Multiple long-term conditions climbed in India as quality of life fell in stepwise fashion
National survey data from India show a sharp rise in multiple long-term conditions among adults, alongside steadily worse quality of life and greater use of healthcare services. The pattern was not subtle. As the number of chronic illnesses accumulated, quality-of-life scores dropped in a graded sequence, while outpatient visits and hospitalisations became more common.
The analysis drew on two waves of the WHO Study on global AGEing and adult health, a large household survey covering adults in six Indian states. Wave 2 included 9,116 adults in 2015, and Wave 3 included 7,885 adults in 2019 to 2020. Investigators used those data to estimate how common multimorbidity had become, which disease pairs appeared most often, and how combinations of chronic disease related to day-to-day function and service use.
Rising prevalence across waves, with the heaviest burden in older adults
Prevalence of multiple long-term conditions increased from 19.2% in the earlier wave to 24.4% in the later wave. The burden was concentrated in groups already known to sit at the intersection of biological risk and social vulnerability: adults aged 60 years and older, women, urban residents, and people in the wealthiest quintile had the highest prevalence. The gradient matters because it suggests that multimorbidity in India is not confined to one social stratum or one geographic setting; it is already embedded across both aging and urbanized populations.
The most common disease combinations were hypertension-cataracts, hypertension-arthritis, and hypertension-diabetes. Those pairings fit familiar clinical pathways. Hypertension often travels with vascular and metabolic disease, while arthritis and cataracts add functional limitation and sensory impairment to the chronic disease load. Once those conditions cluster, the patient’s burden is no longer defined by one diagnosis alone; mobility, medication adherence, appointment attendance, and self-care all become harder to sustain.
Quality of life deteriorated as chronic conditions accumulated
Quality of life was measured using the 8-item WHO Quality of Life scale, which ranges from 0 to 100. Scores declined in a clear stepwise pattern as chronic disease count rose. In 2015, compared with adults without chronic conditions, WHOQoL-8 scores were lower by 2.6 points with one condition, 5.1 points with two conditions, and 6.7 points with three or more conditions. In 2019 to 2020, the corresponding declines were 3.3, 5.6, and 7.9 points.
The physical and functional domains took the sharpest hit. This is clinically intuitive. When chronic illness becomes clustered, symptom burden often compounds through pain, fatigue, breathlessness, limited mobility, and the practical strain of ongoing treatment. The financial domain, in contrast, remained stable across increasing multimorbidity. In a real-world setting, that stability may reflect the way the instrument captured perceived financial strain, or it may indicate that the larger decrement in wellbeing was being driven more by impaired physical and social functioning than by immediate changes in self-rated financial status.
Depression-COPD and depression-stroke combinations were associated with the poorest quality of life. Both pairings are biologically and clinically plausible drivers of disability. Depression can erode motivation, sleep, appetite, and engagement with treatment, while COPD and stroke can sharply restrict exertion, independence, and social participation. When mental illness overlays cardiopulmonary or cerebrovascular disease, the combined effect on daily life can be more disabling than the individual diagnoses taken separately.
Healthcare use increased alongside disease burden
Healthcare utilisation rose as well. Adults with multimorbidity had more outpatient visits and more hospitalisations in the preceding 12 months than adults without chronic disease. The analysis used Poisson regression to assess those associations after adjustment for sociodemographic, socio-economic, and behavioural factors, reinforcing the conclusion that the service burden tracked with disease accumulation rather than with background characteristics alone.
One sentence captures the practical consequence: more chronic conditions meant more contact with the health system. That has implications for primary care capacity, continuity of care, and the need to coordinate treatment plans across conditions that are often managed in separate silos. A person with hypertension, diabetes, arthritis, and cataracts is unlikely to benefit from fragmented follow-up that treats each disorder as though it exists in isolation.
What the pattern means for Indian health systems
The rising prevalence between survey waves suggests that multimorbidity is becoming more common in India over a relatively short period. Ageing population structure likely contributes, but the social patterning seen here points to broader forces as well, including urban living, longer survival with chronic disease, and the cumulative effects of cardiometabolic risk.
For clinicians, the study argues for routine screening beyond a single presenting complaint. Hypertension, diabetes, arthritis, cataracts, depression, COPD, and stroke repeatedly surfaced as part of the same chronic disease cluster, which means care pathways need to anticipate co-occurrence rather than react to it late. For health planners, the findings support stronger integration of noncommunicable disease care at the community and primary-care level, where repeated visits, long-term follow-up, and functional assessment are most likely to happen.
The survey design cannot prove causation, and the results reflect associations at two time points rather than individual disease trajectories over time. Even so, the signal is consistent: as chronic conditions accumulate, quality of life falls and healthcare use rises. The gap between prevalence and service readiness will matter most in older adults, in women, and in communities already carrying the largest burden of chronic disease.