Importance:The simultaneous presence of multiple conditions in one patient (multi-morbidity) is a key challenge facing primary care.Objective: The purpose of this study was to determine the prevalence of multi-morbidity and to document changes in prevalence during the last 25 years.Design/Setting: Cross-sectional study using multiple years (1988 -2014) Results: A total of 57,303 individuals were surveyed regarding the presence of multi-morbidity in separate surveys spanning 1988 -2014. The overall current prevalence in 2013-2014 of >2 morbidities was 59.6% (95% CI 58.1%-61.1%), 38.5% had 3 or more, and 22.7% had 4 or more morbidities, which was significantly higher than in 1988 (45.7%, 95% CI 43.5%-47.8%, with >2 morbidities). Among individuals with 2 or more morbidities, 54.1% have obesity compared to 41.9% in 1988. Among adults age >65, prevalence was 91.8% for 2 or more morbidities. Whites and Blacks had significantly higher prevalence (59.2% and 60.1%) than Hispanic or "other" race (45.0%, P < .0001). Women (58.4%) had more current multi-morbidities (>2) than men (55.9%, P ؍ .01). The simultaneous presence of multiple conditions in one patient (multimorbidity) is a key challenge in primary care. Multimorbidity adds to the complexity of care and threatens the quality, coordination, continuity, and safety of care in the United States health care system and elsewhere. Despite the seriousness and far-reaching impacts of this phenomenon, characterization of this population in recent studies has focused on older populations, include a limited number of chronic conditions, and often do not include obesity as a chronic condition. [1][2][3][4][5][6][7][8] The burden on patients with multimorbidity is considerable and is associated with increased mortality.
Conclusions and9-12 A recent meta-analysis by Nunes and colleagues 10 included 5806 multimorbidity studies, and mortality (26 studies were included) demonstrated a hazard ratio of 1.73 (95% CI, 1.41-2.13) and 2.72 (95% CI, 1.81-4.08) for people with 2 or more and 3 or more morbidities, respectively. This article was externally peer reviewed.