MULTIMORBIDITY BURDEN AND HEALTHCARE-SEEKING BEHAVIOR AMONG ADULTS WITH COEXISTING DIABETES AND HYPERTENSION IN A COMMUNITY SETTING OF LAHORE, PAKISTAN

Abstract

Background: Multimorbidity is the presence of two or more concurrent chronic diseases in a person. Diabetes and hypertension often coexist and cause a complex situation with treatment in low- and middle-income countries (LMICs). The main purpose of our study was to assess the number and type of additional chronic conditions among these patients. The patients’ healthcare-seeking behavior, service utilization, medication adherence, and perceived barriers were the focus of our research, which took place in Lahore, Pakistan. Methods: For this community-based cross-sectional study, 430 individuals living with diabetes and hypertension, who reported a physician diagnosis of both conditions, were recruited. The survey was conducted in the area served by Pak Red Crescent Medical and Dental College, Lahore. Questionnaires were filled in by the community workers who were specially trained for the purpose. The topics covered in the survey were sociodemographic, 18 other chronic diseases, healthcare utilization, medication adherence, and barriers to care. Participants were selected by consecutive sampling between March 2024 and April 2025. Associations were tested with the chi-square test. Results: Of the 430 participants, 389 (90.5%) had at least one additional chronic condition and 263 (61.2%) had four or more chronic conditions in total. Dyslipidemia (32.8%) and obesity (30.0%) were the most common additional conditions. Most participants used private hospitals or clinics as their usual source of care (53.5%), and 88.1% usually consulted a doctor. Poor medication adherence was reported by 26.0% of participants for diabetes and 20.7% for hypertension, and 235 (54.7%) reported at least one major barrier to care. High multimorbidity (two or more additional conditions, four or more in total) was more common in participants aged 60 years or older than in younger participants (71.7% vs 54.1%, chi-square (1) = 13.47, p = 0.0002). Conclusion: Adults with coexisting diabetes and hypertension in this community carry a high burden of additional chronic conditions and face multiple barriers to care, including family responsibilities, limited knowledge, negative previous experiences, and cost-related delays. Affordable, integrated primary care is recommended to improve the management of these patients.