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Estimating and characterizing the burden of multimorbidity in the community: A comprehensive multistep analysis of two large nationwide representative surveys in France

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  • Joël Coste
  • José M Valderas
  • Laure Carcaillon-Bentata

Abstract

Background: Given the increasing burden of chronic conditions, multimorbidity is now a priority for healthcare and public health systems worldwide. Appropriate methodological approaches for assessing the phenomenon have not yet been established, resulting in inconsistent and incomplete descriptions. We aimed to estimate and characterize the burden of multimorbidity in the adult population in France in terms of number and type of conditions, type of underlying mechanisms, and analysis of the joint effects for identifying combinations with the most deleterious interaction effects on health status. Methods and findings: We used a multistep approach to analyze cross-sectional and longitudinal data from 2 large nationwide representative surveys: 2010/2014 waves of the Health, Health Care, and Insurance Survey (ESPS 2010–2014) and Disability Healthcare Household Survey 2008 (HSM 2008), that collected similar data on 61 chronic or recurrent conditions. Adults aged ≥25 years in either ESPS 2010 (14,875) or HSM 2008 (23,348) were considered (participation rates were 65% and 62%, respectively). Longitudinal analyses included 7,438 participants of ESPS 2010 with follow-up for mortality (97%) of whom 3,798 were reinterviewed in 2014 (52%). Mortality, activity limitation, self-reported health, difficulties in activities/instrumental activities of daily living, and Medical Outcomes Study Short-Form 12-Item Health Survey were the health status measures. Multiple regression models were used to estimate the impact of chronic or recurrent conditions and multimorbid associations (dyads, triads, and tetrads) on health status. Etiological pathways explaining associations were investigated, and joint effects and interactions between conditions on health status measures were evaluated using both additive and multiplicative scales. Conclusions: Multimorbidity assessments should move beyond simply counting conditions and take into account the variable impacts on health status, etiological pathways, and joint effects of associated conditions. In particular, the multimorbid combinations with substantial health impacts or shared risk factors deserve closer attention. Our findings also suggest that multimorbidity assessment and management may be beneficial already in midlife and probably earlier in disadvantaged groups. Why was this study done?: What did the researchers do and find?: What do these findings mean?:

Suggested Citation

  • Joël Coste & José M Valderas & Laure Carcaillon-Bentata, 2021. "Estimating and characterizing the burden of multimorbidity in the community: A comprehensive multistep analysis of two large nationwide representative surveys in France," PLOS Medicine, Public Library of Science, vol. 18(4), pages 1-22, April.
    • Handle: RePEc:plo:pmed00:1003584
    DOI: 10.1371/journal.pmed.1003584
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    1. Concepció Violan & Quintí Foguet-Boreu & Gemma Flores-Mateo & Chris Salisbury & Jeanet Blom & Michael Freitag & Liam Glynn & Christiane Muth & Jose M Valderas, 2014. "Prevalence, Determinants and Patterns of Multimorbidity in Primary Care: A Systematic Review of Observational Studies," PLOS ONE, Public Library of Science, vol. 9(7), pages 1-9, July.
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    1. Joël Coste & José M Valderas & Laure Carcaillon-Bentata, 2022. "The epidemiology of multimorbidity in France: Variations by gender, age and socioeconomic factors, and implications for surveillance and prevention," PLOS ONE, Public Library of Science, vol. 17(4), pages 1-21, April.

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