The increasing burden and complexity of multimorbidity

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Abstract

Background

Multimorbidity, the co-occurrence of two or more chronic conditions, is common among older adults and is known to be associated with high costs and gaps in quality of care. Population-based estimates of multimorbidity are not readily available, which makes future planning a challenge. We aimed to estimate the population-based prevalence and trends of multimorbidity in Ontario, Canada and to examine patterns in the co-occurrence of chronic conditions.

Methods

This retrospective cohort study includes all Ontarians (aged 0 to 105 years) with at least one of 16 common chronic conditions. Descriptive statistics were used to examine and compare the prevalence of multimorbidity by age and number of conditions in 2003 and 2009. The co-occurrence of chronic conditions among individuals with multimorbidity was also explored.

Results

The prevalence of multimorbidity among Ontarians rose from 17.4% in 2003 to 24.3% in 2009, a 40% increase. This increase over time was evident across all age groups. Within individual chronic conditions, multimorbidity rates ranged from 44% to 99%. Remarkably, there were no dominant patterns of co-occurring conditions.

Conclusion

The high prevalence of multimorbidity and numerous combinations of conditions suggests that single, disease-oriented management programs may be less effective or efficient tools for high quality care compared to person-centered approaches.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1733-2) contains supplementary material, which is available to authorized users.

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Most cited references 56

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Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study.

Karen Barnett, Stewart Mercer, Michael Norbury … (2012)

Long-term disorders are the main challenge facing health-care systems worldwide, but health systems are largely configured for individual diseases rather than multimorbidity. We examined the distribution of multimorbidity, and of comorbidity of physical and mental health disorders, in relation to age and socioeconomic deprivation. In a cross-sectional study we extracted data on 40 morbidities from a database of 1,751,841 people registered with 314 medical practices in Scotland as of March, 2007. We analysed the data according to the number of morbidities, disorder type (physical or mental), sex, age, and socioeconomic status. We defined multimorbidity as the presence of two or more disorders. 42·2% (95% CI 42·1-42·3) of all patients had one or more morbidities, and 23·2% (23·08-23·21) were multimorbid. Although the prevalence of multimorbidity increased substantially with age and was present in most people aged 65 years and older, the absolute number of people with multimorbidity was higher in those younger than 65 years (210,500 vs 194,996). Onset of multimorbidity occurred 10-15 years earlier in people living in the most deprived areas compared with the most affluent, with socioeconomic deprivation particularly associated with multimorbidity that included mental health disorders (prevalence of both physical and mental health disorder 11·0%, 95% CI 10·9-11·2% in most deprived area vs 5·9%, 5·8%-6·0% in least deprived). The presence of a mental health disorder increased as the number of physical morbidities increased (adjusted odds ratio 6·74, 95% CI 6·59-6·90 for five or more disorders vs 1·95, 1·93-1·98 for one disorder), and was much greater in more deprived than in less deprived people (2·28, 2·21-2·32 vs 1·08, 1·05-1·11). Our findings challenge the single-disease framework by which most health care, medical research, and medical education is configured. A complementary strategy is needed, supporting generalist clinicians to provide personalised, comprehensive continuity of care, especially in socioeconomically deprived areas. Scottish Government Chief Scientist Office. Copyright © 2012 Elsevier Ltd. All rights reserved.

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Aging with multimorbidity: a systematic review of the literature.

Alessandra Marengoni, Sara Angleman, René F Melis … (2011)

A literature search was carried out to summarize the existing scientific evidence concerning occurrence, causes, and consequences of multimorbidity (the coexistence of multiple chronic diseases) in the elderly as well as models and quality of care of persons with multimorbidity. According to pre-established inclusion criteria, and using different search strategies, 41 articles were included (four of these were methodological papers only). Prevalence of multimorbidity in older persons ranges from 55 to 98%. In cross-sectional studies, older age, female gender, and low socioeconomic status are factors associated with multimorbidity, confirmed by longitudinal studies as well. Major consequences of multimorbidity are disability and functional decline, poor quality of life, and high health care costs. Controversial results were found on multimorbidity and mortality risk. Methodological issues in evaluating multimorbidity are discussed as well as future research needs, especially concerning etiological factors, combinations and clustering of chronic diseases, and care models for persons affected by multiple disorders. New insights in this field can lead to the identification of preventive strategies and better treatment of multimorbid patients. Copyright © 2011 Elsevier B.V. All rights reserved.

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A systematic review of prevalence studies on multimorbidity: toward a more uniform methodology.

Martin Fortin, Moira Stewart, Marie-Eve Poitras … (2012)

We sought to identify and compare studies reporting the prevalence of multimorbidity and to suggest methodologic aspects to be considered in the conduct of such studies. We searched the literature for English- and French-language articles published between 1980 and September 2010 that described the prevalence of multimorbidity in the general population, in primary care, or both. We assessed quality of included studies with a modified version of the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Results of individual prevalence studies were adjusted so that they could be compared graphically. The final sample included 21 articles: 8 described studies conducted in primary care, 12 in the general population, and 1 in both. All articles were of good quality. The largest differences in prevalence of multimorbidity were observed at age 75 in both primary care (with prevalence ranging from 3.5% to 98.5% across studies) and the general population (with prevalence ranging from 13.1% to 71.8% across studies). Apart from differences in geographic settings, we identified differences in recruitment method and sample size (primary care: 980-60,857 patients; general population: 1,099-316,928 individuals), data collection, and the operational definition of multimorbidity used, including the number of diagnoses considered (primary care: 5 to all; general population: 7 to all). This last aspect seemed to be the most important factor in estimating prevalence. Marked variation exists among studies of the prevalence of multimorbidity with respect to both methodology and findings. When undertaking such studies, investigators should carefully consider the specific diagnoses included and their number, as well as the operational definition of multimorbidity.

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Author and article information

Contributors

Anna J Koné Pefoyo: Anna.Kone@cancercare.on.ca

Susan E Bronskill: susan.bronskill@ices.on.ca

Andrea Gruneir: gruneir@ualberta.ca

Andrew Calzavara: andrew.calzavara@ices.on.ca

Kednapa Thavorn: kthavorn@ohri.ca

Yelena Petrosyan: yelena.petrosyan@mail.utoronto.ca

Colleen J Maxwell: colleen.maxwell@uwaterloo.ca

YuQing Bai: yuqing.bai@utoronto.ca

Walter P Wodchis: walter.wodchis@utoronto.ca

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 23 April 2015

Publication date PMC-release: 23 April 2015

Publication date Collection: 2015

Volume: 15

Electronic Location Identifier: 415

Affiliations

[ ]Cancer Screening, Cancer Care Ontario/Action Cancer Ontario, 505 University Avenue, Room 18-14, Toronto, M5G 1X3 Ontario Canada

[ ]Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON Canada

[ ]Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada

[ ]Institute for Clinical Evaluative Sciences, Toronto, ON Canada

[ ]Women’s College Research Institute, Women’s College Hospital, Toronto, ON Canada

[ ]Department of Family Medicine, University of Alberta, Edmonton, AB Canada

[ ]Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON Canada

[ ]School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON Canada

[ ]Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, Waterloo, ON Canada

[ ]Toronto Rehabilitation Institute, Toronto, ON Canada

Article

Publisher ID: 1733

DOI: 10.1186/s12889-015-1733-2

PMC ID: 4415224

PubMed ID: 25903064

SO-VID: 404598b1-8c44-47fb-97c2-fdb558268269

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 7 January 2015

Date accepted : 2 April 2015

Custom metadata

ScienceOpen disciplines: Public health

Keywords: multimorbidity,chronic conditions,prevalence,disease clusters,age,administrative health data,ontario

Data availability:

ScienceOpen disciplines: Public health

Keywords: multimorbidity, chronic conditions, prevalence, disease clusters, age, administrative health data, ontario

The increasing burden and complexity of multimorbidity

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Results

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Electronic supplementary material

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Jiangsu Journal of Preventive Medicine

Most cited references 56

Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study.

Aging with multimorbidity: a systematic review of the literature.

A systematic review of prevalence studies on multimorbidity: toward a more uniform methodology.

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