Abstract
Background
Multimorbidity is an emerging public health concern in low- and middle-income countries, where rapidly ageing populations face the dual burden of chronic disease and economic necessity. In India, a substantial proportion of older adults aged 45+ continue to engage in paid work, yet the relationship between working status and multimorbidity remains poorly understood, limiting evidence for occupational health policy and chronic disease management in ageing workforces.
Methods
Data from the Longitudinal Ageing Study in India (LASI 2017–18) included 59,073 adults aged 45+. Multimorbidity was the outcome variable and working status the primary exposure. Descriptive, bivariate, and multivariate logistic regression models were conducted, adjusting for sociodemographic, behavioural, and anthropometric covariates.
Results
Overall multimorbidity prevalence was 41%. Prevalence was highest among those not currently working (49.9%), followed by never-worked (45.2%), and lowest among currently working adults (33.5%). Currently working adults had significantly lower odds of multimorbidity (OR: 0.60; 95% CI: 0.57–0.62), while those not currently working had higher odds (OR: 1.25; 95% CI: 1.19–1.30). Associations persisted after full adjustment (AOR: 0.73; 95% CI: 0.70–0.76 and AOR: 1.17; 95% CI: 1.12–1.23, respectively). Older age, widowhood, urban residence, higher income, overweight/obesity, tobacco use, and alcohol consumption independently increased multimorbidity odds. Physical activity was protective (AOR: 0.92; 95% CI: 0.88–0.95).
Conclusions
Current employment is independently associated with lower odds of multimorbidity among older Indian adults, even after comprehensive adjustment. While reverse causality cannot be excluded in this cross-sectional analysis, findings highlight the need for targeted interventions addressing modifiable risk factors and policies that support sustained economic participation among India’s ageing workforce.
Key messages
• Current employment is protective against multimorbidity in older Indian adults, with currently working adults one-third less likely to have multiple chronic conditions.
• Modifiable risk factors such as obesity, tobacco, alcohol, and inactivity, compound multimorbidity risk among older Indian adults, highlighting urgent targets for intervention.