Dec 16, 2025
Version 1
Multimorbidity in Young Adults in India: A PRISMA-ScR-Guided Scoping Review V.1
- Koustubh D Bhat1,
- Dr Anusha S J2
- 1MBBS Student, India;
- 2MBBS, MD
- Public Health and Clinical Research Protocols
Protocol Citation: Koustubh D Bhat, Dr Anusha S J 2025. Multimorbidity in Young Adults in India: A PRISMA-ScR-Guided Scoping Review. protocols.io https://dx.doi.org/10.17504/protocols.io.261ge1ppyv47/v1
License: This is an open access protocol distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Protocol status: In development
We are still developing and optimizing this protocol
Created: December 15, 2025
Last Modified: December 16, 2025
Protocol Integer ID: 235030
Keywords: Multimorbidity, Young Adults, India, Scoping Review, PRISMA-ScR, reporting multimorbidity, multiple chronic condition, literature on multimorbidity, young adults in india, definitions of multimorbidity, more chronic conditions in an individual, comprehensive overview of multimorbidity, multimorbidity, more chronic condition, prevalence, public health policy, health, disease pattern, public health challenge, secondary analysis
Abstract
Background:
Multimorbidity, defined as the coexistence of two or more chronic conditions in an individual,
is increasingly observed among young adults in India. This poses unique clinical,
psychosocial, and public health challenges, yet evidence in this population remains
fragmented and under-synthesized.
Objectives:
To map and synthesize existing literature on multimorbidity in young adults (18-44 years) in
India, focusing on prevalence, disease patterns, determinants, consequences, and
health-system implications.
Eligibility Criteria:
Studies conducted in India, reporting multimorbidity or multiple chronic conditions in young
adults, including observational studies, secondary analyses, and review articles published in
English.
Information sources:
Electronic Databases (PubMed/MEDLINE, Google Scholar, IndMED) and reference lists of
relevant studies.
Charting methods:
Data will be extracted using a standardized form capturing study
characteristics, definitions of multimorbidity, prevalence, disease clusters, determinants,
outcomes, and health-system challenges. Findings will be synthesized thematically
Conclusion / Expected Outcomes:
This scoping review will provide a comprehensive overview of multimorbidity in young adults
in India, highlight gaps in current evidence, and inform clinical practice, public health policy,
and future research directions.
Protocol Version
Version 1.0 - 15 December 2025
Abstract
Background:
Multimorbidity, defined as the coexistence of two or more chronic conditions in an individual,
is increasingly observed among young adults in India. This poses unique clinical,
psychosocial, and public health challenges, yet evidence in this population remains
fragmented and under-synthesized.
Objectives:
To map and synthesize existing literature on multimorbidity in young adults (18-44 years) in
India, focusing on prevalence, disease patterns, determinants, consequences, and
health-system implications
Eligibility Criteria:
Studies conducted in India, reporting multimorbidity or multiple chronic conditions in young
adults, including observational studies, secondary analyses, and review articles published in
English.
Information sources:
Electronic Databases (PubMed/MEDLINE, Google Scholar, IndMED) and reference lists of
relevant studies.
Charting methods: Data will be extracted using a standardized form capturing study
characteristics, definitions of multimorbidity, prevalence, disease clusters, determinants,
outcomes, and health-system challenges. Findings will be synthesized thematically
Conclusion / Expected Outcomes:
This scoping review will provide a comprehensive overview of multimorbidity in young adults
in India, highlight gaps in current evidence, and inform clinical practice, public health policy,
and future research directions.
Introduction
Rationale:
Multimorbidity, defined as the presence of two or more chronic conditions in an individual, is
traditionally considered a health issue of older adults. However, evidence indicates a rising
prevalence of multimorbidity among young adults in India, driven by rapid urbanization,
lifestyle changes, early onset of noncommunicable diseases, persistent infections diseases,
and psychosocial stressors. Young adulthood (approximately 18-44 years) is a critical life
stage, and multimorbidity during this period can lead to long term clinical, psychosocial, and
economic consequences, including reduced quality of life, productivity loss, mental health
burden, and increased healthcare costs.
Despite these consequences, research on multimorbidity in young adults in India is
fragmented.. Existing studies use heterogenous definitions, focus on specific diseases or
regions, and have not been systematically mapped. Furthermore, national health programs
and clinical guidelines remain largely disease-centric and oriented toward older populations,
potentially overlooking the needs of young adults with multiple chronic conditions.
A scoping review is therefore warranted to systematically map the extent, range and nature
of available evidence on multimorbidity in young adults in India. This will identify knowledge
gaps, inform clinical practice, guide public health interventions, and highlight priorities for
future research and policy development.
Introduction
Objectives:
Primary objective: To map and synthesize existing evidence on multimorbidity among
young adults in India
Secondary objectives:
● To describe the prevalence and epidemiological distribution of multimorbidity among
young adults.
● To identify common disease patterns and clusters involving physical and mental
health conditions.
● To examine determinants and risk factors associated with multimorbidity in this age
group.
● To summarise clinical, psychosocial, and economic consequences.
● To explore challenges in clinical management and health-system responses.
● To identify gaps in evidence and priorities for future research and policy
Methods
Protocol and Registration
This scoping review protocol has been prospectively registered with protocols.io prior to the
start of the review to enhance transparency and methodological rigor. The registration
includes detailed information on the objectives, eligibility criteria, search strategy, data
charting methods, and planned synthesis approach. The protocol can be accessed publicly
at protocols.io.
Any deviations from this protocol during the conduct of the review will be documented and
justified in the final manuscript.
Eligibility criteria
Population: Young adults aged 18-44 years
Concept: Multimorbidity, defined as the coexistence of two or more chronic conditions in an
individual.
Context: India, across community and healthcare settings.
Inclusion criteria:
● Studies conducted in India
● Studies reporting multimorbidity or multiple chronic conditions
● Studies including young adults(18-44 years)
● Observational studies, secondary analysis of surveys, and review articles
● Publications in English
Exclusion criteria:
● Studies exclusively including children (<18 years) or adults aged >60 years
● Single-disease studies without multimorbidity assessment
● Case reports, editorials, commentaries without empirical data.
Information Sources:
Pubmed/MEDLINE
IndMED
Google Scholar
Manual Screening of reference lists of included studies
Search Strategy
A systemic search will be conducted using combinations of controlled vocabulary and
free-text terms:
“Multimorbidity” OR “multiple chronic conditions” AND “young adults” OR “early adulthood”
AND “India”
Search strategies will be adapted for each database. The search will include articles
published up to December 2025
Selection of Sources of Evidence
Titles and abstracts will be screened for relevance, followed by full-text assessment of
potentially eligible studies. Sources meeting inclusion criteria will be included in the review.
The selection process will be documented using a PRISMA-ScR flow diagram.
Data charting Process
Data will be charted using a standardized extraction form developed a priori. The form will be
iteratively refined as needed during the review process.
Data items
The following data will be extracted:
● Author(s), year of publication
● Study Design and setting
● Population characteristics and age range
● Definition of multimorbidity used
● Prevalence estimates
● Disease patterns or clusters
● Determinants and outcomes reported
Critical Appraisal of Individual Sources
Consistent with PRISMA-ScR guidance, formal risk-of-bias assessment will not be
performed, as the objective is to map existing evidence rather than assess intervention
effects. Methodological limitations of included studies will be narratively discussed.
Synthesis of Results
Findings will be synthesized using thematic narrative synthesis, organized under the
following domains:
● Epidemiology
● Disease patterns and clusters
● Determinants and risk factors
● Clinical and psychosocial consequences
● Health-system and policy implications
No quantitative meta-analysis will be undertaken.
Results
Selection of Sources of Evidence
The selection process will be documented using PRISMA-ScR flow diagram, detailing the
number of records identified through database searching and other sources, records
screened, full-text articles assessed for eligibility, and sources of evidence included in the
review, along with reasons for exclusion at each stage.
Characteristics of Sources of Evidence
Characteristics of included studies will be summarized in tabular form, including author and
year of publication, study design, setting, population characteristics, age range, definition of
multimorbidity used, and key outcomes relevant to the review objectives.
Critical Appraisal Within Sources of Evidence
In keeping with the scoping review methodology, a formal critical appraisal of the individual
sources of evidence will not be undertaken. However, key methodological limitations and
variations across studies will be noted narratively where relevant.
Synthesis of Results
Findings will be synthesized using a thematic narrative approach and organized under
predefined domains, including epidemiology, patterns of multimorbidity, determinants and
risk factors, clinical and psychosocial consequences, and health-system implications.
Discussion
Summary of Evidence
The discussion will provide a summary of the key findings of the scoping review, relating
them to the review objectives and the broader context of multimorbidity research in India.
Emphasis will be placed on the extent and nature of evidence available for young adults.
Limitations
Limitations of the scoping review will be discussed, including potential publication bias,
heterogeneity in definitions of multimorbidity, variability in age group classifications, and
reliance on observational and secondary data sources.
Conclusions
Conclusions will highlight the implications of the findings for clinical practice, public health
policy, and health-system planning in India. Key evidence gaps and priorities for future
research on multimorbidity among young adults will be outlined.
Funding
The scoping review did not receive any specific funding from public, commercial, or
not-for-profit funding agencies.