A comparative study of morbidity pattern in elderly of rural and urban areas of Allahabad district, Uttar Pradesh, India

Abstract

Background: The ageing process is a biological reality which has its own dynamics, largely beyond human control. The aged population has specific health problem that basically differs from those of an adult or young men. The aim was to study the socio demographic profile and pattern of morbidity in the elderly people of Allahabad district in Uttar Pradesh, India.

Methods: A cross sectional study was carried out on elderly aged 60 years and above; selected from urban and rural areas of Allahabad district by multistage random sampling and were interviewed using pre tested schedule. Data analysis was done on SPSS 16 version.

Results: A total of 400 elderly were surveyed (Male=215 and Female=185). Majority were Hindus (95.7%),) lived in joint families (59%), illiterate (43.75%), were either retired or not working (53%), and belonged to lower class (34.75%). The most common morbidities reported among them were ocular problems (68.5%), followed by musculoskeletal (59.7%), and psychological problems (29.75%). The urban elderly had significantly higher proportion of psychological problems (35%), diabetes (23.5%), hypertension (39%) and obesity (35%) whereas prevalence of anemia (43%) and malnutrition (38.5%) and respiratory problems (16%) were more common in rural area.

Conclusions: Over all the study showed that prevalence of certain diseases such as diabetes, hypertension, obesity, and psychological problems was more in urban elderly whereas the prevalence of anemia, under-nutrition, respiratory and skin problems were more in rural elderly.

Full text

International Journal of Community Medicine and Public Health | May 2016 | Vol 3 | Issue 5 Page 1152
International Journal of Community Medicine and Public Health
Verma V et al. Int J Community Med Public Health. 2016 May;3(5):1152-1156
http://www.ijcmph.com
pISSN 2394-6032 | eISSN 2394-6040
Research Article
A comparative study of morbidity pattern in elderly of rural and urban
areas of Allahabad district, Uttar Pradesh, India
Vandana Verma*, Shiv Prakash, Khurshid Parveen, Shama Shaikh, Neha Mishra
INTRODUCTION
The aging population is a sign of successful development
in medical sciences and technology, living standards, and
education, but the elderly also raise unique social,
economic, and clinical challenges, including a growing
demand for increasingly complex healthcare services.
At the moment, there is no United Nations standard
numerical criterion, but the UN agreed cut off is 60+
years to refer to the older population.1 Populations are
growing older in countries throughout the world. While
the population of more developed countries have been
aging for well over a century, this process began recently
in most less developed countries, and it is being
compressed into a few decades.2 The number of elderly
people residing in the world was estimated about 841
million in the year 2013, which is four times higher than
the 202 million that once lived in 1950.
The older population will almost triple by 2050, when it
is expected to surpass the two billion mark.3
ABSTRACT
Background:
The ageing process is a biological reality which has its own dynamics, largely beyond human control.
The aged population has specific health problem that basically differs from those of an adult or young men. The aim
was to study the socio demographic profile and pattern of morbidity in the elderly people of Allahabad district in
Uttar Pradesh, India.
Methods:
A cross sectional study was carried out on elderly aged 60 years and above; selected from urban and rural
areas of Allahabad district by multistage random sampling and were interviewed using pre tested schedule.
Data
analysis was done on SPSS 16 version.
Results:
A total of 400 elderly were surveyed (Male=215 and Female=185). Majority were Hindus (95.7%),) lived in
joint families (59%), illiterate (43.75%), were either retired or not working (53%), and belonged to lower class
(34.75%). The most common morbidities reported among them were ocular problems (68.5%), followed by
musculoskeletal (59.7%), and psychological problems (29.75%). The urban elderly had significantly higher
proportion of psychological problems (35%), diabetes (23.5%), hypertension (39%) and obesity (35%) whereas
prevalence of anemia (43%) and malnutrition (38.5%) and respiratory problems (16%) were more common in rural
area.
Conclusions:
Over all the study showed that prevalence of certain diseases such as diabetes, hypertension, obesity,
and psychological problems was more in urban elderly whereas the prevalence of anemia, under-nutrition, respiratory
and skin problems were more in rural elderly.
Keywords: Elderly, Rural and urban, Morbidities
Department of community medicine, MLN medical college, Allahabad, Uttar Pradesh, India
Received: 27 February 2016
Revised: 5 March 2016
Accepted: 06 April 2016
*Correspondence:
Dr. Vandana Verma,
E-mail: shineit47@gmail.com
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20161375

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International Journal of Community Medicine and Public Health | May 2016 | Vol 3 | Issue 5 Page 1153
The demographic transition with ageing of the population
is a global phenomenon which demands international,
national, regional and local action.
Over the next four decades, India’s demographic
structure is also expected to shift dramatically from a
young to an aging population resulting in 316 million
elderly persons by 2050.4 The percentage of the elderly
population in India increased from 5.4 per cent in 1950 to
6.1 per cent in 1990 and is expected to be about 8.7 per
cent in 2015, 11.1 per cent in 2025, 12.4 per cent in 2030
and 19.6 per cent in 2050.5 Several forces are driving
India’s changing age structure, including an upward trend
in life expectancy and falling fertility.
A WHO report states that non communicable disease’s
account for at least 32% of all deaths in India with a word
of caution that this could be an under and inadequate
estimation.
The impact should be higher in the geriatric population.
According to Government of India statistics,
cardiovascular disorders account for one-third of elderly
mortality. Respiratory disorders account for 10%
mortality while infections including tuberculosis account
for another 10%.
Neoplasm accounts for 6% and accidents, poisoning, and
violence constitute less than 4% of elderly mortality with
more or less similar rates for nutritional, metabolic,
gastrointestinal, and genito-urinary infections.7
A study conducted in the rural area of Pondicherry
reported decreased visual acuity due to cataract and
refractive errors in 57% of the elderly followed by pain in
the joints and joint stiffness in 43.4%, dental and chewing
complaints in 42%, and hearing impairment in 15.4%.
Other morbidities were hypertension (14%), diarrhea
(12%), chronic cough (12%), skin diseases (12%), heart
disease (9%), diabetes (8.1%), asthma (6%), and urinary
complaints (5.6%).8
Over the past decades, India’s health program and
policies have been focusing on issues like population
stabilization, maternal and child health, and disease
control.
However, current statistics for the elderly in India also
gives a prelude to a new set of medical, social, and
economic problems that could arise if adequate initiative
in this direction is not taken by the program managers
and policy makers.
There is a need to highlight the medical and socio-
economic problems that are being faced by the elderly
people in India.9 To formulate policies and programmes
and for them to function effectively, good approximate
measure of morbidity status of elderly should be studied
which will provide with such information that are
lacking. So, based on above facts the present study was
carried out with the objective to compare the morbidity
pattern in rural and urban areas of Allahabad district.
METHODS
For setting and study design it was a cross-sectional study
carried out on elderly aged 60 years and above selected
from rural and urban areas of Allahabad district, by
multistage random sampling.
A sample size of 400 was calculated from the research
adviser 2006 based on target population of 5,06,123
elderly in Allahabad district, with 95% of confidence
interval and 5% margin of error.10,11
For the data collection informed consent was obtained
from the study subjects after explaining the purpose and
objective of the study. Data was collected by house to
house visits. The study subjects were interviewed and
examined. The collected information was recorded on a
pre-designed, pretested, semi structured questionnaire.
Morbidity was assessed by taking history, doing a clinical
examination, reviewing past medical records and
medicines taken by the study subject.
The data was analyzed using statistical software, SPSS
Version 16. Chi- square tests and Z- test were used to test
the associations between the different variables. P value
less than 0.05 was considered as significant.
RESULTS
A total 200 elderly each from rural and urban areas were
selected. Out of which majority in both groups belonged
to age group of 60-70 years followed by 70-80 years. The
mean age of the elderly in rural was found to be 68.96
years (SD 7.48) and in the urban area, the mean age was
68.97(SD 7.45).
In rural more than half (64.5%) were living in joint
families, followed by (18%) living in third generation
families, while among urban elderly, about half (53.5%)
were living in joint families, and about (28%) in nuclear
families. Majority (70.55%) in rural and (79.5%) in urban
were married at the time of study.
More than half (62%) elderly in the rural were found to
be illiterate as compared to (25.5%) in urban group. Most
elderly in both the group i.e. (53.0%) were either retired
from service or were not working at the time of study.
More of elderly in rural areas were engaged in
agricultural activities (22.5%), followed by (8.5%) who
were laborer, while in urban area the proportion of
elderly engaged in service and semiskilled work were
7.5% and 5% respectively.
The socioeconomic classification was based on Modified.
Prasad B.G scale 2014, which showed that significantly
more of rural elderly belonged to lower class [SES-V]
(48.5%) and upper lower class [SES IV] (25%) whereas

Verma V et al. Int J Community Med Public Health. 2016 May;3(5):1152-1156
International Journal of Community Medicine and Public Health | May 2016 | Vol 3 | Issue 5 Page 1154
more proportion of urban elderly belonged to upper class
[SES I] (28.5%) and upper middle class [SES II] (20.5%).
The body mass index shows more of rural elderly
(38.5%) were underweight, whereas prevalence of over-
nutrition i.e. (overweight and obesity) were more in urban
elderly (27.5%) and (7.5%) respectively. This difference
was also found to be statistically significant (Table-1).
Over all most prevalent diseases were related to ocular,
musculoskeletal, psychological system, gastrointestinal
system, and dental disorder affecting 274(68.5%),
239(59.75%), 119(29.75%), 100 (25%), 94 (23.5%), of
elderly respectively. The prevalence of anemia (43%),
under-nutrition (38.5%) and respiratory problems (16%)
were more in rural elderly whereas psychological
problems (24.5%), hypertension (39%), obesity (35%)
and diabetes (23.5% were found more in urban elderly.
This difference in prevalence of morbidity among rural
and urban elderly was also found to be significant
statistically (p<0.05) (Table-2).
Table 1: Socio-demographic and biophysical profile of study population.
Variables
Rural
(N=200)
Urban
(N=200)
Total
(N=400)
p-value
Age
60-70
129(64.5%)
124(62%)
253(63.25%)
p>0.05
70-80
49(24.5%)
58(29%)
107(26.75%)
80 and above
22(11%)
18(9%)
40 (10%)
Type of Family
Nuclear
31(15.5)
56(28)
87(21.75%)
p<0.05*
Joint
129(64.5)
107(53.5)
236(59%)
Third generation
36(18)
32(16)
68(17%)
Single member
04(02)
05(2.5)
09(2.25%)
Marital Status
p>0.05
Unmarried
04(2)
01(0.5)
5(1.25%)
Married
141(70.5)
159(79.5)
300(75%)
Divorced
03(1.5)
01(0.5)
04(1%)
Widow
52(26)
39(19.5)
91(22.75%)
Educational Status
Illiterate
124(62)
51(25.5)
175(43.75%)
p<0.05*
Literate
76(38)
149(74.5)
225(56.25%)
Occupation
Not working/ Retired
89(44.5)
123(61.5)
212(53%)
p<0.05*
Agriculture
45(22.5)
02(1)
47(11.75%)
Labourer
17(8.5)
03(1.5)
20(5%)
Semi-skilled Worker
05(2.5)
10(5)
15(3.75%)
Skilled Worker
03(1.5)
07(3.5)
10(2.5%)
Business
07(3.5)
08(4)
15(2.5%)
Service
04(2)
15(7.5)
19(4.75%)
Other(housewife)
30(15)
32(16)
62(15.5%)
Socio Economic Status
Upper(I)
09(4.5)
57(28.5)
66(16.5%)
p<0.05*
Upper Middle(II)
19(9.5)
41(20.5)
60(15%)
Lower Middle(III)
25(12.5)
24(12)
49(12.25%)
Upper Lower(IV)
50(25)
36(18)
86(21.5%)
Lower(V)
97(48.5)
42(21)
139(34.75%)
Body Mass Index (BMI)
Underweight – (<18.50 Kg/m2)
77(38.5)
27(13.5)
104(26%)
p<0.05*
Normal Range – (18.50 -24.99 Kg/m2)
96(48)
103(51.5)
199(49.75%)
Overweight- (25.00 to 29.99Kg/m2)
22(11)
55(27.5)
77(19.25%)
Obese – (30.00-40.00 Kg/m2)
05(2.5)
15(7.5)
20(05%)
*significant

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International Journal of Community Medicine and Public Health | May 2016 | Vol 3 | Issue 5 Page 1155
Table 2: Distribution of morbidity pattern in rural and urban elderly.
Disease
Rural
Urban
Total
Z test
No.
%
No.
%
No.
%
Ocular
133
66.5
141
70.5
274
68.5
0.9
Musculoskeletal
117
58.5
122
61
239
59.75
0.5
Psychological*
49
24.5
70
35
119
29.75
2.3*
Gastrointestinal
54
27
46
23
100
25
0.9
Dental
46
23
48
24
94
23.5
0.2
Ear
22
11
30
15
52
13
1.2
Genitourinary
23
11.5
25
12.5
48
12
0.7
Respiratory*
32
16
13
6.5
45
11.25
3*
Skin
13
6.5
9
4.5
22
5.5
0.9
Anaemia*
86
43
66
33
152
38
2.1*
Diabetes*
12
06
47
23.5
59
14.75
4.9*
Hypertension*
55
27.5
78
39
133
33.25
2.4*
Obesity*
27
13.5
70
35
97
24.3
5*
Chronic energy deficiency (BMI<18.50)*
77
38.5
27
13.5
104
26
5.7*
*p<0.05, significant
DISCUSSION
In the present study more of urban elderly (70.5%) had
ocular disease as compared to (66.5%) of rural elderly.
Refractive error followed by cataract was most common
ocular morbidity observed out of which prevalence of
cataract was more common among rural area. Kanfade M
et al in a study conducted on elderly in urban area of
Nagpur found prevalence of eye disease around 74% and
Mahesh C and et al found the prevalence of ocular
diseases among elderly around 60% which is nearer to
present finding. In the present study, more of urban
elderly (61%) had musculoskeletal problems as compared
to (58.5%) of rural elderly which is similar to the study
conducted in rural area by Sharma D et al and Shankar R
et al (58% ) which is again similar to our rural finding.12-
15 In present study the prevalence of anaemia among rural
elderly (43%) was found to be higher than urban elderly
(33%), Hakmaosa A et al in rural areas of Assam found
prevalence of anemia among elderly around 40% which
is similar to our rural finding.16 In the present study more
of urban elderly had hypertension (39%) as compared to
(27.5%) of rural elderly, which was also statistically
significant. Mahesh C et al, Charle HN et al in Nepal and
Woo E et al in South Korea observed the prevalence of
hypertension in urban elderly around 40%, 39% & 37%
respectively which is again nearer to our urban finding
(39%).13,18,19 Purty AJ et al in rural area of Pondicherry
found the prevalence of hypertension around 26% which
is similar to our rural finding 27.5%. On contrary,
Kanfade M et al in a study on elderly in urban area of
Nagpur reported prevalence of hypertension around 70%
which is much higher than our urban finding. In present
study, more of rural elderly (38.5%) were underweight
(BMI<18 Kg/m2) as compared to (13.5%) of urban
elderly.17,12 Saxena V et al in rural area of Dehradun
found the prevalence of underweight around 36% which
is comparable to our rural finding.20 Similar finding was
seen in study done in rural and urban area of Pune by RP
Thakur & et al where higher proportion of elderly in rural
were underweight as compared to urban elderly and
overweight and obesity was more common in urban area.
In our study more proportion of urban elderly (23.5%)
were found to be diabetic as compared to (06%) of rural
elderly.21 Hakmaosa A et al in rural areas of Assam found
prevalence of diabetes among rural elderly around 07%
which is comparable to our rural finding.16 Chodhury M
et al found the prevalence of Diabetes in urban elderly
around 26% which is nearer to our urban finding 23.5%.
Charle HN et al found prevalence of diabetes 24% in
urban elderly Qadri S et al in rural Haryana, found
prevalence of diabetes was 09% which is similar to our
rural finding.13,18,22 On contrary, Yerpude PN et al in
rural area of Guntur, found prevalence of diabetes in rural
area around 23% which is higher than our rural finding.23
CONCLUSION
The present study highlighted that prevalence of certain
diseases such as diabetes, hypertension, obesity, and
psychological problems were more in urban elderly
which could be due to sedentary lifestyle and lack of
physical activities whereas the prevalence of anemia,
under-nutrition, respiratory and skin problems are more
in rural elderly which could be attributed to lower socio-
econic status of elderly in rural areas and more
involvement in outdoor activities. Comprehensive care
including imparting health education and promoting the
healthy lifestyle, creating awareness regarding the
various geriatric welfare scheme will further enable the
elderly to improve their quality of life. The present study
will further help in creating felt need health services for
the elderly which will enable to decrease the common

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International Journal of Community Medicine and Public Health | May 2016 | Vol 3 | Issue 5 Page 1156
preventable disease and better utilization of health
facilities among the elderly.
Strength and limitation of the study explains that Most
morbidity was elicited by asking questions, self-
reporting, and simple field investigations without any
further confirmation by other laboratory investigations.
Because of which morbidity may have been
underestimated or missed.
The strength of the study lies in the facts that very few
comparative study in Northern India is carried out for
morbidity in rural and urban elderly, which will further
help to specify the need of elderly in these areas which
will further strengthen the preventive and curative aspect
of health sector and better utilization of health services.
Funding: No funding sources
Conflict of interest: None declared
Ethical approval: The study was approved by the
Institutional Ethics Committee
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Cite this article as: Verma V, Prakash S, Parveen K,
Shaikh S, Mishra N. A comparative study of morbidity
pattern in elderly of rural and urban areas of Allahabad
district, Uttar Pradesh, India. Int J Community Med
Public Health 2016;3:1152-6.