Exploring the non-communicable disease (NCD) network of multi-morbid individuals in India: A network analysis

Nationally representative evidence discussing the interplay of non-communicable diseases (diseases) are scarce in India. Therefore, the present study aims to fill this research void by providing empirical evidence on disease networking using a large nationally representative cross-sectional sample segregated by gender among older adults in India. The analysis utilized data on 10,606 multimorbid women and 7,912 multimorbid men from the Longitudinal Ageing Study in India (LASI), 2017-18. Multimorbidity was defined as the co-occurrence of two or more diseases in an individual using a list of 16 self-reported diseases. Weighted networks were visualized to illustrates the complex relationships between the diseases using network analysis. The findings suggest that women possess a higher burden of multimorbidity than men. Hypertension, musculoskeletal disorder, gastrointestinal disorder, diabetes mellitus, and skin diseases were reported as the most recurrent diseases. 'Hypertension-musculoskeletal disorder', 'diabetes mellitus-hypertension', 'gastrointestinal disorders-hypertension' and 'gastrointestinal disorders- musculoskeletal disorder' were recurrent disease combinations among the multimorbid individuals. The study generated compelling evidence to establish that there are statistically significant differences between the prevalence of diseases and how they interact with each other between women and men. These findings further accentuate that disease networks are slightly more complex among women. In totality, the study visualizes disease association, identifies the most influential diseases to the network, and those which acts as a bridge between other diseases, causing multimorbidity among the older adult population in India.