Prevalence of multimorbidity in the adult population attending primary care in Portugal: a cross-sectional study

Abstract

ObjectivesTo determine the prevalence of multimorbidity in the adult population attending primary care in Portugal, to identify associated sociodemographic factors, and to reveal combinations of chronic health problems.DesignCross-sectional, analytical study.SettingPrimary Care Centres in mainland Portugal across the five Portuguese Healthcare Administrative Regions.Participants1279 women and 714 men agreed to participate. The mean age was 56.3 years (59.0 years for men; 54.8 years for women). The most frequent marital status was married/cohabiting (69.5%). The most predominant living arrangement was living as a couple (57.2%). A considerable proportion consisted of pensioners/retirees (41.5%) and adults with a low educational level (48.7%). Sufficient monthly income was reported in 54.4% of the cases.Primary outcome measuresFor each patient, multimorbidity was measured either by the presence of ≥2 or ≥3 chronic health problems, from a list of 147 chronic health problems. Clinical data were collected using the general practitioner's knowledge of the patient's history, patient's self-report and medical records. Cluster analyses were performed to reveal distinct patterns of multimorbidity.Secondary outcome measuresPatient social and demographic data (sex, age, residence area, current marital status, number of years of formal education, living arrangements, professional status and self-perceived economic status). Logistic regression analyses were performed to determine the association between sociodemographic factors and multimorbidity.ResultsMultimorbidity (2 or more chronic health problems) was present in 72.7%. When a cut-off of three or more was used, an expressive percentage of multimorbidity (57.2%) remained present. The likelihood of having multimorbidity increased significantly with age. Pensioners/retirees and adults with low levels of education were significantly more likely to suffer from multimorbidity. Cardiometabolic and mental disorders were the most common chronic health problems. Six multimorbidity clusters have been identified.ConclusionsMultimorbidity was found to be a common occurrence in the Portuguese primary care users. Future primary healthcare policies should take multimorbidity into consideration.

Relationship between health-related quality of life, perceived family support and unmet health needs in adult patients with multimorbidity attending primary care in Portugal: a multicentre cross-sectional study

“…Portuguese epidemiologic data follows the same tendency, with a high prevalence of multimorbidity (72.7 %) amongst adult patients attending primary care [4]. Factors such as social deprivation [5], marginalisation [6], mental health disorders [5], and poor housing conditions [7] are associated with an increased prevalence of multimorbidity.…”

Challenges of Ageing in Portugal: Data from the EpiDoC Cohort

“…33 The most prevalent chronic diseases in our study population were hypertension, rheumatic disease, hypercholesterolemia, gastrointestinal disease, cardiac disease, and diabetes, which are similar to the findings reported in other European and North American countries. 5,[34][35][36] Portuguese older adults reported lower levels of quality of life, as reflected by a mean EQ-5D-3L score of 0.59 ± 0.38, when compared with adults from other countries. In the Netherlands, quality of life expressed as the mean EQ-5D-3L score was 0.94 for adults 65 to 69 years old and 0.86 for individuals 85 years or older.…”

“…4 Several of these chronic diseases occur in clusters and are associated with health-related behaviours, such as physical inactivity and unhealthy diets. 5,6 This leads to the multimorbidity concept, which has been defined as the coexistence of two or more chronic diseases at the same time. [7][8][9] Individual, societal, and economic costs associated with the last 5 to 10 years of life are mainly due to multimorbidity.…”

“…[7][8][9] Individual, societal, and economic costs associated with the last 5 to 10 years of life are mainly due to multimorbidity. 5,10 Assessment and intervention in older adults with multimorbidity require an interdisciplinary approach. An understanding of risk factors, clinical situation, healthcare consumption, and social and economic status will help with the design of new strategies and policies to achieve better care.…”

The Knowledge, Awareness, and Practices of Portuguese General Practitioners Regarding Multimorbidity and its Management: Qualitative Perspectives from Open-Ended Questions

“…Also, in America, the number of people with chronic conditions is projected to increase steadily for the next 30 years [9]. In a recent study in Portugal the prevalence of multimorbidity in primary care was above 70% in adult patients [10]. …”