Prevalence, Determinants and Patterns of Multimorbidity in Primary Care: A Systematic Review of Observational Studies

Abstract

IntroductionMultimorbidity is a major concern in primary care. Nevertheless, evidence of prevalence and patterns of multimorbidity, and their determinants, are scarce. The aim of this study is to systematically review studies of the prevalence, patterns and determinants of multimorbidity in primary care.MethodsSystematic review of literature published between 1961 and 2013 and indexed in Ovid (CINAHL, PsychINFO, Medline and Embase) and Web of Knowledge. Studies were selected according to eligibility criteria of addressing prevalence, determinants, and patterns of multimorbidity and using a pretested proforma in primary care. The quality and risk of bias were assessed using STROBE criteria. Two researchers assessed the eligibility of studies for inclusion (Kappa = 0.86).ResultsWe identified 39 eligible publications describing studies that included a total of 70,057,611 patients in 12 countries. The number of health conditions analysed per study ranged from 5 to 335, with multimorbidity prevalence ranging from 12.9% to 95.1%. All studies observed a significant positive association between multimorbidity and age (odds ratio [OR], 1.26 to 227.46), and lower socioeconomic status (OR, 1.20 to 1.91). Positive associations with female gender and mental disorders were also observed. The most frequent patterns of multimorbidity included osteoarthritis together with cardiovascular and/or metabolic conditions.ConclusionsWell-established determinants of multimorbidity include age, lower socioeconomic status and gender. The most prevalent conditions shape the patterns of multimorbidity. However, the limitations of the current evidence base means that further and better designed studies are needed to inform policy, research and clinical practice, with the goal of improving health-related quality of life for patients with multimorbidity. Standardization of the definition and assessment of multimorbidity is essential in order to better understand this phenomenon, and is a necessary immediate step.

Multimorbidity associated with polypharmacy and negative self-perception of health

“…The prevalence of multimorbidity found in the elderly population was 45%, a rate lower than that found in systematic review studies in which the prevalence was between 50 and 98% 1,19 . These differences can be explained by the different forms of analyzing the prevalence of multimorbidity of the studies, making evaluation of the outcome difficult, mainly due to the lack of a standard in relation to the number of diseases to be considered.…”

“…The outcome of multimorbidity was not associated with the place of residence in systematic analysis, however 19 .…”

“…These differences can be explained by the different forms of analyzing the prevalence of multimorbidity of the studies, making evaluation of the outcome difficult, mainly due to the lack of a standard in relation to the number of diseases to be considered. While the occurrence of two or more chronic diseases is frequently used 20 , the number of chronic conditions evaluated in studies ranges from 5 to 335, with a subsequent variation in the prevalence of multimorbidity 19 .…”

Comorbilidad en personas con depresión que consultan en centros de la atención primaria de salud en Santiago, Chile

“…Estos resultados apuntan en la misma dirección que estudios internacionales que confirmaron la elevada prevalencia de múltiples comorbilidades físicas y mentales en consultantes de APS [35][36][37] , subrayando la necesidad de dejar atrás la atención de patologías específicas 35 , y relevando el uso de estrategias para la prevención de factores de riesgo comunes 36 .…”

Excess weight and multimorbidity: putting people's health experience in risk factor epidemiology

“…5 A distinct body of work in medicine, population health, and health services has focused on defining and measuring multimorbidity, a phenomenon that is familiar to primary care providers who see many people and patients simultaneously affected by multiple conditions. [6][7][8] Although ageing is a key determinant of multimorbidity, multimorbidity affects people throughout the lifecourse, and is especially high in those afflicted by poverty and deprivation, which are risk factors for several mental and physical illnesses. 8 Despite its importance for people's health experience and health-care needs, multimorbidity is rarely used in analyses of prospective cohorts, which instead tend to use occurrence of single adverse events (eg, death or incidence of cancer, acute myocardial infarction, or stroke) as their outcome.…”