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Multimorbidity is highly prevalent in high income countries, the growing interest of multimorbidity in a lower middle income country is great news for the prevention of epidemic exacerbation of chronic diseases.
The occidental and indian context are fairly different; In an occidental context, the inclusion of visual difficulty, deafness and chronic back pain in the list of chronic disease would have likely over-represented the multimorbidity in the sample. I would be interested to hear about the authors experience with these conditions in their context.
It has been highlighted by the authors that higher socio-economic status was associated with increased multimorbidity. In the occidental context, salary alone is often not representative of socio-economical status; a combinaison of education level and family income is often used. I would be interested to understand the dichotomic description used for the income level in the analysis and its representativity to population of India.
It was interesting to read about stratified results report for the different age groups and sex. Recent work suggests that a cutoff of three chronic conditions offers a more specific way to identify patient with more complex needs in multimorbidity. It would have been interesting to reports results with both definitions of multimorbidity.
Best Regards, Maxime Sasseville
Competing interests: None declared