Prevalence of multimorbidity in community settings: A systematic review and meta-analysis of observational studies

Hai Nguyen, Gergana Manolova, Christina Daskalopoulou, Silia Vitoratou, Martin Prince, A Matthew Prina, Hai Nguyen, Gergana Manolova, Christina Daskalopoulou, Silia Vitoratou, Martin Prince, A Matthew Prina

Abstract

Background: With ageing world populations, multimorbidity (presence of two or more chronic diseases in the same individual) becomes a major concern in public health. Although multimorbidity is associated with age, its prevalence varies. This systematic review aimed to summarise and meta-analyse the prevalence of multimorbidity in high, low- and middle-income countries (HICs and LMICs).

Methods: Studies were identified by searching electronic databases (Medline, Embase, PsycINFO, Global Health, Web of Science and Cochrane Library). The term 'multimorbidity' and its various spellings were used, alongside 'prevalence' or 'epidemiology'. Quality assessment employed the Newcastle-Ottawa scale. Overall and stratified analyses according to multimorbidity operational definitions, HICs/LMICs status, gender and age were performed. A random-effects model for meta-analysis was used.

Results: Seventy community-based studies (conducted in 18 HICs and 31 LMICs) were included in the final sample. Sample sizes ranged from 264 to 162,464. The overall pooled prevalence of multimorbidity was 33.1% (95% confidence interval (CI): 30.0-36.3%). There was a considerable difference in the pooled estimates between HICs and LMICs, with prevalence being 37.9% (95% CI: 32.5-43.4%) and 29.7% (26.4-33.0%), respectively. Heterogeneity across studies was high for both overall and stratified analyses (I 2 > 99%). A sensitivity analysis showed that none of the reviewed studies skewed the overall pooled estimates.

Conclusion: A large proportion of the global population, especially those aged 65+, is affected by multimorbidity. To allow accurate estimations of disease burden, and effective disease management and resources distribution, a standardised operationalisation of multimorbidity is needed.

Keywords: HICs; LMICs; Multimorbidity; prevalence.

Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram of studies selection.
Figure 2.
Figure 2.
Age- and sex-specific prevalence of multimorbidity.
Figure 3.
Figure 3.
(a) Forest plot showing multimorbidity prevalence in HICs. (b) Forest plot showing multimorbidity prevalence in LMICs. HIC: high-income country; LMIC: low-income country.

References

    1. Academy of Medical Sciences. Multimorbidity: a priority for global health research. 2018. (accessed 12 May 2018).
    1. Ryan A, Wallace E, O’Hara P, et al. Multimorbidity and functional decline in community-dwelling adults: a systematic review. Health Qual Life Outcomes 2015; 13: 168.
    1. Nunes BP, Flores TR, Mielke GI, et al. Multimorbidity and mortality in older adults: a systematic review and meta-analysis. Arch Gerontol Geriatr 2016; 67: 130–138.
    1. Vetrano DL, Palmer K, Marengoni A, et al. Frailty and multimorbidity: a systematic review and meta-analysis. J Gerontol A Biol Sci Med Sci 2019; 74(5): 659–666.
    1. Salisbury C, Johnson L, Purdy S, et al. Epidemiology and impact of multimorbidity in primary care: a retrospective cohort study. Br J Gen Pract 2011; 61(582): e12–21.
    1. Huntley AL, Johnson R, Purdy S, et al. Measures of multimorbidity and morbidity burden for use in primary care and community settings: a systematic review and guide. Ann Fam Med 2012; 10(2): 134–141.
    1. Zulman DM, Pal Chee C, Wagner TH, et al. Multimorbidity and healthcare utilisation among high-cost patients in the US veterans affairs health care system. BMJ Open 2015; 5(4): e007771.
    1. Lee JT, Hamid F, Pati S, et al. Impact of noncommunicable disease multimorbidity on healthcare utilisation and out-of-pocket expenditures in middle-income countries: cross sectional analysis. PLoS One 2015; 10(7): e0127199.
    1. Akker MV, Buntinx F, Knottnerus A. Comorbidity or multimorbidity. What’s in a name: a review of literature. Eur J Gen Pract 1996; 2(2): 65–70.
    1. Violan C, Foguet-Boreu Q, Flores-Mateo G, et al. Prevalence, determinants and patterns of multimorbidity in primary care: a systematic review of observational studies. PLos One 2014; 9(7): e102149.
    1. Fortin M, Stewart M, Poitras ME, et al. A systematic review of prevalence studies on multimorbidity: toward a more uniform methodology. Ann Fam Med 2012; 10(2): 142–151.
    1. Pati S, Swain S, Hussain MA, et al. Prevalence and outcomes of multimorbidity in South Asia: a systematic review. BMJ Open 2015; 5(10): e007235.
    1. Shamseer L, Moher D, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ-Brit Med J 2015; 350: g7647.
    1. Modesti PA, Reboldi G, Cappuccio FP, et al. Panethnic differences in blood pressure in Europe: a systematic review and meta-analysis. PLoS One 2016; 11: e0147601.
    1. Viswanathan M, Ansari MT, Berkman ND, et al. Assessing the risk of bias of individual studies in systematic reviews of health care interventions. Rockville: Aency for Healthcare Research and Quality Methods Guide for Comparative Effectiveness Reviews, 2012.
    1. World Bank. World Bank list of economies. 2017. (accessed 30 August 2017).
    1. Nyaga V, Arbyn M, Aerts M. Metaprop: a Stata command to perform meta-analysis of binomial data. Arch Public Health 2014; 72: 39.
    1. Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21(11): 1539–1558.
    1. StataCorp. Stata statistical software: release 15. College Station: StataCorp LLC, 2017.
    1. Islam MM, Valderas JM, Yen L, et al. Multimorbidity and comorbidity of chronic diseases among the senior Australians: prevalence and patterns. PLoS One 2014; 9(1): e83783.
    1. Lujic S, Simpson JM, Zwar N, et al. Multimorbidity in Australia: comparing estimates derived using administrative data sources and survey data. PLoS One [Electronic Resource] 2017; 12(8): e0183817.
    1. Noguchi N, Blyth FM, Waite LM, et al. Prevalence of the geriatric syndromes and frailty in older men living in the community: the concord health and ageing in men project. [Erratum appears in Australas]. J Ageing 2017; 36(1): 80 PMID: 28326691 Australasian Journal on Ageing 2016; 35(4): 255–261.
    1. Ruel G, Levesque JF, Stocks N, et al. Understanding the evolution of multimorbidity: evidences from the North West Adelaide Health Longitudinal Study (NWAHS). PLoS One [Electronic Resource] 2014; 9(5): e96291.
    1. Wang L, Palmer AJ, Cocker F, et al. Multimorbidity and health-related quality of life (HRQoL) in a nationally representative population sample: implications of count versus cluster method for defining multimorbidity on HRQoL. Health & Qual Life Outcomes 2017; 15(1): 7.
    1. Agborsangaya CB, Ngwakongnwi E, Lahtinen M, et al. Multimorbidity prevalence in the general population: the role of obesity in chronic disease clustering. BMC Public Health 2013; 13: 1161.
    1. Ramond-Roquin A, Haggerty J, Lambert M, et al. Different Multimorbidity measures result in varying estimated levels of physical quality of life in individuals with multimorbidity: a cross-sectional study in the general population. BioMed Res Int 2016; 2016: 7845438.
    1. Roberts KC, Rao DP, Bennett TL, et al. Prevalence and patterns of chronic disease multimorbidity and associated determinants in Canada. Health Promot Chronic Dis Prev Can 2015; 35(6): 87–94.
    1. Sakib MN, Shooshtari S, St John P, et al. The prevalence of multimorbidity and associations with lifestyle factors among middle-aged Canadians: an analysis of Canadian Longitudinal Study on Aging data. BMC Public Health 2019; 19(1): 243.
    1. Afshar S, Roderick PJ, Kowal P, et al. Multimorbidity and the inequalities of global ageing: a cross-sectional study of 28 countries using the world health surveys. BMC Public Health 2015; 15: 776.
    1. Garin N, Koyanagi A, Chatterji S, et al. Global multimorbidity patterns: a cross-sectional, population-based, multi-country study. J Gerontol A-Bio Sci Med Sci 2016; 71(2): 205–214.
    1. Loza E, Jover JA, Rodriguez L, et al. Multimorbidity: prevalence, effect on quality of life and daily functioning, and variation of this effect when one condition is a rheumatic disease. Semin Arthritis Rheum 2009; 38(4): 312–319.
    1. Violan C, Foguet-Boreu Q, Hermosilla-Perez E, et al. Comparison of the information provided by electronic health records data and a population health survey to estimate prevalence of selected health conditions and multimorbidity. BMC Public Health 2013; 13: 251.
    1. Buttery AK, Du Y, Busch MA, et al. Changes in physical functioning among men and women aged 50-79 years in Germany: an analysis of National Health Interview and Examination Surveys, 1997-1999 and 2008-2011. BMC Geriat 2016; 16: 205.
    1. Fuchs J, Busch M, Lange C, et al. Prevalence and patterns of morbidity among adults in germany. Results of the German telephone health interview survey German Health Update (GEDA) 2009. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55(4): 576–586.
    1. Kirchberger I, Meisinger C, Heier M, et al. Patterns of multimorbidity in the aged population results from the KORA-age study. PLoS One 2012; 7(1): e30556.
    1. Laires P, Perelman J. The current and projected burden of multimorbidity: a cross-sectional study in a southern Europe population. Eur J Ageing 2018; 16: 181–192. No Pagination Specified.
    1. Rodrigues AM, Gregorio MJ, Sousa RD, et al. Challenges of ageing in Portugal: data from the EpiDoC cohort. Acta Med Port 2018; 31(2): 80–93.
    1. Quinaz Romana G, Kislaya I, Salvador MR, et al. Multimorbidity in Portugal: results from the first national health examination survey. [Portuguese]. Acta Med Port 2019; 32(1): 30–37.
    1. Dhalwani NN, O’Donovan G, Zaccardi F, et al. Long terms trends of multimorbidity and association with physical activity in older English population. Int J Behav Nutr Phys Act 2016; 13: 8.
    1. Humphreys J, Jameson K, Cooper C, et al. Early-life predictors of future multi-morbidity: results from the Hertfordshire cohort. Age Ageing 2018; 47(3): 474–478.
    1. Johnston MC, Black C, Mercer SW, et al. Impact of educational attainment on the association between social class at birth and multimorbidity in middle age in the Aberdeen children of the 1950s cohort study. BMJ Open 2019; 9(1): e024048 (no pagination).
    1. Cheung JTK, Yu R, Wu Z, et al. Geriatric syndromes, multimorbidity, and disability overlap and increase healthcare use among older Chinese. BMC Geriat 2018; 18(1): 147.
    1. Lai FTT, Guthrie B, Wong SYS, et al. Sex-specific intergenerational trends in morbidity burden and multimorbidity status in Hong Kong community: an age-period-cohort analysis of repeated population surveys. BMJ Open 2019; 9(1): e023927 (no pagination).
    1. Wong SYS, Mercer SW, Woo J, et al. The influence of multi-morbidity and self-reported socio-economic standing on the prevalence of depression in an elderly Hong Kong population. BMC Public Health 2008; 8: 119.
    1. Ge L, Wei Yap C, Heng BH. Sex differences in associations between multimorbidity and physical function domains among community-dwelling adults in Singapore. PLoS One 2018; 13(5): e0197443 (no pagination).
    1. Picco L, Achilla E, Abdin E, et al. Economic burden of multimorbidity among older adults: impact on healthcare and societal costs. BMC Health Serv Res 2016; 16: 173.
    1. Lang K, Alexander IM, Simon J, et al. The impact of multimorbidity on quality of life among midlife women: findings from a U.S. nationally representative survey. J Women’s Health 2015; 24(5): 374–383.
    1. Loprinzi PD. Sedentary behavior and medical multimorbidity. Physiol Behav 2015; 151: 395–397.
    1. Kiliari N, Theodosopoulou E, Papanastasiou E. Multimorbidity and unmet citizens’ needs and expectations urge for reforms in the health system of Cyprus: a questionnaire survey. JRSM Open 2014; 5(1): 2042533313515860.
    1. Larsen FB, Pedersen MH, Friis K, et al. A latent class analysis of multimorbidity and the relationship to socio-demographic factors and health-related quality of life. a National population-based study of 162,283 Danish adults. PLoS One [Electronic Resource] 2017; 12(1): e0169426.
    1. Le Cossec C, Perrine AL, Beltzer N, et al. Pre-frailty, frailty, and multimorbidity: prevalences and associated characteristics from two French national surveys. J Nutr Health Aging 2016; 20(8): 860–869.
    1. Ryan A, Murphy C, Boland F, et al. What is the impact of physical activity and physical function on the development of multimorbidity in older adults over time? A population-based cohort study. J Gerontol A, Biol Sci Med Sci 2018; 73(11): 1538–1544.
    1. Park B, Ock M, Lee HA, et al. Multimorbidity and health-related quality of life in Koreans aged 50 or older using KNHANES 2013-2014. Health & Qual Life Outcomes 2018; 16(1): 186.
    1. Timmermans EJ, Hoogendijk EO, Broese van Groenou MI, et al. Trends across 20 years in multiple indicators of functioning among older adults in the Netherlands. Eur J Public Health 2019: pii: ckz065.
    1. Marengoni A, Angleman S, Meinow B, et al. Coexisting chronic conditions in the older population: variation by health indicators. Eur J Intern Med 2016; 31: 29–34.
    1. Pache B, Vollenweider P, Waeber G, et al. Prevalence of measured and reported multimorbidity in a representative sample of the Swiss population. BMC Public Health 2015; 15: 164.
    1. Chen H, Cheng M, Zhuang Y, et al. Multimorbidity among middle-aged and older persons in urban China: prevalence, characteristics and health service utilization. Geriatr Gerontol Int 2018; 18(10): 1447–1452.
    1. Gu J, Chao J, Chen W, et al. Multimorbidity in the community-dwelling elderly in urban China. Arch Gerontol Geriatr 2017; 68: 62–67.
    1. Li X, Cai L, Cui WL, et al. Association of socioeconomic and lifestyle factors with chronic non-communicable diseases and multimorbidity among the elderly in rural southwest China. J Public Health 2019; 12: 12.
    1. Ruel G, Shi Z, Zhen S, et al. Association between nutrition and the evolution of multimorbidity: the importance of fruits and vegetables and whole grain products. Clin Nutr 2014; 33(3): 513–520.
    1. Su P, Ding H, Zhang W, et al. The association of multimorbidity and disability in a community-based sample of elderly aged 80 or older in Shanghai, China. BMC Geriat 2016; 16(1): 178.
    1. Wang HH, Wang JJ, Wong SY, et al. Epidemiology of multimorbidity in China and implications for the healthcare system: cross-sectional survey among 162,464 community household residents in southern China. BMC Med 2014; 12: 188.
    1. Wang R, Yan Z, Liang Y, et al. Prevalence and patterns of chronic disease pairs and multimorbidity among older Chinese adults living in a rural area. PLoS One [Electronic Resource] 2015; 10(9): e0138521.
    1. Wang SB, D’Arcy C, Yu YQ, et al. Prevalence and patterns of multimorbidity in northeastern China: a cross-sectional study. Public Health 2015; 129(11): 1539–1546.
    1. Banjare P, Pradhan J. Socio-economic inequalities in the prevalence of multi-morbidity among the rural elderly in Bargarh District of Odisha (India). PLoS One [Electronic Resource] 2014; 9(6): e97832.
    1. Shahul H, Nanjesh K, Naik PM, et al. Morbidity pattern among the elderly population in a rural area of Dakshina Kannada, Karnataka - a cross sectional study. Natl J Community Med 2015; 6(2): 222–225.
    1. Kshipra J, Perianaygam A. Urbanization, multi-morbidities and preference for health care facility: an insight from Rajasthan, India. J Urban Regional Anal 2018; 10(2): 143–176.
    1. Kumar D, Raithatha SJ, Gupta S, et al. Burden of self-reported Noncommunicable diseases in 26 villages of Anand district of Gujarat, India. Int J Chronic Dis 2015; 2015: 260143.
    1. Lalitha V, Vinod K, Barun K. Rising challenge of multiple morbidities among the rural poor in India - a case of the Sundarbans in West Bengal. Int J Med Sci Public Health 2016; 5(2): 343–350.
    1. Mini GK, Thankappan KR. Pattern, correlates and implications of non-communicable disease multimorbidity among older adults in selected Indian states: a cross-sectional study. BMJ Open 2017; 7(3): e013529.
    1. Singh K, Patel SA, Biswas S, et al. Multimorbidity in South Asian adults: prevalence, risk factors and mortality. J Public Health (Oxf) 2019; 41(1): 80–89.
    1. Amaral TLM, Amaral CA, Lima NS, et al. Multimorbidity, depression and quality of life among elderly people assisted in the family health strategy in Senador Guiomard, Acre, Brazil. Cien Saude Colet 2018; 23(9): 3077–3084.
    1. Araujo MEA, Silva MT, Galvao TF, et al. Prevalence and patterns of multimorbidity in amazon region of Brazil and associated determinants: a cross-sectional study. BMJ Open 2018; 8(11): e023398 (no pagination).
    1. De Carvalho JN, Roncalli AG, Cancela MC, et al. Prevalence of multimorbidity in the Brazilian adult population according to socioeconomic and demographic characteristics. PLoS One 2017; 12(4): e0174322.
    1. De Souza Santos MacHado V, Valadares ALR, Da Costa-Paiva LS, et al. Multimorbidity and associated factors in Brazilian women aged 40 to 65 years: a population-based study. Menopause 2012; 19(5): 569–575.
    1. Machado SSV, Valadares AL, Costa-Paiva LH, et al. Aging, obesity, and multimorbidity in women 50 years or older: a population-based study. Menopause 2013; 20(8): 818–824.
    1. Nunes BP, Batista SRR, Andrade FB, et al. Multimorbidity: the Brazilian longitudinal study of aging (ELSI-Brazil). Rev Saude Publica 2018; 52(Suppl 2): 10s.
    1. Nunes BP, Camargo-Figuera FA, Guttier M, et al. Multimorbidity in adults from a southern Brazilian city: occurrence and patterns. Int J Public Health 2016; 61(9): 1013–1020.
    1. Nunes BP, Thume E, Facchini LA. Multimorbidity in older adults: magnitude and challenges for the Brazilian health system. BMC Public Health 2015; 15: 1172.
    1. Valadares AL, Lui-Filho JF, Costa-Paiva L, et al. Middle-aged female sexual dysfunction and multimorbidity: a population-based study. Menopause 2016; 23(3): 304–310.
    1. Alaba O, Chola L. The social determinants of multimorbidity in South Africa. Int J Equity Health 2013; 12: 63.
    1. Khanam MA, Streatfield PK, Kabir ZN, et al. Prevalence and patterns of multimorbidity among elderly people in rural Bangladesh: a cross-sectional study. J Health Popul Nutr 2011; 29(4): 406–414.
    1. Hien H, Berthe A, Drabo MK, et al. Prevalence and patterns of multimorbidity among the elderly in Burkina Faso: cross-sectional study. Trop Med Int Health 2014; 19(11): 1328–1333.
    1. Camargo-Casas S, Suarez-Monsalve S, Zepeda MUP, et al. Multimorbidity, depressive symptoms, and self-reported health in older adults: a secondary analysis of the Sabe Bogota Study. Rev Inves Clin 2018; 70(4): 192–197.
    1. El Lawindi MI, Salem MR, Razik MMA, et al. Socioeconomic predictors of morbidities in a rural setting: a community based study. Int J Epidemiol 2019; 15(1): 1–7.
    1. Alimohammadian M, Majidi A, Yaseri M, et al. Multimorbidity as an important issue among women: results of a gender difference investigation in a large population-based cross-sectional study in West Asia. BMJ Open 2017; 7(5): e013548.
    1. Jerliu N, Toci E, Burazeri G, et al. Prevalence and socioeconomic correlates of chronic morbidity among elderly people in Kosovo: a population-based survey. BMC Geriatr 2013; 13: 22.
    1. Jankovic J, Mirkovic M, Jovic-Vranes A, et al. Association between non-communicable disease multimorbidity and health care utilization in a middle-income country: population-based study. Public Health 2018; 155: 35–42.
    1. Ninh Thi H, Ninh Hoang L, Khanal V, et al. Multimorbidity and its social determinants among older people in southern provinces, Vietnam. Int J Equity Health 2015; 14: 50.
    1. Marengoni A, Angleman S, Melis R, et al. Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev 2011; 10(4): 430–439.
    1. Harrison C, Britt H, Miller G, et al. Examining different measures of multimorbidity, using a large prospective cross-sectional study in Australian general practice. BMJ Open 2014; 4(7): e004694.
    1. Ferrer A, Formiga F, Sanz H, et al. Multimorbidity as specific disease combinations, an important predictor factor for mortality in octogenarians: the Octabaix study. Clin Interv Aging 2017; 12: 223–231.
    1. Quinones AR, Markwardt S, Botoseneanu A. Multimorbidity combinations and disability in older adults. J Gerontol a-Biol 2016; 71(6): 823–830.
    1. van den Bussche H, Koller KD, Kolonko T, et al. Which chronic diseases and disease combinations are specific to multimorbidity in the elderly? Results of a claims data based cross-sectional study in Germany. BMC Public Health 2011; 11: 101.
    1. Xu X, Mishra GD, Jones M. Mapping the global research landscape and knowledge gaps on multimorbidity: a bibliometric study. J Glob Health 2017; 7(1): 010414.
    1. Fortin M, Bravo G, Hudon C, et al. Prevalence of multimorbidity among adults seen in family practice. Ann Fam Med 2005; 3(3): 223–228.
    1. Pathirana TI, Jackson CA. Socioeconomic status and multimorbidity: a systematic review and meta-analysis. Aust Nz J Public Health 2018; 42(2): 186–194.

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