Prevalence and patterns of multimorbidity in Australian baby boomers: the Busselton healthy ageing study

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Abstract

Background and objective

Chronic medical conditions accumulate within individuals with age. However, knowledge concerning the trends, patterns and determinants of multimorbidity remains limited. This study assessed the prevalence and patterns of multimorbidity using extensive individual phenotyping in a general population of Australian middle-aged adults.

Methods

Participants ( n = 5029, 55% female), born between 1946 and 1964 and attending the cross-sectional phase of the Busselton Healthy Ageing Study (BHAS) between 2010 and 2015, were studied. Prevalence of 21 chronic conditions was estimated using clinical measurement, validated instrument scores and/or self-reported doctor-diagnosis. Non-random patterns of multimorbidity were explored using observed/expected (O/E) prevalence ratios and latent class analysis (LCA). Variables associated with numbers of conditions and class of multimorbidity were investigated.

Results

The individual prevalence of 21 chronic conditions ranged from 2 to 54% and multimorbidity was common with 73% of the cohort having 2 or more chronic conditions. (mean ± SD 2.75 ± 1.84, median = 2.00, range 0–13). The prevalence of multimorbidity increased with age, obesity, physical inactivity, tobacco smoking and family history of asthma, diabetes, myocardial infarct or cancer. There were 13 pairs and 27 triplets of conditions identified with a prevalence > 1.5% and O/E > 1.5. Of the triplets, arthritis (> 50%), bowel disease (> 33%) and depression-anxiety (> 33%) were observed most commonly. LCA modelling identified 4 statistically and clinically distinct classes of multimorbidity labelled as: 1) “Healthy” (70%) with average of 1.95 conditions; 2) “Respiratory and Atopy” (11%, 3.65 conditions); 3) “Non-cardiometabolic” (14%, 4.77 conditions), and 4) “Cardiometabolic” (5%, 6.32 conditions). Predictors of multimorbidity class membership differed between classes and differed from predictors of number of co-occurring conditions.

Conclusion

Multimorbidity is common among middle-aged adults from a general population. Some conditions associated with ageing such as arthritis, bowel disease and depression-anxiety co-occur in clinically distinct patterns and at higher prevalence than expected by chance. These findings may inform further studies into shared biological and environmental causes of co-occurring conditions of ageing. Recognition of distinct patterns of multimorbidity may aid in a holistic approach to care management in individuals presenting with multiple chronic conditions, while also guiding health resource allocation in ageing populations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11578-y.

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Most cited references 41

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Author and article information

Contributors

Michael L. Hunter:

ORCID: http://orcid.org/0000-0001-6704-4815

michael.hunter@uwa.edu.au

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): 11 August 2021

Publication date PMC-release: 11 August 2021

Publication date Collection: 2021

Volume: 21

Electronic Location Identifier: 1539

Affiliations

[1 ]Busselton Population Medical Research Institute Inc, Nedlands, WA 6009 Australia

[2 ]GRID grid.1012.2, ISNI 0000 0004 1936 7910, School of Population and Global Health, The University of Western Australia, ; Crawley, WA 6009 Australia

[3 ]BPMRI Busselton Health Study Centre, PO Box 659, Busselton, Western Australia 6280

[4 ]GRID grid.415461.3, ISNI 0000 0004 6091 201X, PathWest Laboratory Medicine of WA, , QEII Medical Centre, ; Nedlands, WA 6009 Australia

[5 ]GRID grid.3521.5, ISNI 0000 0004 0437 5942, Department of Pulmonary Physiology and Sleep Medicine, , Sir Charles Gairdner Hospital, ; Nedlands, WA 6009 Australia

[6 ]GRID grid.1012.2, ISNI 0000 0004 1936 7910, Faculty of Health and Medical Sciences, , Medical School, University of Western Australia, ; Crawley, 6009 Australia

[7 ]GRID grid.1038.a, ISNI 0000 0004 0389 4302, Exercise Medicine Research Institute, Edith Cowan University, ; Joondalup, WA 6027 Australia

[8 ]GRID grid.1012.2, ISNI 0000 0004 1936 7910, School of Psychological Science, University of Western Australia, ; Perth, WA 6083 Australia

[9 ]GRID grid.1032.0, ISNI 0000 0004 0375 4078, School of Physiotherapy and Exercise Science, Curtin University, ; Bentley, WA 6845 Australia

[10 ]GRID grid.3521.5, ISNI 0000 0004 0437 5942, Department of Endocrinology and Diabetes, , Sir Charles Gairdner Hospital, ; Nedlands, WA 6009 Australia

[11 ]GRID grid.466593.b, ISNI 0000 0004 0636 2475, Ear Science Institute Australia, ; Subiaco, WA 6008 Australia

[12 ]GRID grid.1012.2, ISNI 0000 0004 1936 7910, Ear Sciences Centre, , The University of Western Australia, ; Crawley, WA Australia

[13 ]GRID grid.49697.35, ISNI 0000 0001 2107 2298, Department of Speech Language Pathology and Audiology, , University of Pretoria, ; Pretoria, South Africa

[14 ]GRID grid.415051.4, ISNI 0000 0004 0402 6638, Medical School, University of Western Australia, Fremantle Hospital, ; Fremantle, WA 6959 Australia

[15 ]GRID grid.1489.4, ISNI 0000 0000 8737 8161, Centre for Ophthalmology and Visual Science, , University of Western Australia, Lions Eye Institute, ; Perth, Australia

Author information

Michael L. Hunter http://orcid.org/0000-0001-6704-4815

Matthew W. Knuiman https://orcid.org/0000-0001-8874-2305

Bill (A.W.) Musk https://orcid.org/0000-0003-4730-4645

Jennie Hui https://orcid.org/0000-0002-1653-2496

Kevin Murray https://orcid.org/0000-0002-8856-6046

John P. Beilby https://orcid.org/0000-0002-4915-2254

David R. Hillman https://orcid.org/0000-0001-9987-539X

Joseph Hung https://orcid.org/0000-0002-4468-6097

Robert U. Newton https://orcid.org/0000-0003-0302-6129

Romola S. Bucks https://orcid.org/0000-0002-4207-4724

Leon Straker https://orcid.org/0000-0002-7786-4128

John P. Walsh https://orcid.org/0000-0002-1766-2612

Kun Zhu https://orcid.org/0000-0002-8723-7574

David G. Bruce https://orcid.org/0000-0002-9979-6867

Robert H. Eikelboom https://orcid.org/0000-0003-2911-5381

Timothy M. E. Davis https://orcid.org/0000-0003-0749-7411

David A. Mackey https://orcid.org/0000-0001-7914-4709

Alan L. James https://orcid.org/0000-0002-6018-0547

Article

Publisher ID: 11578

DOI: 10.1186/s12889-021-11578-y

PMC ID: 8359115

PubMed ID: 34380465

SO-VID: 56fa5bfa-aa6e-46c3-9118-0c54f993941e

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. 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 in a credit line to the data.

History

Date received : 27 January 2021

Date accepted : 30 July 2021

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100003921, Department of Health, Australian Government;

Funded by: City of Busselton

Funded by: Government of Western Australia (Department of Jobs, Tourism, Science and Innovation)

Custom metadata

ScienceOpen disciplines: Public health

Keywords: multimorbidity,ageing,co-morbidities,middle-aged,chronic disease

Data availability:

ScienceOpen disciplines: Public health

Keywords: multimorbidity, ageing, co-morbidities, middle-aged, chronic disease

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Prevalence and patterns of multimorbidity in Australian baby boomers: the Busselton healthy ageing study

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Abstract

Background and objective

Methods

Results

Conclusion

Supplementary Information

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Jiangsu Journal of Preventive Medicine

Most cited references 41

A brief measure for assessing generalized anxiety disorder: the GAD-7.

The PHQ-9: validity of a brief depression severity measure.

A new equation to estimate glomerular filtration rate.

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Cited by 7

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