Prevalence, healthcare utilisation and economic burden of chronic musculoskeletal disorders among adults in Puducherry: A concurrent mixed method study

Background and objectives Chronic musculoskeletal disorders (MSDs) are a significant contributor to pain and disability worldwide, with burden varying across different regions. The study aimed to estimate the prevalence of chronic MSDs in Puducherry, assess health-seeking behaviour, and evaluate the economic burden associated with MSD-related healthcare. Methods A community-based concurrent mixed-method study was conducted in selected areas of Puducherry. Households were selected using systematic random sampling, and individuals were chosen using simple random sampling. The WHO-ILAR COPCORD questionnaire identified individuals with MSDs. Direct and indirect costs from a patient perspective were assessed using a structured questionnaire. Data were collected through Epicollect5 and analysed using STATA v14. Prevalence was reported as proportions with 95% confidence intervals (CI). Focused group discussions (FGDs) were conducted to identify challenges in seeking healthcare. Results Among 400 participants, the prevalence of chronic MSDs was 16% (95% CI: 12.5-19.9), with the majority reporting mild disability and more common in women, but there was no urban-rural difference. Around half (48.4%) of participants reported out-of-pocket expenditures (OOPE) in the past three months, with a higher proportion in urban (53.8%) compared to rural areas (45.9%). The median expenditure was ₹204, with urban participants spending ₹308 and rural participants ₹154. FGDs revealed that while many initially preferred private facilities for quicker access to pain medications, they later returned to public facilities due to financial constraints. Interpretation and Conclusions The prevalence of chronic musculoskeletal disorders is high in Puducherry, particularly among women and older adults, causing mild disability. Despite a preference for government healthcare, many incurred out of pocket expenditures, highlighting financial challenges in accessing care.