Lifestyle factors and multimorbidity: a cross sectional study

How do individuals with alcohol problems use social and healthcare services in Finland? Comparison of service use patterns between two high-need patient groups

Aims:

Alcohol use disorders (AUDs) are associated with high risk of comorbidities and excess use of social and healthcare services. We examined health service use (HSU) frequencies of patients with AUD in comparison to those with type 2 diabetes mellitus (T2DM).

Design:

A random sample of individuals with AUD (n = 396) were identified based on ICD-10 codes and HSU patterns, morbidity and mortality were compared with age- and gender-matched T2DM controls (n = 792) using logistic regression analysis. Six years (2011–2016) of electronic health record (EHR) data from the North Karelia district in Finland were used.

Results:

Similarities in comorbidity patterns existed, although mental health comorbidity (odds ratio [OR] 1.86) was more prevalent in the AUD group. The average annual HSU varied according to the groups: T2DM patients had more continuous contact with public health nurses in primary care, whereas AUD patients were more likely to experience somatic specialised care hospitalisations (OR 11.30) and have frequent somatic primary healthcare doctor visits (OR 3.30) and frequent emergency room doctor visits in specialised care (OR 8.89). Furthermore, patients with AUD had a 7.5 times higher risk of death compared with T2DM patients.

Conclusions:

This study identified rather similar comorbidity status for the AUD and T2DM patients, but their HSU patterns differed noticeably. AUD patients had higher frequencies of hospitalisation periods and emergency service use and were at a higher risk of death compared with T2DM patients, indicating greater challenges in the organisation of care for AUD patients compared with those having T2DM.

Association between health literacy and multimorbidity: a nationwide, cross-sectional study of a Japanese population

OBJECTIVES

To examine the relationship between health literacy and multimorbidity.

DESIGN

Nationwide cross-sectional study.

SETTING

Community settings across Japan.

PARTICIPANTS

Community-dwelling participants aged 20 years or older were selected based on a quota sampling method that adjusted for age, sex and residential area. In total, 3678 participants from the Health Diary Study, with a mean age of 52.3 years (SD, 18.2 years; 1943 (52.8%) female participants), were included.

PRIMARY OUTCOME MEASURE

Multimorbidity, the primary outcome measure, was defined as the presence of two or more chronic diseases.

RESULTS

Of the 3678 participants, 824 (22.4%) had multimorbidity. The mean functional health literacy (FHL) and communicative and critical health literacy (CCHL) scores were 3.2 (SD, 0.7) and 3.6 (SD, 0.9), respectively. In the univariable analysis, both scores were associated with multimorbidity (p<0.001). However, in the multivariable modified Poisson regression analysis, only the FHL score was significantly associated with multimorbidity (per 1-point increase, 0.91; 95% CI 0.84 to 0.99).

CONCLUSIONS

After adjusting for confounding variables, FHL, not CCHL, was significantly related to the presence of multimorbidity. Further longitudinal studies are required to examine the causal relationship between health literacy and multimorbidity.

Primary healthcare personnel challenges and barriers on the management of patients with multimorbidity in Albania

The number of people living with chronic conditions is increasing worldwide with most of these people receiving the needed healthcare services in primary healthcare (PHC) settings. The objective of this study was to explore the main challenges and barriers that PHC providers confront while treating multimorbid patients. This is a qualitative study utilising semi-structured individual in-depth interviews. The study took place in Vlora City, which is the biggest city located in south Albania. Τhe two biggest PHC centres of the city were enrolled. Purposive sampling method was used to recruit PHC practitioners. Main criteria of participation in the study were being fully employed at the enrolled primary care centres, having worked for at least 1 year and to deal with multimorbid patients in daily practice. Data collection took place from September 2019 to January 2020. In total, 36 semi-structured interviews took place with 23 (63.9%) nurses and 12 (33.3%) physicians (general practitioners/family doctors). Communication problems and disputes, lack of materials/equipment and the inappropriate infrastructure, miscommunication and problems in doctor-nurse relationships, coordination problems, lack of protocols and problems in the referral system were reported as the main challenges and barriers that the PHC personnel confront. The findings of this study are critical in understanding challenges that PHC personnel face when dealing with multimorbid patients in PHC settings. The emerged knowledge contributes significantly in a better understanding of the actual situation and to inform health policy makers on how to deal with the existing problems.

Sociodemographic Differences in Multimorbidity: A Closer Look from Indonesian Family and Life Survey

The prevalence of multimorbidity, the coexistence of two or more chronic diseases, is expected to increase, including in Indonesia. This phenomenon is associated with increased life expectancy and incidence of non-communicable diseases. Therefore, this study assesses the burden of multimorbidity in Indonesia by sociodemographic factors. The researchers analyzed cross-sectional data from the latest wave of IFLS conducted in 2014, the IFLS wave 5. The researchers included individuals aged 15 and above with blood pressure measurements (n= 32.256) from 13,536 households. Meanwhile, the researchers excluded individuals with missing data on BMI (183 individuals) or who had biologically implausible or extreme values (n=6). The analyses were then conducted on 32,067 individuals. The analyses comprised the ten most common self-reported chronic diseases diagnosis in IFLS-5. The findings revealed that the prevalence of self-reported multimorbidity in Indonesia was relatively high, at 9.32% (n= 2.989), with the highest proportion of multimorbidity reported among the elderly. Approximately 2.76% of the respondents (n- 885) reported having three or more chronic diseases. The most common combinations were hypertension and digestive problem (2.15%, n= 689), followed by hypertension and arthritis (1.79%, n= 574), and hypertension and high cholesterol (1.68%, n= 539). When stratified by sociodemographic factors, the researchers found a higher proportion of multimorbidity among females (11.01%, n= 3,530) compared to males (7.41%, n= 2.376), elderly (21.54%, n= 3.530) compared to younger adults, and previous smokers (20.90%, n= 6.072). People who were obese and overweight also reported a higher prevalence of multimorbidity (13.73%, n= 4.403 and 9.3%, n= 2.998, respectively). In addition, those living in urban areas had a higher proportion of multimorbidity (10.33%, n= 3.313) compared to rural areas (7.2%, n= 2.527). In conclusion, this study uncovered a relatively high prevalence of multimorbidity. People living in urban areas were overweight/obese and those who had low SES had a higher proportion of multimorbidity. With the nature of self-reported data and previously reported underdiagnosis of chronic diseases, screening to examine multimorbidity is needed.

Inequalities in developing multimorbidity over time: A population-based cohort study from an urban, multi-ethnic borough in the United Kingdom

Background

Social and material deprivation accelerate the development of multimorbidity, yet the mechanisms which drive multimorbidity pathways and trajectories remain unclear. We aimed to examine the association between health inequality, risk factors and accumulation or resolution of LTCs, taking disease sequences into consideration.

Methods

We conducted a retrospective cohort of adults aged 18 years and over, registered between April 2005 and May 2020 in general practices in one inner London borough (n = 826,936). Thirty-two long term conditions (LTCs) were selected using a consensus process, based on a definition adapted to the demographic characteristics of the local population. sThe development and resolution of these LTCs were examined according to sociodemographic and clinical risk factors (hypertension; moderate obesity (BMI 30·0-39·9 kg/m2), high cholesterol (total cholesterol > 5 mmol/L), smoking, high alcohol consumption (>14 units per week), and psychoactive substance use), through the application of multistate Markov chain models.

Findings

Participants were followed up for a median of 4.2 years (IQR = 1·8 - 8·4); 631,760 (76%) entered the study with no LTCs, 121,424 (15%) with 1 LTC, 41,720 (5%) with 2 LTCs, and 31,966 (4%) with three or more LTCs. At the end of follow-up, 194,777 (24%) gained one or more LTCs, while 45,017 (5%) had resolved LTCs and 27,021 (3%) died. In multistate models, deprivation (hazard ratio [HR] between 1·30 to 1·64), female sex (HR 1·13 to 1·20), and Black ethnicity (HR 1·20 to 1·30; vs White) were independently associated with increased risk of transition from one to two LTCs, and shorter time spent in a healthy state. Substance use was the strongest risk factor for multimorbidity with an 85% probability of gaining LTCs over the next year. First order Markov chains identified consistent disease sequences including: chronic pain or osteoarthritis followed by anxiety and depression; alcohol and substance dependency followed by HIV, viral hepatitis, and liver disease; and morbid obesity followed by diabetes, hypertension, and chronic pain.

Interpretation

We examined the relations among 32 LTCs, taking the order of disease occurrence into consideration. Distinctive patterns for the development and accumulation of multimorbidity have emerged, with increased risk of transitioning from no conditions to multimorbidity and mortality related to ethnicity, deprivation and gender. Musculoskeletal disorders, morbid obesity and substance abuse represent common entry points to multimorbidity trajectories.

Preventing Multimorbidity with Lifestyle Interventions in Sub-Saharan Africa: A New Challenge for Public Health in Low and Middle-Income Countries

Objectives: Low and Middle-Income Countries are experiencing a fast-paced epidemiological rise in clusters of non-communicable diseases such as diabetes and cardiovascular disease, forming an imminent rise in multimorbidity. However, preventing multimorbidity has received little attention in LMICs, especially in Sub-Saharan African Countries. Methods: Narrative review which scoped the most recent evidence in LMICs about multimorbidity determinants and appropriated them for potential multimorbidity prevention strategies. Results: MMD in LMICs is affected by several determinants including increased age, female sex, environment, lower socio-economic status, obesity, and lifestyle behaviours, especially poor nutrition, and physical inactivity. Multimorbidity public health interventions in LMICs, especially in Sub-Saharan Africa are currently impeded by local and regional economic disparity, underdeveloped healthcare systems, and concurrent prevalence of communicable and non-communicable diseases. However, lifestyle interventions that are targeted towards preventing highly prevalent multimorbidity clusters, especially hypertension, diabetes, and cardiovascular disease, can provide early prevention of multimorbidity, especially within Sub-Saharan African countries with emerging economies and socio-economic disparity. Conclusion: Future public health initiatives should consider targeted lifestyle interventions and appropriate policies and guidelines in preventing multimorbidity in LMICs.

Multimorbidity, psychoactive substance use and psychological distress among acute medically ill patients: a cross-sectional study

BACKGROUND

In order to target the complex health needs of patients with multimorbidity using psychoactive substances, knowledge regarding the association between substance use and multimorbidity in an acute setting is needed.

AIMS

Examine psychoactive substance use patterns among acute medically ill patients, and determine the association between multimorbidity and substance use, and psychological distress.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

2874 acute medically ill patients admitted to a medical emergency department in Oslo, Norway.

MEASUREMENTS

Primary outcome: multimorbidity recorded by the presence of ≥2 International Classification of Diseases 10th revision-physical and/or mental health conditions per patient, extracted from medical records. Predictor variables: self-reported data on age, sex, occupational status, psychological distress (Hopkins Symptom Check List-5), alcohol use (Alcohol Use Disorder Identification Test-4) and results from blood samples on psychoactive medicinal and illicit drugs.

FINDINGS

Of all patients, 57.2% had multimorbidity. Of these, 62.6% reported psychological distress, 85.5% consumed either alcohol, medicinal and/or illicit drugs and 64.4% combined alcohol with psychoactive medicinal drugs. Patients with risky alcohol use were more likely to have multimorbidity compared with patients with low-risk alcohol use (OR 1.53; 95% CI 1.05 to 2.24). Patients using psychoactive medicinal drugs were more likely to have multimorbidity compared with non-users (OR 1.34; 95% CI 1.07 to 1.67).

CONCLUSION

Multimorbidity was associated with psychoactive medicinal drug and risky alcohol use, and psychological distress. Substance use was widespread, with alcohol and psychoactive medicinal drugs most frequently combined. Monitoring substance use among multimorbid patients is necessary to develop tailored treatments, and reduce burden on the healthcare system.

Studying trajectories of multimorbidity: a systematic scoping review of longitudinal approaches and evidence

OBJECTIVES

Multimorbidity-the co-occurrence of at least two chronic diseases in an individual-is an important public health challenge in ageing societies. The vast majority of multimorbidity research takes a cross-sectional approach, but longitudinal approaches to understanding multimorbidity are an emerging research area, being encouraged by multiple funders. To support development in this research area, the aim of this study is to scope the methodological approaches and substantive findings of studies that have investigated longitudinal multimorbidity trajectories.

DESIGN

We conducted a systematic search for relevant studies in four online databases (Medline, Scopus, Web of Science and Embase) in May 2020 using predefined search terms and inclusion and exclusion criteria. The search was complemented by searching reference lists of relevant papers. From the selected studies, we systematically extracted data on study methodology and findings and summarised them in a narrative synthesis.

RESULTS

We identified 35 studies investigating multimorbidity longitudinally, all published in the last decade, and predominantly in high-income countries from the Global North. Longitudinal approaches employed included constructing change variables, multilevel regression analysis (eg, growth curve modelling), longitudinal group-based methodologies (eg, latent class modelling), analysing disease transitions and visualisation techniques. Commonly identified risk factors for multimorbidity onset and progression were older age, higher socioeconomic and area-level deprivation, overweight and poorer health behaviours.

CONCLUSION

The nascent research area employs a diverse range of longitudinal approaches that characterise accumulation and disease combinations and to a lesser extent disease sequencing and progression. Gaps include understanding the long-term, life course determinants of different multimorbidity trajectories, and doing so across diverse populations, including those from low-income and middle-income countries. This can provide a detailed picture of morbidity development, with important implications from a clinical and intervention perspective.

Long-term conditions, multimorbidity, lifestyle factors and change in grip strength over 9 years of follow-up: Findings from 44,315 UK biobank participants

Background

Weak grip strength is associated with a range of adverse health outcomes and an accelerated decline in grip strength confers an even greater risk. The factors associated with change in grip strength in mid-life remain to be fully determined.

Methods

We used data from 44,315 UK Biobank participants who had grip strength measured at baseline (2006-10) and a subsequent visit approximately nine years later. At baseline, participants’ long-term conditions (LTCs) were categorised against a hierarchy, with multimorbidity characterised by the number of LTC categories. Lifestyle factors were assessed. Change in grip strength was grouped into four patterns: decline, stable low, stable high or reference (no change or increase) and used as the outcome in multinomial logistic regression.

Results

Most LTC categories were associated with adverse patterns of change in grip strength (stable low and/or decline): for example, musculoskeletal/trauma conditions were associated with an increased risk of the stable low pattern (Relative Risk Ratio [RRR] = 1.63; 95% confidence interval [CI]: 1.49-1.79). Multimorbidity and lifestyle factors had independent associations with grip strength change. Those with 3+ categories of LTCs were more likely to experience decline in grip strength (RRR = 1.18; 95% CI: 1.08-1.28) compared to those with none. Low physical activity was associated with adverse patterns of grip strength, while raised body mass index (BMI) had divergent associations.

Conclusions

Individuals living with multimorbidity and those with lifestyle risk factors such as low physical activity are at increased risk of low muscle strength and the loss of strength over time.

Physical Activity in Women With Hypothyroidism on Thyroid Hormone Therapy: Associated Factors and Perceived Barriers and Benefits

BACKGROUND

The purpose of this study was to analyze factors associated with physical activity (PA) and to identify perceived barriers and benefits of PA among patients with hypothyroidism on thyroid hormone therapy.

METHODS

This survey-based cross-sectional study was conducted among members of the Dutch thyroid patient organization. Self-reported data on respondents' PA levels and demographic, clinical, and physical health variables were collected. Moreover, perceived barriers and benefits to PA were identified. Respondents were categorized as physically active when meeting the recommended Dutch PA guidelines and physically inactive otherwise. To compare physically active and inactive respondents, potential confounders were entered into univariate analyses. Factors showing significant correlations (P < .20) were added to a multivariate model to determine the associated factors of PA.

RESULTS

About 1724 female respondents (mean age 53.0 [11.6] y) were included; 16.1% reported meeting the PA recommendations. Multivariate analysis showed that factors associated with PA included levothyroxine/liothyronine therapy, comorbidities, self-perceived physical fitness, and diminished physical endurance. Overall, physically related barriers to PA were rated highest.

CONCLUSIONS

The vast majority of treated hypothyroid respondents are physically inactive and experience long-term exercise intolerance. Considering the health implications of physical inactivity, promotion of regular PA is of key importance in this population.

Standardised Outcome Reporting for the Nutrition Management of Complex Chronic Disease: A Rapid Review

Individuals with coexisting chronic diseases or with complex chronic disease are among the most challenging and costly patients to treat, placing a growing demand on healthcare systems. Recommending effective treatments, including nutrition interventions, relies on standardised outcome reporting from randomised controlled trials (RCTs) to enable data synthesis. This rapid review sought to determine how the scope and consistency of the outcomes reported by RCTs investigating nutrition interventions for the management of complex chronic disease compared to what is recommended by the core outcome sets (COS) for individual disease states. Peer-reviewed RCTs published between January 2010 and July 2020 were systematically sourced from PubMed, CINAHL and Embase, and COS were sourced from the International Consortium for Health Outcomes Measurements (ICHOM) and the Core Outcome Measures in Effectiveness Trials (COMET) database. A total of 45 RCTs (43 studies) and 7 COS were identified. Outcomes were extracted from both the RCTs and COS and were organised using COMET Taxonomy Core Areas. A total of 66 outcomes and 439 outcome measures were reported by the RCTs. The RCTs demonstrated extensive outcome heterogeneity, with only five outcomes (5/66, 8%) being reported with relative consistency (cited by ≥50% of publications). Furthermore, the scope of the outcomes reported by studies was limited, with a notable paucity of patient-reported outcomes. Poor agreement (25%) was observed between the outcomes reported in the RCTs and those recommended by the COS. This review urges greater uptake of the existing COS and the development of a COS for complex chronic disease to be considered so that evidence can be better synthesised regarding effective nutrition interventions.

A cross-sectional analysis of health literacy: patient- versus family doctor-reported and associations with self-efficacy and chronic disease

BACKGROUND

Adequate health literacy (HL) levels contribute to good health outcomes and successful disease self-management in patients with chronic disease. Hence, it is essential that family doctors recognize patients with inadequate HL in need of additional support. This study had two aims: (1) to assess and compare patient self-reported versus family doctor-rated HL estimates, and (2) to explore associations between patient-reported HL, self-efficacy and chronic diseases.

METHODS

Participants in this cross-sectional survey were recruited through general practices in North Rhine-Westphalia, Germany. Patient self-reported HL was measured using the European Health Literacy Survey-16. Family doctor-rated HL was measured with an adapted version of this instrument. Using crosstabulations patient-reported and family doctor-rated HL estimates were compared for 346 patient-family doctor pairs. Associations between HL, self-efficacy and chronic disease were investigated using regression analyses.

RESULTS

Patient-reported and family doctor-rated HL estimates were concordant in 38% of all cases. On average family doctors rated their patients' HL lower than patients rated their own HL. The lower average family doctor ratings were more pronounced when patients were older, male and had more than one chronic disease. Female family doctors rated HL of male patients lower than their male colleagues. Patient reported HL had a significant positive association with self-efficacy. Mediation analysis provided support that self-efficacy acts as mediator between HL and the number of chronic diseases.

CONCLUSIONS

Our study findings indicate a significant discrepancy between patients' self-reported HL and externally rated HL by family doctors. A more systematic utilization of HL screeners might help reduce this discrepancy. At the same time, consideration should be given to enhancing communication training for family doctors and addressing critical HL skills in patient education.

Health-Related and Lifestyle Factors as Predictors of Intentions to Improve Lifestyle Habits in Employees Participating in a Workplace Health Promotion Program

OBJECTIVES

To explore employees' intentions to improve lifestyle habits, investigate the health and lifestyle-related predictors of these intentions, and how it translated into behavioral improvement.

METHODS

Employees participating in the Activate Your Health WHPP completed a questionnaire of their demographics, health-related variables, as well as six lifestyle habits and intention to improve them.

RESULTS

At baseline (n = 2729), most employees wanted to focus on physical activity and eating habits. Many predictors were identified for each intention. Majority of intentions were associated with behavioral improvement post-program (n = 525), especially in High.

CONCLUSIONS

In the context of WHPPs, intention to improve may lead to actual behavioral improvement. Exploring employees' intentions to improve various lifestyle habits at the start of the program could improve the effectiveness of these programs.

Depression as a Risk Factor for Physical Illness and Multimorbidity in a Cohort with No Prior Comorbidity

OBJECTIVE

This study examines whether depression is associated with the development of physical illness and multimorbidity, after controlling for socioeconomic, behavioral, and other potential confounders.

METHODS

This is a retrospective cohort study in which adult respondents to three nationally representative population health surveys were linked to health administrative databases in Ontario, Canada, and followed for 10 years from survey index. Respondents with any of the study outcome conditions at baseline were excluded to create a final cohort of 29,838 participants. The main exposure of interest was depression, measured using the Composite International Diagnostic Interview-Short Form for Major Depression. We controlled for age, body mass index, marital status, immigrant status, annual household income, smoking, alcohol consumption, physical activity, health status, and having a regular doctor. The outcome measure was the development of physical illness over 10 years of follow-up, defined as 1 of 15 common chronic conditions using administrative data.

RESULTS

Among the 29,838 participants (15,259 [51%] female), 8% of females and 4% of males had depression at baseline. In this cohort with no comorbidities at baseline, even in the fully adjusted model, depression increased the risk of developing a first physical illness for females (hazard ratio [HR] 1.16; 95% CI, 1.07 to 1.26) and males (HR 1.20; 95% CI, 1.07 to 1.36) and increased the risk of developing a second physical illness for females (HR 1.16; 95% CI, 1.02 to 1.33) over 10 years of follow-up.

CONCLUSIONS

For individuals with no prior comorbidities, depression is associated with a greater risk of developing subsequent physical illness and multimorbidity over time. Thus, depression identifies a population of people who may benefit from early identification, additional screening, and intervention. Further study needs to be done to determine whether interventions to manage and support people with depression can prevent or delay the increased risk of multimorbidity.

Clustering of comorbidities

Within the last decade, clustering of comorbidities has become an increasing health problem on a global scale and will continue to challenge healthcare professionals in the coming years. People with multiple diseases find difficulties in managing their daily lives due to the implications each disease brings; attending and keeping up to date with hospital appointments, being prescribed and taking various medications, the effects of mental health and quality of life, and the impact it has on their families. Most research in clinical trials often exclude individuals with multimorbidity and observational studies mainly focus on single disease outcomes, therefore there is an opportunity to encourage future research in an area which could help prevent further cases and improve the lives of those already living with multimorbidity. This review aims to summarise the rising prevalence and most common clusters, highlight the challenges faced in healthcare, and explore ways to improve future research.

The prevalence of multimorbidity and its association with physical activity and sleep duration in middle aged and elderly adults: a longitudinal analysis from China

Background

Preventing chronic disease is important in health policy in countries with significantly ageing populations. This study aims to examine the prevalence of chronic disease multimorbidity and its association with physical activity and sleep duration; and to understand whether physical activity modifies associations between sleep duration and multimorbidity.

Methods

We utilized longitudinal data of a nationally-representative sample from the China Health and Retirement Longitudinal Study (in year 2011 and 2015; N = 5321; 54.7% female; age ≥ 45 years old). Fourteen chronic diseases were used to measure multimorbidity (ten self-reported, and four by blood test). Participants were grouped into high, moderate, and low level based on self-reported frequencies and durations of physical activity with different intensities for at least 10 min at a time in a usual week. Poor and good sleepers were categorized according to average hours of actual sleep at each night during the past month. Panel data method of random-effects logistic regression model was applied to estimate the association of physical activity and sleep with multimorbidity, adjusting for social-demographic and behavioural confounders.

Results

From 2011 to 2015, the prevalence of multimorbidity increased from 52.2 to 62.8%. In 2015, the proportion of participants engaging in high, moderate, and low level of physical activity was 30.3, 24.4 and 45.3%, respectively, and 63.6% of adults had good sleep. For both genders, compared with good sleep, poor sleep was associated with higher odds of multimorbidity (OR = 1.527, 95% CI: 1.277, 1.825). Compared to the high-level group, participants with a low level of physical activity were significantly more likely to have multimorbidity (OR = 1.457, 95% CI: 1.277, 1.825), but associations were stronger among women. The relative excess risk due to interaction between poor sleep and moderate or low physical activity was positive but non-significant on multimorbidity.

Conclusions

The burden of multimorbidity was high in China. Low physical activity and poor sleep was independently and significantly associated with a higher likelihood of multimorbidity in women and both genders, separately. Physical activity could modify the association between sleep and multimorbidity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01150-7.

Interaction of physical activity on the association of obesity-related measures with multimorbidity among older adults: a population-based cross-sectional study in India

OBJECTIVE

To explore the associations between obesity-related measures and multimorbidity among older Indian adults and the interactive effects of physical activity in those associations.

DESIGN

A cross-sectional study was conducted using large representative survey data.

SETTING AND PARTICIPANTS

The present study used data from the Longitudinal Aging Study in India (LASI) conducted during 2017-2018. Participants included 15 098 male and 16 366 female older adults aged 60 years and above in India.

PRIMARY AND SECONDARY OUTCOME MEASURES

The outcome variable was multimorbidity among older adults coded as no and yes. Descriptive statistics along with bivariate analysis are presented in the paper. Additionally, binary logistic regression analysis was used to fulfil the study objectives.

RESULTS

About 24% of older adults in the LASI cohort suffered from multimorbidity. Older adults who were overweight/obese (adjusted OR (AOR): 1.61, CI 1.48 to 1.74), had high-risk waist circumference (AOR: 1.66, CI 1.52 to 1.80) and had high-risk waist to hip ratio (AOR: 1.45, CI 1.33 to 1.59) were significantly more likely to suffer from multimorbidity compared with their counterparts. Older adults who were obese and physically inactive had significantly increased odds of suffering from multimorbidity compared with older adults who were obese and physically active. Similarly, older adults with high-risk waist circumference (AOR: 1.30, CI 1.11 to 1.53) and high-risk waist to hip ratio (AOR: 1.32, CI 1.20 to 1.46) along with being physically inactive had significantly higher odds of suffering from multimorbidity in comparison with older adults with high-risk waist circumference and waist to hip ratio along with being physically active.

CONCLUSION

While developing health strategies for older adults, physical activity needs to be recognised as a way of minimising comorbidities. Further, the study highlights the importance of using multiple obesity-related measures to predict chronic conditions in the older population.

Chronic disease multimorbidity among the Canadian population: prevalence and associated lifestyle factors

Background

Chronic diseases is increasingly becoming one of the most pressing public health concerns in most part of the world, including the Canadian population. The purpose of this study was to estimate the prevalence of multimorbidity in the general population based on 14 major chronic diseases and examine associations with lifestyle/behavioral factors.

Methods

The data source was the 2015–2016 Canadian Community Health Survey (CCHS). The CCHS is a cross sectional, complex multi-stage survey based on information collected from 109,659 participants aged 12+, covering all provinces and territories. Multimorbidity was defined as the co-occurrence of two or more chronic diseases within a person. Multiple logistic regression was used to examine the key determinants of multimorbidity.

Results

The prevalence of multimorbidity was 33 %. Adjusting for sociodemographic variables, there was an increased odd of multimorbidity for those having a sedentary lifestyle (AOR = 1.06; CI:1.01–1.11) and being obese (AOR = 1.37; CI:1.32–1.43) or overweight (AOR = 2.65; CI: 2.54–2.76). There were two statistically significant interactions, between sex and smoking, and between immigration status and alcohol intake. Smoking was more strongly associated with multimorbidity in females than males. The association between alcohol intake and multimorbidity was also dependent upon immigration status.

Conclusions

Given the high prevalence of multimorbidity among the general Canadian population, policy makers and service providers should give more attention to the behavioral/lifestyle factors which significantly predicted multimorbidity. Policy and program efforts that promote a healthy lifestyle should be a priority.

Rising burden of multimorbidity and related socio-demographic factors: a repeated cross-sectional study of Ontarians

OBJECTIVE

This study aimed to provide population-level data regarding trends in multimorbidity over 13 years.

METHODS

We linked provincial health administrative data in Ontario, Canada, to create 3 cross-sectional panels of residents of any age in 2003, 2009, and 2016 to describe: (i) 13-year trends in multimorbidity prevalence and constellations among residents and across age, sex, and income; and (ii) chronic condition clusters. Multimorbidity was defined as having at least any 2 of 18 selected conditions, and further grouped into levels of 2, 3, 4, or 5 or more conditions. Age-sex standardized multimorbidity prevalence was estimated using the 2009 population as the standard. Clustering was defined using the observed combinations of conditions within levels of multimorbidity.

RESULTS

Standardized prevalence of multimorbidity increased over time (26.5%, 28.8%, and 30.0% across sequential panels), across sex, age, and area-based income. Females, older adults and those living in lower income areas exhibited higher rates in all years. However, multimorbidity increased relatively more among males, younger adults, and those with 4 or 5 or more conditions. We observed numerous and increasing diversity in disease clusters, namely at higher levels of multimorbidity.

CONCLUSION

Our study provides relevant and needed population-based information on the growing burden of multimorbidity, and related socio-demographic risk factors. Multimorbidity is markedly increasing among younger age cohorts. Also, there is an increasing complexity and lack of common clustering patterns at higher multimorbidity levels.

Moving from "let's fix them" to "actually listen": the development of a primary care intervention for mental-physical multimorbidity

BACKGROUND

Effective person-centred interventions are needed to support people living with mental-physical multimorbidity to achieve better health and wellbeing outcomes. Depression is identified as the most common mental health condition co-occurring with a physical health condition and is the focus of this intervention development study. The aim of this study is to identify the key components needed for an effective intervention based on a clear theoretical foundation, consideration of how motivational interviewing can inform the intervention, clinical guidelines to date, and the insights of primary care nurses.

METHODS

A multimethod approach to intervention development involving review and integration of the theoretical principles of Theory of Planned Behavior and the patient-centred clinical skills of motivational interviewing, review of the expert consensus clinical guidelines for multimorbidity, and incorporation of a thematic analysis of group interviews with Australian nurses about their perspectives of what is needed in intervention to support people living with mental-physical multimorbidity.

RESULTS

Three mechanisms emerged from the review of theory, guidelines and practitioner perspective; the intervention needs to actively 'engage' patients through the development of a collaborative and empathic relationship, 'focus' on the patient's priorities, and 'empower' people to make behaviour change.

CONCLUSION

The outcome of the present study is a fully described primary care intervention for people living with mental-physical multimorbidity, with a particular focus on people living with depression and a physical health condition. It builds on theory, expert consensus guidelines and clinician perspective, and is to be tested in a clinical trial.

Linear and non-linear associations between physical activity, body composition and multimorbidity over 10 years among community-dwelling older adults

BACKGROUND

This study aims to describe the relationships between physical activity (PA), body composition and multimorbidity over 10 years.

METHODS

Participants (N=373; 49% women; average age 61.3±6.7 years) were followed for 10 years. Multimorbidity was defined by self-report as the presence of two or more of 12 listed chronic conditions. PA (steps-per-day) at baseline was assessed by pedometer, handgrip strength (HGS) by dynamometer and appendicular lean mass (ALM) and total body fat mass by dual x-ray absorptiometry . Relative HGS and ALM were calculated by dividing each body mass index (BMI). Regression cubic splines were used to assess evidence for a non-linear relationship.

RESULTS

After 10 years, 45% participants had multimorbidity. There was a non-linear relationship between PA and multimorbidity - PA was associated with lower multimorbidity risk among individuals who engaged in <10,000 steps-per-day (RR=0.91, 95% CI: 0.85, 0.97, per 1000 steps-per-day), but not among those who participated in ≥10,000 steps-per-day (RR=1.04, 95% CI: 0.93, 1.09, per 1000 steps-per-day). Higher BMI (RR=1.05, 95% CI: 1.02, 1.08, per kg/m 2) and fat mass (RR=1.03, 95% CI: 1.01, 1.04, per kg), and lower relative HGS (RR=0.85, 95% CI: 0.77, 0.94, per 0.1 psi/kg/m 2) and ALM (RR=0.93, 95% CI: 0.88, 0.98, per 0.1 kg/kg/m 2) were linearly associated with a higher risk of multimorbidity. Absolute HGS and ALM were not significantly associated with multimorbidity.

DISCUSSION

These findings highlight the potential clinical importance of maintaining adequate levels of PA and of reducing adiposity and maintaining muscle function for minimising the risk of multimorbidity in older adults.

Prevalence of non-communicable chronic conditions, multimorbidity and its correlates among older adults in rural Nepal: a cross-sectional study

OBJECTIVES

This study's objectives were to estimate the prevalence of major non-communicable conditions and multimorbidity among older adults in rural Nepal and examine the associated socioeconomic and behavioural risk factors.

DESIGN

This was a community-based cross-sectional study conducted between January and April 2018.

SETTING

Rural municipalities of Sunsari and Morang districts in eastern Nepal.

PARTICIPANTS

794 older Nepalese adults, 60 years and older, were recruited using a multistage cluster sampling approach.

PRIMARY OUTCOME MEASURES

Prevalence of four major non-communicable chronic conditions (osteoarthritis, cardiovascular disease, diabetes and chronic obstructive pulmonary disease (COPD) and multimorbidity.

RESULTS

Almost half (48.9%: men 45.3%; women 52.4%) of the participants had at least one of four non-communicable chronic conditions, and 14.6% (men 12.5%; women 16.8%) had two or more conditions. The prevalence of individual conditions included: osteoarthritis-41.7% (men 37.5%; women 45.9%), cardiovascular disease-2.4% (men 2.8%; women 2.0%), diabetes-5.3% (men 6.0%; women 4.6%) and COPD-15.4% (men 13.3%; women 17.5%). In the adjusted model, older adults aged 70-79 years (adjusted OR (AOR): 1.62; 95% CI: 1.04 to 2.54), those from Madhesi and other ethnic groups (AOR: 1.08; 95% CI: 1.02 to 1.72), without a history of alcohol drinking (AOR: 1.53; 95% CI: 1.18 to 2.01) and those physically inactive (AOR: 5.02; 95% CI: 1.47 to 17.17) had significantly higher odds of multimorbidity.

CONCLUSIONS

This study found one in seven study participants had multimorbidity. The prevalence of multimorbidity and associated socioeconomic and behavioural correlates need to be addressed by integrating social programmes with health prevention and management at multiple levels. Moreover, a longitudinal study is suggested to understand the temporal relationship between lifestyle predictors and multimorbidity among older Nepalese adults.

Discrimination and Multimorbidity Among Black Americans: Findings from the National Survey of American Life

OBJECTIVES

There is a notable lack of research on the risk factors for multimorbidity, which has become more common over recent decades. Black Americans experience discrimination more often than their White counterparts, and also have significantly higher prevalence of multimorbidity. This paper examines the associations between discrimination and multimorbidity among Black Americans.

METHODS

We analyzed data from the National Survey of American Life to calculate the prevalence of two types of discrimination (everyday discrimination, major discriminatory events) and multimorbidity (physical, psychiatric, mixed, any). Using multivariable logistic regression, we examined the associations between discrimination and multimorbidity, adjusting for age, sex, years of education, income-to-poverty ratio, and ethnicity. The everyday discrimination scale was discretized into five categories (none, low, medium, high, very high), but was also treated as a continuous variable. The major discriminatory events were analyzed in separate adjusted models, and as a count of events.

RESULTS

When compared with those who did not experience any discrimination, people who experienced everyday discrimination were significantly more likely to report all types of multimorbidity in a dose-response fashion at a conventional level of statistical significance. Most major discriminatory events were associated with greater odds of reporting all types of multimorbidity, as were the counts of major discriminatory events, in a dose-response fashion.

CONCLUSIONS

We found strong evidence to suggest that discrimination was associated with greater odds of reporting multimorbidity. Future studies can expand on these findings using longitudinal data to capture the relations between discrimination and health over time, or by testing preventive interventions that allay the damaging health effects of discrimination.

Associating modifiable lifestyle factors with multimorbidity in community dwelling individuals from mainland China

AIMS 

Lifestyle factors have been well-established as essential targets for fighting individual chronic diseases, but little research has concentrated on multimorbidity from the perspective of multiple lifestyle factors in the Chinese population. Thus, this study aimed to explore the associations of lifestyle factors with the occurrence of multimorbidity.

METHODS AND RESULTS 

Cross-sectional data retrieved from the China Health and Retirement Longitudinal Study were used for analysis. Multimorbidity was calculated on a simple count of self-reported chronic conditions. Lifestyle factors included sleep duration, physical activity, alcohol intake, smoking status, and body mass index. Logistic regression analysis was used to examine the independent and accumulating effects of lifestyle factors on multimorbidity. Latent class analysis was performed to explore the lifestyle patterns. Six thousand, five hundred, and ninety-one valid subjects were included for analysis. Overall, the community dweller's median number of chronic conditions was 1 (range 1-11) and median number of high-risk lifestyle factors was 2 (range 0-5). All lifestyle factors were associated with the occurrence of multimorbidity but varied between genders. We also identified that participants who accumulated more unhealthy lifestyle factors having a higher likelihood of multimorbidity. 'Physical activity and weight', 'smoke and drink', and 'sleep and weight' dominated high-risk lifestyles were the most common lifestyle patterns.

CONCLUSION 

This study revealed the associations of unhealthy lifestyle factors and their accumulating effect with multimorbidity in Chinese community dwellers. Three common lifestyle patterns indicated that a holistic approach focused on engaging and changing multiple modifiable lifestyle behaviours within an individual might be more effective in managing multimorbidity.

Clustering of lifestyle risk factors among adult population in India: A cross-sectional analysis from 2005 to 2016

Introduction

Individual’s early life style and health behaviors are directly linked to chronic non-communicable diseases. Considering the increased burden of NCDs during the last two decades, the aim of this study is to assess co-occurrence/clustering of lifestyle risk factors and its association with different socio-demographic and economic characteristics among adult men and women in India from 2005–2016.

Methods

This study utilized the data from the National Family Health Survey 2005–06 and 2015–16 survey rounds. Multinomial logistic regression is employed to evaluate co-occurrence of multiple risk factors among adult men and women of different socio-economic and demographic characteristics to identify the subgroups with elevated risk of clustering of multiple unhealthy lifestyle risk factors.

Results

More adult men in India tend to exhibit clustering of multiple non-communicable disease risk factors than females. Individuals between 30–49 years of age, residing in urban areas, the population with no education, separated couples and those from poor economic strata are the specific population subgroups show higher prevalence of co-occurrence of multiple risk factors. The regional pattern of clustering of risk factors shows that the prevalence of co-occurrence of multiple risk factors is higher among men and women from the North-Eastern part of India compared to the other regions of the country.

Conclusion

The prevalence of clustering of multiple risk factors associated with chronic NCDs is substantially high and has increased between 2005–06 to 2015–16. India may therefore experience a significant increase in the burden of chronic non-communicable diseases in the coming years. We therefore conclude that appropriate strategies should be implemented by policy makers and the government to reduce the overall health burden of NCDs due to lifestyle habits.

Association of multimorbidity with higher levels of urinary incontinence: a cross-sectional study of 23 089 individuals aged ≥15 years residing in Spain

BACKGROUND

One can assume a relatively high prevalence of urinary incontinence (UI) in people with multimorbidity. However, literature in this area is scarce. There is a need for further robust research to aid GPs to identify patients at a particular risk for UI, and to initiate the early treatment and multidisciplinary management of this condition.

AIM

To examine the association between multimorbidity and UI in 23 089 individuals aged ≥15 years and residing in Spain.

DESIGN AND SETTING

This study used data from the Spanish National Health Survey 2017, a cross-sectional sample of 23 089 participants aged ≥15 years residing in Spain (54.1% female; mean [standard deviation] age = 53.4 [18.9] years).

METHOD

UI and 30 other physical and mental chronic conditions were self-reported. Multimorbidity was defined as the presence of ≥2 physical and/or mental chronic conditions (excluding UI). Control variables included sex, age, marital status, education, smoking, and alcohol consumption. Multivariable logistic regression analyses were conducted to assess the association between multimorbidity and UI.

RESULTS

The prevalence of UI was 5.9% in this sample. UI was more frequent in the presence than in the absence of each one of the 30 chronic conditions (P<0.001). The proportion of people with UI was also higher in the multimorbidity than in the no-multimorbidity group (9.8% versus 0.7%, P<0.001). After adjusting for several potential confounders (that is, sex, age, marital status, education, smoking, and alcohol), there was a significant and positive relationship between multimorbidity and UI (odds ratio = 5.02, 95% confidence interval [CI] = 3.89 to 6.59, P<0.001).

CONCLUSION

In this large sample of Spanish individuals aged ≥15 years, suffering from multimorbidity was associated with a significantly higher level of UI.

Leading determinants for multimorbidity in middle-aged Australian men and women: A nine-year follow-up cohort study

Although socioeconomic, behavioural, psychological, and biological factors have been individually linked to multimorbidity, data on the importance of these factors are limited. Our study aimed to determine the leading predictors for multimorbidity of chronic conditions in middle-aged Australian adults using machine learning methods. We included 53,867 participants aged 45-64 years from the 45 and Up Study who were free of eleven predefined chronic conditions at baseline (2006-2009) in the analysis. Incident multimorbidity was defined by the co-existence of ≥2, ≥3, or ≥ 4 conditions during follow-up until December 31, 2016. The five leading predictors for multimorbidity in men were age (7.2-20.5% of total variance), body mass index (6.5-15.4%), smoking (4.0-8.3%), chicken intake (3.6-7.5%), and red meat intake (4.6-6.3%) across the three definitions. Leading predictors varied across the three definitions in women, but the four common ones were body mass index (6.3-20.1%), age (6.2-16.4%), chicken intake (4.1-8.3%), and red meat intake (4.2-4.7%). The ten leading modifiable health factors accounted for 39.4-46.1% of total variance across the three definitions. Men with 6-10 health factors had 46-54% lower risks for multimorbidity compared with those reporting ≤2. The corresponding percentage for women was 45-52%. Non-behavioural factors including psychological distress, low education and income and high relative economic disadvantage were among the leading risk factors for multimorbidity. In conclusion, modifications on behavioural factors including diets, physical activity, smoking, alcohol consumption may reduce the risk of multimorbidity in middle-aged adults, whereas individuals with low socioeconomic status or psychological distress are at the highest priority for intervention.

Lifestyle factors and multimorbidity among older adults (ELSI-Brazil)

The objective of the study was to evaluate the association between unhealthy lifestyle factors (individual and combined) and multimorbidity stratified by sex, in a national sample representative of Brazilians aged 50 years or older. Data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil) baseline, conducted in 2015-2016, were used. Multimorbidity was defined by the existence of two or more of the 19 chronic diseases. Four unhealthy lifestyle factors were considered: (1) at-risk alcohol consumption, (2) current or past smoking, (3) insufficient physical activity and (4) below-recommended consumption of fruits and vegetables. The association between unhealthy lifestyle factors, individual and combined, was assessed by logistic regression. Among the 7918 study participants, the prevalence of multimorbidity was 75.8% (95% CI 73.7-77.7) among women and 58.7% (95% CI 56.0-61.3) among men. Among women, none of the analyzed behaviors presented an independent and statistically significant association (p < 0.05) with multimorbidity. Among men, at-risk alcohol consumption was associated with lower odds of multimorbidity. On the other hand, current or past smoking and insufficient physical activity were associated with greater odds of this condition. In addition, the presence of three or four unhealthy lifestyle factors was associated with greater odds of multimorbidity among men. The results reinforce the need for interventions to promote healthy behaviors among older men with two or more chronic diseases. In addition, it is evident that the health services need to act in an attempt to modify unhealthy behaviors after medical diagnosis of chronic diseases to reduce the risk of future complications.

Lifestyle-associated health risk indicators across a wide range of occupational groups: a cross-sectional analysis in 72,855 workers

Background

Identify and compare health risk indicators for common chronic diseases between different occupational groups.

Methods

A total of 72,855 participants (41% women) participating in an occupational health service screening in 2014–2019 were included. Occupation was defined by the Swedish Standard Classification of Occupation, and divided into nine major and additionally eight sub-major groups. These were analysed separately, as white- and blue-collar occupations and as low- and high-skilled occupations. Seven health risk indicators were self-reported: exercise, physical work situation, sitting at work and leisure, smoking, diet, and perceived health, whereas cardiorespiratory fitness, BMI and blood pressure were measured. These were further dichotomized (yes/no) and as clustering of risk indicators (≥3 vs. <3).

Results

The greatest variation in OR across sub-major and major occupational groups were seen for daily smoking (OR = 0.68 to OR = 5.12), physically demanding work (OR = 0.55 to OR = 45.74) and high sitting at work (OR = 0.04 to OR = 1.86). For clustering of health risk indicators, blue-collar workers had significantly higher clustering of health risks (OR: 1.80; 95% CI 1.71–1.90) compared to white-collar workers (reference). Compared to high-skilled white-collar workers, low-skilled white-collar workers had similar OR (2.00; 1.88–2.13) as high-skilled blue-collar workers (1.98; 1.86–2.12), with low-skilled blue-collar workers having the highest clustered risk (2.32; 2.17–2.48).

Conclusion

There were large differences in health risk indicators across occupational groups, mainly between high-skilled white-collar occupations and the other occupations, with important variations also between major and sub-major occupational groups. Future health interventions should target the occupational groups identified with the highest risk for effective disease prevention.

Multimorbidity, Function, and Cognition in Aging

Multimorbidity is a global health challenge. Here, we define multimorbidity, describe ways multimorbidity is measured, discuss the prevalence of multimorbidity and how it differs across different populations, examine mechanisms of disease and disability, and discuss the effects of multimorbidity on outcomes such as survival and function.

Association of Cardiometabolic Multimorbidity Pattern with Dietary Factors among Adults in South Korea

Globally, cardiometabolic multimorbidity pattern (CMP) is a complex chronic health status that negatively effects the life expectancy of adults globally, even more than single diseases. We aimed to identify multimorbidity patterns in Korean adults to clarify the associations between dietary factors and CMP. Nationally representative data of 9011 Korean adults aged 19–64 years were obtained from the Korean National Health and Nutrition Examination Survey (KNHANES) from the period 2013 to 2015. Multimorbidity patterns for CMP, inflammatory disease, cancer and other disease patterns were identified by exploratory factor analysis. Dietary factors including food and nutrient intake and dietary habits were evaluated. Multivariable-adjusted logistic regression models examined the associations between dietary factors and CMP. More than half of the multimorbidity patterns were CMP (n = 4907, 54.5%); CMP subjects were more likely to be older, male, less educated, lower income, laborers, smokers, and high-risk consumers of alcohol than those of non-CMP subjects. A higher intake of calcium (OR = 0.809, 95% CI = 0.691–0.945), potassium (OR = 0.838, 95% CI = 0.704–0.998), and fruits (OR = 0.841, 95% CI = 0.736–0.960) were inversely associated with the prevalence of CMP, while the consumption of irregular meals (OR = 1.164, 95% CI = 1.034–1.312) and skipping breakfast (OR = 1.279, 95% CI = 1.078–1.518) was positively related to a 16% and 28% higher likelihood of CMP, respectively. CMP accounts for more than half of the multimorbidity patterns in the Korean population, and lower intake of calcium, potassium, fruits, and skipping meals have strong associations with CMP.

Regional variation in multimorbidity prevalence in British Columbia, Canada: a cross-sectional analysis of Canadian Community Health Survey data, 2015/16

INTRODUCTION

Multimorbidity represents a major concern for population health and service delivery planners. Information about the population prevalence (absolute numbers and proportions) of multimorbidity among regional health service delivery populations is needed for planning for multimorbidity care. In Canada, health region-specific estimates of multimorbidity prevalence are not routinely presented. The Canadian Community Health Survey (CCHS) is a potentially valuable source of data for these estimates.

METHODS

Data from the 2015/16 cycle of the CCHS for British Columbia (BC) were used to estimate and compare multimorbidity prevalence (3+ chronic conditions) through survey-weighted analyses. Crude frequencies and proportions of multimorbidity prevalence were calculated by BC Health Service Delivery Area (HSDA). Logistic regression was used to estimate differences in multimorbidity prevalence by HSDA, adjusting for known confounders. Multiple imputation using chained equations was performed for missing covariate values as a sensitivity analysis. The definition of multimorbidity was also altered as an additional sensitivity analysis.

RESULTS

A total of 681 921 people were estimated to have multimorbidity in BC (16.9% of the population) in 2015/16. Vancouver (adj-OR = 0.65; 95% CI: 0.44-0.97) and Richmond (adj-OR = 0.55; 95% CI: 0.37-0.82) had much lower prevalence of multimorbidity than Fraser South (reference HSDA). Missing data analysis and sensitivity analysis showed results consistent with the main analysis.

CONCLUSION

Multimorbidity prevalence estimates varied across BC health regions, and were lowest in Vancouver and Richmond after controlling for multiple potential confounders. There is a need for provincial and regional multimorbidity care policy development and priority setting. In this context, the CCHS represents a valuable source of information for regional multimorbidity analyses in Canada.

General practitioner strategies for managing patients with multimorbidity: a systematic review and thematic synthesis of qualitative research

Background

General practitioners (GPs) increasingly manage patients with multimorbidity but report challenges in doing so. Patients describe poor experiences with health care systems that treat each of their health conditions separately, resulting in fragmented, uncoordinated care. For GPs to provide the patient-centred, coordinated care patients need and want, research agendas and health system structures and policies will need to adapt to address this epidemiologic transition. This systematic review seeks to understand if and how multimorbidity impacts on the work of GPs, the strategies they employ to manage challenges, and what they believe still needs addressing to ensure quality patient care.

Methods

Systematic review and thematic synthesis of qualitative studies reporting GP experiences of managing patients with multimorbidity. The search included nine major databases, grey literature sources, Google and Google Scholar, a hand search of Journal of Comorbidity, and the reference lists of included studies.

Results

Thirty-three studies from fourteen countries were included. Three major challenges were identified: practising without supportive evidence; working within a fragmented health care system whose policies and structures remain organised around single condition care and specialisation; and the clinical uncertainty associated with multimorbidity complexity and general practitioner perceptions of decisional risk. GPs revealed three approaches to mitigating these challenges: prioritising patient-centredness and relational continuity; relying on knowledge of patient preferences and unique circumstances to individualise care; and structuring the consultation to create a sense of time and minimise patient risk.

Conclusions

GPs described an ongoing tension between applying single condition guidelines to patients with multimorbidity as security against uncertainty or penalty, and potentially causing patients harm. Above all, they chose to prioritise their long-term relationships for the numerous gains this brought such as mutual trust, deeper insight into a patient’s unique circumstances, and useable knowledge of each individual’s capacity for the work of illness and goals for life. GPs described a need for better multimorbidity management guidance. Perhaps more than this, they require policies and models of practice that provide remunerated time and space for nurturing trustful therapeutic partnerships.

Prevalence of secondary care multimorbidity in mid-life and its association with premature mortality in a large longitudinal cohort study

OBJECTIVES

Multimorbidity is the coexistence of two or more health conditions in an individual. Multimorbidity in younger adults is increasingly recognised as an important challenge. We assessed the prevalence of secondary care multimorbidity in mid-life and its association with premature mortality over 15 years of follow-up, in the Aberdeen Children of the 1950s (ACONF) cohort.

METHOD

A prospective cohort study using linked electronic health and mortality records. Scottish ACONF participants were linked to their Scottish Morbidity Record hospital episode data and mortality records. Multimorbidity was defined as two or more conditions and was assessed using healthcare records in 2001 when the participants were aged between 45 and 51 years. The association between multimorbidity and mortality over 15 years of follow-up (to ages 60-66 years) was assessed using Cox proportional hazards regression. There was also adjustment for key covariates: age, gender, social class at birth, intelligence at age 7, secondary school type, educational attainment, alcohol, smoking, body mass index and adult social class.

RESULTS

Of 9625 participants (51% males), 3% had multimorbidity. The death rate per 1000 person-years was 28.4 (95% CI 23.2 to 34.8) in those with multimorbidity and 5.7 (95% CI 5.3 to 6.1) in those without. In relation to the reference group of those with no multimorbidity, those with multimorbidity had a mortality HR of 4.5 (95% CI 3.4 to 6.0) over 15 years and this association remained when fully adjusted for the covariates (HR 2.5 (95% CI 1.5 to 4.0)).

CONCLUSION

Multimorbidity prevalence was 3% in mid-life when measured using secondary care administrative data. Multimorbidity in mid-life was associated with premature mortality.

Assessing the relationship between multimorbidity and depression in older men and women: the International Mobility in Aging Study (IMIAS)

Objectives: Our study aims to assess whether multimorbidity is an independent risk factor for the development of depression in older adults living in Canada, Brazil, Colombia, and Albania and examines differences in incidence of depression regarding social and psychosocial characteristics.Methods: The longitudinal International Mobility Aging Study (IMIAS) collected information from adults between 65-74 years old. Depression was defined by a 16 or higher score assessed by the Centre for Epidemiological Studies Depression (CES-D) Scale. Multimorbidity was defined as having two or more chronic conditions, which were self-reported by participants using a list of eight physical chronic conditions. Poisson regression was performed to estimate the relative risk of depression in older adults with multimorbidity compared to those living with 0-1 chronic conditions, adjusting for sex, age, education, number of doctor visits, degree of assistance needed, social support, and smoking status. The analysis was stratified by study region (Canada; Latin America; Albania).Results: Crude and adjusted models showed no statistically significant associations between multimorbidity and the incidence of depression in any of the study regions, confirmed by sensitivity analyses. However, the incidence of depression varied across study region, confirmed by the intra-class correlation coefficient which indicated that 13% of variations in depression incidence were due to geographic differences.Conclusion: Multimorbidity does not appear to increase the risk of developing depression in older adults between 65-74. Higher rates of depression in Latin America and Albania (compared to Canada) may be attributed to lifecourse exposures to social and economic adversity in these regions.

Exploration of mental health problems in association with health-promoting lifestyle profile in Iranian medical students: A cross-sectional study

OBJECTIVE

The aim was to explore the relationship between mental health problems (MHPs) and health-promoting lifestyle (HPL) in the medical students.

METHODS

This cross-sectional study was carried out on medical students in 2017 at Semnan University of Medical Sciences applying a stratified random sampling. The Symptom Checklist-25 and the HPL profile scales were used. Logistic regression models were used to analysis.

RESULTS

Of the participants, 84 were male and 148 were female. The mean age was 22.69 years (±2.42). Most students (95.3%) were single and 40.1% were in the preclinical stage. The mean MHP score was 44.14 (±13.99), and 3% were in the severe category. The mean HPL score was 104.88 (±16.84); 95.7% and 4.3% of them had average and satisfactory lifestyles, respectively. The MHP score of the female (P < 0.001), younger (P < 0.001), single (P = 0.045), preclinical (P < 0.001), and who were away from home (P = 0.009) were significantly higher. The HPL score of female (P < 0.001), older (P = 0.041), and married students (P = 0.028) were significantly higher. The female gender (odds ratio [OR] = 4.45, P < 0.001) and studying in the clinical level (OR = 0.30, P < 0.001) were the most important associated factors with MHP. Adjusting for them, there was a significant relationship between an increase in the HPL score and a decrease in the likelihood of MHP (OR = 0.96, P < 0.001).

CONCLUSIONS

The mental health of medical students was shown to be in association with lifestyle independent of other important determinants, including gender and academic level. It seems that modifying the lifestyle to a healthier way can improve students' mental health.

Difficulties that patients with chronic diseases face in the primary care setting in Singapore: a cross-sectional study

INTRODUCTION

Patients with chronic diseases face difficulties when navigating the healthcare system. Using the Healthcare System Hassles Questionnaire (HSHQ) developed by Parchman et al, this study aimed to explore the degree of hassles faced by primary care patients in Singapore and identify the characteristics associated with higher hassles.

METHODS

A cross-sectional study was conducted among patients with chronic disease at Hougang Polyclinic, Singapore, using interviewer-administered HSHQ. Mean HSHQ score was compared with Parchman et al's study. The associations between number of chronic diseases, demographic variables and healthcare hassles were assessed using multivariate linear logistic regression analysis.

RESULTS

217 outpatients aged 21 years and above were enrolled. Our overall mean HSHQ score (4.77 ± 6.18) was significantly lower than that in Parchman et al's study (15.94 ± 14.23, p < 0.001). Participants with five or more chronic diseases scored 3.38 (95% confidence interval [CI] 0.11-6.65, p = 0.043) points higher than those with one chronic disease. With each increasing year of age, mean HSHQ score decreased by 0.17 (95% CI -0.26 to -0.08, p = 0.001) points. Those with polytechnic/diploma/university education and higher scored 2.65 (95% CI 0.19-5.11, p = 0.035) points higher than those with primary education and lower.

CONCLUSION

Patients in our population reported lower hassles than those in Parchman et al's study. Increasing age and lower education level were associated with lower hassles. Further analysis of the types of chronic diseases may yield new information about the association of healthcare hassles with the number and types of chronic diseases.

Mediterranean Diet Nutrients to Turn the Tide against Insulin Resistance and Related Diseases

Insulin resistance (IR), defined as an attenuated biological response to circulating insulin, is a fundamental defect in obesity and type 2 diabetes (T2D), and is also linked to a wide spectrum of pathological conditions, such as non-alcoholic fatty liver disease (NAFLD), cognitive impairment, endothelial dysfunction, chronic kidney disease (CKD), polycystic ovary syndrome (PCOS), and some endocrine tumors, including breast cancer. In obesity, the unbalanced production of pro- and anti-inflammatory adipocytokines can lead to the development of IR and its related metabolic complications, which are potentially reversible through weight-loss programs. The Mediterranean diet (MedDiet), characterized by high consumption of extra-virgin olive oil (EVOO), nuts, red wine, vegetables and other polyphenol-rich elements, has proved to be associated with greater improvement of IR in obese individuals, when compared to other nutritional interventions. Also, recent studies in either experimental animal models or in humans, have shown encouraging results for insulin-sensitizing nutritional supplements derived from MedDiet food sources in the modulation of pathognomonic traits of certain IR-related conditions, including polyunsaturated fatty acids from olive oil and seeds, anthocyanins from purple vegetables and fruits, resveratrol from grapes, and the EVOO-derived, oleacein. Although the pharmacological properties and clinical uses of these functional nutrients are still under investigation, the molecular mechanism(s) underlying the metabolic benefits appear to be compound-specific and, in some cases, point to a role in gene expression through an involvement of the nuclear high-mobility group A1 (HMGA1) protein.

Attention-deficit/hyperactivity disorder and physical multimorbidity: A population-based study

Background:

There has been little research on the association of attention-deficit/hyperactivity disorder (ADHD) with co-occurring physical diseases. The aim of this study was to examine the association between possible ADHD and physical multimorbidity (i.e. = 2 physical diseases) among adults in the English general population.

Methods:

Data were analyzed from 7274 individuals aged = 18 years that came from the Adult Psychiatric Morbidity Survey 2007. ADHD symptoms were assessed with the Adult Self-Report Scale (ASRS) Screener. Information was also obtained on 20 self-reported doctor/other health professional diagnosed physical health conditions present in the past 12 months. Multivariable logistic regression and mediation analyses were conducted to assess the associations.

Results:

There was a monotonic relation between the number of physical diseases and possible ADHD (ASRS score = 14). Compared to those with no diseases, individuals with = 5 diseases had over 3 times higher odds for possible ADHD (odds ratio [OR]: 3.30, 95% confidence interval [CI]: 2.48–4.37). This association was observed in all age groups. Stressful life events (% mediated 10.3–24.3%), disordered eating (6.8%), depression (12.8%), and anxiety (24.8%) were significant mediators in the association between possible ADHD and physical multimorbidity.

Conclusion:

Adults that screen positive for ADHD are at an increased risk for multimorbidity and several factors are important in this association. As many adults with ADHD remain undiagnosed, the results of this study highlight the importance of detecting adult ADHD as it may confer an increased risk for poorer health outcomes, including physical multimorbidity.

Chronic Diseases Multimorbidity among Adult People Living with HIV at Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia

Background

Due to the wide implementation of antiretroviral therapy (ART), people living with HIV (PLWHIV) are now living longer. This increased the risk of developing noncommunicable chronic diseases (NCCDs) among them.

Objective

We aimed to describe prevalence of NCCDs multimorbidity among PLWHIV at Hawassa University Comprehensive Specialized Hospital (HUCSH).

Method

In April 2016, institution-based cross-sectional study was conducted among PLWHIV, aged ≥ 18 years at the ART unit of HUCSH. A nurse working in the ART unit interviewed patients and reviewed medical records. Data on the NCCDs and its risk factors were obtained. List of diseases considered in this study were arthritis, diabetes mellitus, hypertension, congestive heart failure (CHF), rheumatic heart diseases (RHD), chronic bronchitis, asthma, and cancer.

Results

More than half of the respondents (196) had at least one of the NCCDs and 34 (8.9%) had multimorbidity. The main system of the body affected were the musculoskeletal system, 146 (38.2%) and respiratory system, 46 (12.0%). There was no significant difference in the prevalence of individual NCCDs by gender. Patients aged above 44 years, patients with ART duration of at least 6 years, and patients with higher CD4 counts had increased odds of having any one of the NCCDs. Multimorbidity patients with a longer ART duration had an increased risk.

Conclusion

The prevalence of NCCD multimorbidity among PLWHIV was high. Monitoring the occurrence of NCCDs among PLWHIV and noncommunicable disease care is recommended.

Patterns of physical activity and health-related quality of life amongst patients with multimorbidity in a multi-ethnic Asian population

BACKGROUND

The co-occurrence of two or more chronic medical conditions in an individual is defined as multimorbidity. Lifestyle factors, including poor dietary patterns, physical inactivity, tobacco use, and excessive alcohol consumption are key modifiable risk factors that play a role in the development of chronic medical conditions and potentially multimorbidity. The current study aimed to examine the level of physical activity among those with multimorbidity and its association with socio-demographic factors, clinical parameters, and health-related quality of life (HRQoL) among community-dwelling adults attending a primary care clinic in Singapore.

METHODS

This cross-sectional study was conducted among patients with multimorbidity between August 2014 and June 2016. Physical activity was measured using the International Physical Activity Questionnaire (IPAQ) Short Form. HRQoL was measured using the EuroQol-5 Dimension (EQ-5D-3 L). Data on clinical parameters including hemoglobin A1c (HbA1C), low-density lipoprotein cholesterol (LDL-C), and blood pressure were collected from patient records. Multivariable logistic regression analysis and linear regression were performed to determine the association between IPAQ and clinical health outcomes, as well as HRQoL measures, respectively.

RESULTS

In all, 932 respondents with multimorbidity were recruited for the study. Of these, 500 (53.8%) had low physical activity, 325 (35.0%) had moderate physical activity, while 104 (11.2%) had high physical activity. Respondents who were insufficiently active had significantly higher odds of being overweight/ obese (OR: 1.5, 95% confidence interval [CI]: 1.1-1.9, p = 0.01) as compared to those who were sufficiently physically active. The multiple linear regression model revealed that insufficient activity level was negatively associated with EQ-5D index score (β = - 0.05, p <  0.001) and the visual analogue scale (β = - 4.4, p <  0.001) measuring HRQoL as compared to sufficient activity levels in respondents with multimorbidity.

CONCLUSIONS

The low levels of physical activity among patients with multimorbidity, and its association with overweight status and poorer HRQoL emphasizes the importance of increasing physical activity in this population. Family physicians treating patients with chronic diseases need to continue encouraging and helping individuals to initiate and maintain appropriate physical activity levels.

Multimorbidity, polypharmacy and primary prevention in community-dwelling adults in Quebec: a cross-sectional study

BACKGROUND

Polypharmacy carries the risk of adverse events, especially in people with multimorbidity.

OBJECTIVE

To investigate the prevalence of polypharmacy in community-dwelling adults, the association of multimorbidity with polypharmacy and the use of medications for primary prevention.

METHODS

Cross-sectional analysis of the follow-up data from the Program of Research on the Evolution of a Cohort Investigating Health System Effects (PRECISE) in Quebec, Canada. Multimorbidity was defined as the presence of three or more chronic diseases and polypharmacy as self-reported concurrent use of five or more medications. Primary prevention was conceptualized as the use of statin or low-dose antiplatelets without a reported diagnostic of cardiovascular disease.

RESULTS

Mean age 56.7 ± 11.6, 62.5% female, 30.3% had multimorbidity, 31.9% had polypharmacy (n = 971). The most common drugs used were statins, renin-angiotensin system inhibitors and psychotropics. Compared to participants without any chronic disease, the adjusted odds ratios (ORs) for having polypharmacy were 2.78 [95% confidence interval (CI): 1.23-6.28] in those with one chronic disease, 8.88 (95% CI: 4.06-19.20) in those with two chronic diseases and 25.31 (95% CI: 11.77-54.41) in those with three or more chronic diseases, P < 0.001. In participants without history of cardiovascular diseases, 16.2% were using antiplatelets and 28.5% were using statins. Multimorbidity was associated with increased likelihood of using antiplatelets (adjusted OR: 2.98, 95% CI: 1.98-4.48, P < 0.001) and statins (adjusted OR: 3.76, 95% CI: 2.63-5.37, P < 0.001) for primary prevention.

CONCLUSION

There was a high prevalence of polypharmacy in community-dwelling adults in Quebec and a strong association with multimorbidity. The use of medications for primary prevention may contribute to polypharmacy and raise questions about safety.

Health behaviour, social support, socio-economic status and the 5-year progression of multimorbidity: Results from the MultiCare Cohort Study

Background:

Multimorbidity in elderly patients is a major challenge for physicians, because of a high prevalence of and associations with many adverse outcomes. However, the mechanisms of progressing multimorbidity are not well-understood. The aim of our study was to determine if the progression of multimorbidity is influenced by health behaviour and social support and to analyse if the patients’ socio-economic status had an effect on these prognostic factors.

Methods:

The study was designed as prospective cohort study based on interviews of 158 GPs and 3189 patients randomly selected from GP records (response rate: 46.2%). Patients were aged 65–85 years at recruitment and observed in four waves of data collection (dropout rate: 41.5%). Statistical analyses of the ‘hot deck’ imputed data included multilevel mixed-effects linear regression allowing for random effects at the study centre and GP practice within study centre level.

Results:

Regarding cardiovascular and metabolic diseases, multimorbidity progressed more rapidly in patients who reported less physical activity (ß = −0.28; 95% confidence interval = −0.35 to −0.20), had more tobacco-related pack years (0.15; 0.07–0.22) and consumed less alcohol (−0.21; −0.31 to −0.12) at baseline. Multimorbidity related to psychiatric and pain-related disorders progressed more rapidly if the patients had less perceived social support (−0.31; −0.55 to −0.07) and reported less physical activity (−0.08; −0.15 to −0.02) at baseline. Education and income only slightly modified the effects of these variables.

Conclusion:

Depending on the multimorbidity cluster, different strategies should be used for slowing down the progression of multimorbidity. Changing lifestyle and increasing social support are beneficial for the entire group of elderly multimorbid patients – regardless of their socio-economic status.

Registration:

ISRCTN89818205

Do Older Adults with Multimorbidity Meet the Recommended Levels of Physical Activity? An Analysis of Scottish Health Survey

There is a positive association between physical activity (PA) and improved health in older adults. The objective of this study was to assess the prevalence and determinants of meeting recommended levels of PA among older adults with multimorbidity. Data has been derived from the nationally representative Scottish Health Surveys (2014–2017). A sub-sample of 2230 older adults (aged 65+) with multimorbidity were the study participants. Physical activity was evaluated using current recommended guidelines. Overall, 32.3% of the participants met the recommended levels of PA. Independent predictors of meeting the recommended levels of PA include male gender [odds ratio (OR) 2.00 (95% confidence interval (CI) 1.58–2.54)], living in the least deprived areas [OR 1.79 (95% CI 1.20–2.69)]; being a non-smoker [OR 2.22 (95% CI 1.48–3. 34)]. Also, meeting recommended PA decreased with age [OR 0.92 (95% CI 0.90–0.94)] and body mass index [OR 0.93 (95% CI 0.91–0.95]; but increased per additional portion of fruit and vegetables taken [OR 1.19 (95% CI 1.12–1.25)] and with increase in well-being scale score [OR 1.05 (95% CI 1.03 to 1.06)]. Adherence to PA guidelines seems to be more related to age, BMI, gender (i.e. higher PA adherence in men vs. women), social support (i.e. social deprivation), dietary habits (i.e. fruit and vegetable intake) and social isolation among the elderly. In the one-third of older population, adherence to PA was associated to better mental health. Therefore, adaptation of PA guideline to suit theses determinants factors would reduce the gap difference among older adults with multimorbidity and enhance their mental well-being.

What Is the Impact of Physical Activity and Physical Function on the Development of Multimorbidity in Older Adults Over Time? A Population-Based Cohort Study

Background

Multimorbidity is recognized internationally as having a serious impact on health outcomes. It is associated with reduced quality of life, increased health care utilization, and future functional decline. Physical activity is associated with good health and psychological well-being. The aim of this study was to identify the impact of physical activity and physical function on the development and worsening of multimorbidity over time.

Methods

Using The Irish Longitudinal Study on Ageing (TILDA), we analyzed 4,823 participants ≥50 years with and without multimorbidity. Multimorbidity was defined as the presence of ≥2 chronic conditions. Development of multimorbidity was measured as the accrual of additional conditions over a 2-year period. Physical activity and physical function were measured using the International Physical Activity Questionnaire (IPAQ), gait speed (m/sec), and grip strength (kg).

Results

Sixteen groups of chronic conditions were included in analyses. 53.7% of included participants had multimorbidity at baseline and 71.7% at follow-up. Six hundred and thirty-eight of 2,092 (30.4%) participants without multimorbidity and 1,005 of 2,415 (41.6%) with existing multimorbidity developed new condition/s. Gait speed (relative risk [RR] = 0.67, confidence interval [CI]: 0.49–0.90), grip strength (RR = 0.98, CI: 0.97–0.99), and age (compared to 50–59 years, 60–69: RR = 1.30, CI: 1.11–1.52; ≥70: RR = 1.35, CI: 1.03–1.77) were significantly associated with the development of multimorbidity and accrual of additional conditions.

Conclusion

These results show that physical function is associated with the development and worsening of multimorbidity over time. They support the recent National Institute for Health & Care Excellence (NICE) Guidance on multimorbidity that suggests that patients with multimorbidity and reduced gait speed should be identified and targeted for interventions to improve health outcomes.

Physical multimorbidity and subjective cognitive complaints among adults in the United Kingdom: a cross-sectional community-based study

Our goal was to examine the association between physical multimorbidity and subjective cognitive complaints (SCC) using UK nationally representative cross-sectional community-based data, and to quantify the extent to which a broad range of mainly psychological and behavioral factors explain this relationship. Data from the 2007 Adult Psychiatric Morbidity Survey were analyzed [N = 7399 adults, mean (SD) age 46.3 (18.6) years, 48.6% men]. Multimorbidity was defined as ≥2 physical diseases. SCC included two different cognitive constructs: subjective concentration and memory complaints. Multivariable logistic regression and mediation analyses were conducted. Multimorbidity was associated with higher prevalence of subjective concentration (30.7% vs. 17.3%) and memory complaints (42.8% vs. 22.9%) compared to no multimorbidity. In the regression model adjusted for sociodemographics, multimorbidity was associated with subjective concentration (OR = 2.58; 95% CI = 2.25–2.96) and memory complaints (OR = 2.34; 95% CI = 2.08–2.62). Sleep problems, stressful life events and any anxiety disorder explained 21–23%, 20–22% and 14–15% of the multimorbidity-SCC association, respectively. Multimorbidity and SCC are highly co-morbid. The utility of SCC screening in identifying individuals at high risk for future cognitive decline among individuals with multimorbidity should be assessed.

Multimorbidity and quality of life: Systematic literature review and meta-analysis

Multimorbidity is typically defined as the co-existence of two or more chronic diseases within an individual. Its prevalence is highest among the elderly, with poor quality of life (QoL) being one of the major consequences. This study aims to: (1) understand the relationship between multimorbidity and QoL or health-related quality of life (HRQoL) through systematic literature review; (2) explore the strength of this association by conducting the first meta-analysis on the subject. Following PRISMA, Medline/PubMed, Embase, CINAHL and PsycINFO were searched for studies published through September 1st, 2018. Original studies with clear operationalization of multimorbidity and validated QoL (or HRQoL) measurement were retained. For random-effect meta-analysis, a minimum of three studies with the same multimorbidity tool (e.g. number of diseases or equal comorbidity index) and the same QoL tool were required. Number of diseases was most common and the only measure on which meta-analysis was carried out. The outcome of interest was the linear regression slope between increasing number of diseases and QoL. Heterogeneity was explored with meta-regression. Out of 25,890 studies initially identified, 74 studies were retained for systematic review (total of 2,500,772 participants), of which 39 were included in the meta-analysis. The mean decrease in HRQoL per each added disease, depending on the scale, ranged from: -1.55% (95%CI: -2.97%, -0.13%) for the mental component summary score of pooled SF-36, -12 and -8 scales to -4.37% (95%CI: -7.13%, -1.61%) for WHOQoL-BREF physical health domain. Additional studies considering severity, duration and patterns of diseases are required to further clarify this association.

Increasing age- and gender-specific burden and complexity of multimorbidity in Taiwan, 2003-2013: a cross-sectional study based on nationwide claims data

OBJECTIVE

Although there is accumulating evidence regarding multimorbidity in Western countries, this information is very limited in Asian countries. This study aimed to estimate population-based, age-specific and gender-specific prevalence and trends of multimorbidity in the Taiwanese population.

DESIGN

This was a cross-sectional study based on claims data (National Health Insurance Research Database, Taiwan).

PARTICIPANTS

The participants included a subset of the National Health Insurance Research Database, which contains claims data for two million randomly selected beneficiaries (~10% of the total population) under Taiwan's mandatory National Health Insurance system.

OUTCOME MEASUREMENTS

The prevalence of multimorbidity in different age groups and in both sexes in 2003 and 2013 was reported. We analysed data on the prevalence of 20 common diseases in each age group and for both sexes. To investigate the clustering effect, we used graphical displays to analyse the likelihood of co-occurrence with one, two, three, and four or more other diseases for each selected disease in 2003 and 2013.

RESULTS

The prevalence of multimorbidity (two or more diseases) was 20.07% in 2003 and 30.44% in 2013. In 2013, the prevalence varied between 5.21% in patients aged 20-29 years and 80.96% in those aged 80-89 years. In patients aged 50-79 years, the prevalence of multimorbidity was higher in women than in men. In men, the prevalence of chronic pulmonary disease and cardiovascular-related diseases was predominant, while in women the prevalence of osteoporosis, arthritis, cancer and psychosomatic disorders was predominant. Co-occurring diseases varied across different age and gender groups.

CONCLUSIONS

The burden of multimorbidity is increasing and becoming more complex in Taiwan, and it was found to vary across different age and gender groups. Fulfilling the needs of individuals with multimorbidity requires collaborative work between healthcare providers and needs to take the age and gender disparities of multimorbidity into account.