Which chronic diseases and disease combinations are specific to multimorbidity in the elderly? Results of a claims data based cross-sectional study in Germany

Abstract

BackgroundGrowing interest in multimorbidity is observable in industrialized countries. For Germany, the increasing attention still goes still hand in hand with a small number of studies on multimorbidity. The authors report the first results of a cross-sectional study on a large sample of policy holders (n = 123,224) of a statutory health insurance company operating nationwide. This is the first comprehensive study addressing multimorbidity on the basis of German claims data. The main research question was to find out which chronic diseases and disease combinations are specific to multimorbidity in the elderly.MethodsThe study is based on the claims data of all insured policy holders aged 65 and older (n = 123,224). Adjustment for age and gender was performed for the German population in 2004. A person was defined as multimorbid if she/he had at least 3 diagnoses out of a list of 46 chronic conditions in three or more quarters within the one-year observation period. Prevalences and risk-ratios were calculated for the multimorbid and non-multimorbid samples in order to identify diagnoses more specific to multimorbidity and to detect excess prevalences of multimorbidity patterns.Results62% of the sample was multimorbid. Women in general and patients receiving statutory nursing care due to disability are overrepresented in the multimorbid sample. Out of the possible 15,180 combinations of three chronic conditions, 15,024 (99%) were found in the database. Regardless of this wide variety of combinations, the most prevalent individual chronic conditions do also dominate the combinations: Triads of the six most prevalent individual chronic conditions (hypertension, lipid metabolism disorders, chronic low back pain, diabetes mellitus, osteoarthritis and chronic ischemic heart disease) span the disease spectrum of 42% of the multimorbid sample. Gender differences were minor. Observed-to-expected ratios were highest when purine/pyrimidine metabolism disorders/gout and osteoarthritis were part of the multimorbidity patterns.ConclusionsThe above list of dominating chronic conditions and their combinations could present a pragmatic start for the development of needed guidelines related to multimorbidity.

Multimorbidity and Health-Related Quality of Life among Older Adults

“…It will help in taking into consideration different patterns of multimorbidity including triplets and higher order combinations of chronic conditions in studying HRQoL. Studies have shown that the co-occurrence of three or more chronic conditions in older adults is common [15,16] but there are no current studies exploring the effects, for example, of most prevalent triplets or higher order combinations of chronic conditions on HRQoL. Studies that consider the effects the crude number of chronic conditions co-occurring in an individual have on HRQoL show that the effects of multimorbidity as triplets or higher order combinations may be much more substantial than the one implied by multimorbidity as pairs [11].…”

Educational inequality in Rio de Janeiro and its impact on multimorbidity: evidence from the Pró-Saúde study. A cross-sectional analysis

“…27 In addition, several methodological issues relating to studies on multimorbidity are still unresolved. 1,28 These include what the best way to measure it would be, 29 which clusters of diseases are more harmful 30 and what role sex has in relation to development of multimorbidity. 31 The aims of the present study were to determine the prevalence of multimorbidity in a population of adult Brazilians and to investigate the relationship between its occurrence and socioeconomic position, measured via educational attainment.…”

Functional gain following knee replacement in patients aged 75 and older: a prospective follow-up study

“…The prevalence of clinical knee osteoarthritis (OA) increases steadily with age, so that almost half of the population aged 80 and over is affected [2]. OA is associated with pain, functional disability and impaired quality of life [3] and is one of the most disabling diseases in the aged [4,5].…”