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Prevalence, Determinants and Patterns of Multimorbidity in Primary Care: A Systematic Review of Observational Studies

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  • Concepció Violan
  • Quintí Foguet-Boreu
  • Gemma Flores-Mateo
  • Chris Salisbury
  • Jeanet Blom
  • Michael Freitag
  • Liam Glynn
  • Christiane Muth
  • Jose M Valderas

Abstract

Introduction: Multimorbidity is a major concern in primary care. Nevertheless, evidence of prevalence and patterns of multimorbidity, and their determinants, are scarce. The aim of this study is to systematically review studies of the prevalence, patterns and determinants of multimorbidity in primary care. Methods: Systematic review of literature published between 1961 and 2013 and indexed in Ovid (CINAHL, PsychINFO, Medline and Embase) and Web of Knowledge. Studies were selected according to eligibility criteria of addressing prevalence, determinants, and patterns of multimorbidity and using a pretested proforma in primary care. The quality and risk of bias were assessed using STROBE criteria. Two researchers assessed the eligibility of studies for inclusion (Kappa = 0.86). Results: We identified 39 eligible publications describing studies that included a total of 70,057,611 patients in 12 countries. The number of health conditions analysed per study ranged from 5 to 335, with multimorbidity prevalence ranging from 12.9% to 95.1%. All studies observed a significant positive association between multimorbidity and age (odds ratio [OR], 1.26 to 227.46), and lower socioeconomic status (OR, 1.20 to 1.91). Positive associations with female gender and mental disorders were also observed. The most frequent patterns of multimorbidity included osteoarthritis together with cardiovascular and/or metabolic conditions. Conclusions: Well-established determinants of multimorbidity include age, lower socioeconomic status and gender. The most prevalent conditions shape the patterns of multimorbidity. However, the limitations of the current evidence base means that further and better designed studies are needed to inform policy, research and clinical practice, with the goal of improving health-related quality of life for patients with multimorbidity. Standardization of the definition and assessment of multimorbidity is essential in order to better understand this phenomenon, and is a necessary immediate step.

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  • 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.
    • Handle: RePEc:plo:pone00:0102149
    DOI: 10.1371/journal.pone.0102149
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    5. Neubert, Lydia & König, Hans-Helmut & Löbner, Margrit & Luppa, Melanie & Pentzek, Michael & Fuchs, Angela & Weeg, Dagmar & Bickel, Horst & Oey, Anke & Wiese, Birgitt & Weyerer, Siegfried & Werle, Joch, 2021. "Excess costs of dementia in old age (85+) in Germany: Results from the AgeCoDe-AgeQualiDe study," The Journal of the Economics of Ageing, Elsevier, vol. 20(C).
    6. Ha T.T. Dinh & Nguyet T. Nguyen & Ann Bonner, 2020. "Health literacy profiles of adults with multiple chronic diseases: A cross‐sectional study using the Health Literacy Questionnaire," Nursing & Health Sciences, John Wiley & Sons, vol. 22(4), pages 1153-1160, December.
    7. Karolina Agur & Gary McLean & Kate Hunt & Bruce Guthrie & Stewart W. Mercer, 2016. "How Does Sex Influence Multimorbidity? Secondary Analysis of a Large Nationally Representative Dataset," IJERPH, MDPI, vol. 13(4), pages 1-12, March.
    8. Juliane Tetzlaff & Denise Muschik & Jelena Epping & Sveja Eberhard & Siegfried Geyer, 2017. "Expansion or compression of multimorbidity? 10-year development of life years spent in multimorbidity based on health insurance claims data of Lower Saxony, Germany," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 62(6), pages 679-686, July.
    9. Viktoria Gastens & Arnaud Chiolero & Daniela Anker & Claudio Schneider & Martin Feller & Douglas C Bauer & Nicolas Rodondi & Cinzia Del Giovane, 2022. "Development and validation of a new prognostic index for mortality risk in multimorbid adults," PLOS ONE, Public Library of Science, vol. 17(8), pages 1-11, August.
    10. Slagboom, M. Nienke & Crone, Mathilde R. & Reis, Ria, 2022. "Exploring syndemic vulnerability across generations: A case study of a former fishing village in the Netherlands," Social Science & Medicine, Elsevier, vol. 295(C).
    11. 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.
    12. Januse Nogueira de Carvalho & Marianna de Camargo Cancela & Dyego Leandro Bezerra de Souza, 2018. "Lifestyle factors and high body mass index are associated with different multimorbidity clusters in the Brazilian population," PLOS ONE, Public Library of Science, vol. 13(11), pages 1-15, November.
    13. Nchidzi Ntiyani & Gobopamang Letamo & Mpho Keetile, 2022. "Prevalence of and factors associated with hypertension, diabetes, stroke and heart attack multimorbidity in Botswana: Evidence from STEPS 2014 survey," PLOS ONE, Public Library of Science, vol. 17(3), pages 1-16, March.
    14. Cristina M Lozano-Hernández & Juan Antonio López-Rodríguez & Milagros Rico-Blázquez & Amaia Calderón-Larrañaga & Francisca Leiva-Fernández & Alexandra Prados-Torres & Isabel del Cura-González & MULTIP, 2022. "Sex differences in social support perceived by polymedicated older adults with multimorbidity. MULTIPAP study," PLOS ONE, Public Library of Science, vol. 17(7), pages 1-16, July.
    15. Alina Schmitz & Patrick Lazarevič, 2020. "The gender health gap in Europe’s ageing societies: universal findings across countries and age groups?," European Journal of Ageing, Springer, vol. 17(4), pages 509-520, December.
    16. Marina Gabriela Nascimento Almeida & Mary Anne Nascimento-Souza & Maria Fernanda Lima-Costa & Sérgio Viana Peixoto, 2020. "Lifestyle factors and multimorbidity among older adults (ELSI-Brazil)," European Journal of Ageing, Springer, vol. 17(4), pages 521-529, December.
    17. Quintí Foguet-Boreu & Concepción Violán & Teresa Rodriguez-Blanco & Albert Roso-Llorach & Mariona Pons-Vigués & Enriqueta Pujol-Ribera & Yolima Cossio Gil & Jose M Valderas, 2015. "Multimorbidity Patterns in Elderly Primary Health Care Patients in a South Mediterranean European Region: A Cluster Analysis," PLOS ONE, Public Library of Science, vol. 10(11), pages 1-14, November.

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