Co- and multimorbidity patterns in an unselected Norwegian population: cross-sectional analysis based on the HUNT Study and theoretical reflections concerning basic medical models

Abstract

Rationale and aims: Accumulating evidence shows that diseases tend to cluster in diseased individuals, so-called multimorbidity. The aim of this study was to analyze multimorbidity patterns, empirically and theoretically, to better understand the phenomenon. Population and methods: The Norwegian population-based Nord-Trøndelag Health Study HUNT 3 (2006-8), with 47,959 individuals aged 20-79 years. A total of 21 relevant, longstanding diseases/malfunctions were eligible for counting in each participant. Multimorbidity was defined as two or more chronic conditions. Results: Multimorbidity was found in 18% of individuals aged 20 years. The prevalence increased with age in both sexes. The overall age-standardized prevalence was 42% (39% for men, 46% for women). 'Musculoskeletal disorders' was the disease-group most frequently associated with multimorbidity. Three conditions, strategically selected to represent different diagnostic domains according to biomedical tradition; gastro-esophageal reflux, thyroid disease and dental problems, were all associated with both mental and somatic comorbid conditions. Conclusions and implications: Multimorbidity appears to be prevalent in both genders and across age-groups, even in the affluent and relatively equitable Norwegian society. The disease clusters typically transcend biomedicine's traditional demarcations between mental and somatic diseases and between diagnostic categories within each of these domains. A new theoretical approach to disease development and recovery is warranted, in order to adequately tackle 'the challenge of multimorbidity', both empirically and clinically. We think the concept allostatic load can be systematically developed to "capture" the interrelatedness of biography and biology and to address the fundamental significance of "that, which gains" versus "that, which drains" any given human being.

Origins of heath inequalities: the case for Allostatic Load

“…The presented connection between allostatic load and the phenomenon embodiment ) is highly concordant with our thinking (Getz, Kirkengen, & Ulvestad, 2011;Kirkengen, 2001Kirkengen, , 2010Kirkengen et al, 2015;Kirkengen & Thornquist, 2012;Mjolstad, Kirkengen, Getz, & Hetlevik, 2013;Thornquist & Kirkengen, 2015;Tomasdottir et al, 2014;Tomasdottir et al, 2015;Vogt, Ulvestad, Eriksen, & Getz, 2014). The interrelatedness of human biology and biography has long been evident to experienced doctors in general practice (GPs) who encounter individuals over time across varying circumstances and stages of life (Kirkengen, 2005).…”

“…An explicit focus on resilience can be found in recent key publications about allostasis (Ghini et al, 2015;Karatsoreos & McEwen, 2013;McEwen, Gray, & Nasca, 2015). Consequently, we suggest that a metaphorical expression of the fundamental idea of allostasis should involve both detrimental ("draining") and health promoting ("gaining") phenomena (Kirkengen, 2010;Tomasdottir et al, 2014). Depiction of an existential balance between drains (adversity) and gains (buffering support) is in fact needed to grasp the very essence of the terms "positive," "tolerable" and "toxic stress" which have become tightly connected to the concept of allostatic load (Shonkoff, Boyce & McEwen, 2009.…”

“…Since then an immense amount of concordant evidence on the detrimental impact of early life adversity has become available (Getz et al, 2011;Kirkengen, 2010). In our research unit -the General Practice Research Unit at the Department of Public Health and General Practice, Norwegian University of Science and Technology -we apply insight from these different perspectives to deal with the conundrum of multimorbidity ( Tomasdottir et al, 2014( Tomasdottir et al, , 2015. So while agreeing that more research would strengthen existing knowledge, we acknowledge that it is possible to pave a good way for public health and primary care with the knowledge we already possess.…”

“…Based on the metaphor "wear and tear," the concept allostatic load can effectively accommodate knowledge pertaining to the pathogenetic impact of socioeconomic disadvantage and adverse lifetime experiences (Tomasdottir et al, 2014). However, between the lines of the allostasis literature we also encounter considerations pertaining to salutogenetic factors which promote and uphold health.…”

Medicine's perception of reality – a split picture: critical reflections on apparent anomalies within the biomedical theory of science

“…2 Multi-or comorbidity -several presumably different diseases and ailments in the same patient, which according to biomedical classification, each has its own specific aetiology, course and prognosis [4,5]. 3 An epidemic of risks -the rising number of so-called risk factors for developing disease in the future, which based on the increasing fragmentation of the human body becomes, in principle, unlimited, and in total, unmanageable [6,7].…”