is a steady increase in the recognition of the importance of multimorbidity to populations in lower and middle- income countries [5]. There is a lack of literature in India on rural and urban differentials of NCDs and multimorbidity prevalence. This lack has hampered evidence-based interventions to reduce the prevalence of multimorbidity. Urban areas are generally associated with lifestyle factors that lead to an increase in NCDs. Interestingly, however, studies have also shown that the prevalence of NCD is similarly high among the rural population [6]. Understandably, the access to services, health and other services, is severely limited in the rural areas compared to the urban areas [7-10]. Studies on the prevalence of NCD multimorbidity in India have been conducted to a large extent. However, studies that signifcantly explain its rural-urban differentials are to be carried out in the country. Hence, the need for the present study, which aims to look at the rural-urban differential in the prevalence of NCDs and at the NCD multimorbidity in the age group between 19-59 years. Previous studies show that in India NCDs starts at an early age, mostly affecting working-age population. This leads to a huge loss in work hours thus impacting the economy adversely. NCD multimorbidity is associated with a higher cost of care. The high cost of treatment becomes an immense burden for most households in India, especially those who are below the poverty line. This becomes even more poignant and alarming when considering the plight of people who are currently employed in the private sectors in the country. Most of the workers here are employed without any health insurance cover or healthcare facilities, high out of pocket expenditure due to multimorbidity leaves many of such workers in precarious conditions. Making both ends meet while desperately attempting to foot the cost of medical treatments at the same time becomes almost always a battle for survival. The present study also aims to compare the out-of-pocket expenditure in the rural and in the urban adult after adjusting for the insurance. In brief, this study focuses on a population between 19-59 years of age considering the pivotal role played by people in between this age group in sustaining their families and in the care and nurture of their children and the impact that NCDs have upon the former [11,12]. The study also seeks to make comparisons of the impact of NCD multimorbidity on the cost of care and out-of-pocket expenditures between the rural and the urban adult population.