Chapter 2
How Common Is Multimorbidity?
Marjan van den Akker1,2 and Christiane Muth3
1School CAPHRI, Department of Family Medicine, Institute for Education FHML, Medical Programme, Maastricht University, Netherlands
2Department of General Practice, KU Leuven, Belgium
3Institute of General Practice, Johann Wolfgang Goethe University, Germany
Overview
- The absolute number of patients suffering from multimorbidity – however, wherever and whenever measured – is large and increasing
- The absolute number of people with multimorbidity is higher among young and middle-aged people (<65 years) than among older people (≥ 65 years)
- Multimorbidity is more frequent among older patients and patients with lower socio-economic status
- Patients suffering from multimorbidity are at risk of fragmented care and polypharmacy
- Further characterization of patients with multimorbidity in terms of both disease profiles and psychosocial profiles is warranted, in order to develop better patient-oriented care programmes and clinical decision support.
Introduction
In Chapter 1, the multiplicity and complexity of the concept of multimorbidity was introduced. Differing concepts and definitions of multimorbidity have led to a variety of ways of measuring multimorbidity. Applying these in different settings and populations and making use of different data sources mean that prevalence estimates vary widely and are not easy to compare and interpret. In this chapter, we will present estimates of prevalence rates of multimorbidity in different settings and using different definitions. In ‘Prevalence estimates’ section, we will discuss socio-economic influences as well as biopsychosocial parameters, which are known to be associated with an increased prevalence of multimorbidity, for example the influence of social class or social network and cross-country differences. In ‘Factors associated with the prevalence of multimorbidity’ section, some insight is provided into the problem of polypharmacy – one of the most prominent consequences of multimorbidity (Box 2.1).
Box 2.1
Are there big differences between the prevalence of multimorbidity in non-western countries as compared to developed countries?
What are the two factors that have the strongest association with the prevalence of multimorbidity?
What is a possible explanation for the plateau that is observed at an advanced age in prevalence studies?
How is polypharmacy defined?
Prevalence estimates
The setting of studies assessing the prevalence of multimorbidity influences the findings. As can be expected, there are large differences in the prevalence of multimorbidity between older patients in hospital and those consulting in primary care and community-dwelling older people. Looking at hospitalized patients, they often suffer from multiple chronic diseases. Studies from different Western countries report prevalence rates of 22–65% multimorbidity for all inpatients, and even up to 96% in patients admitted from an emergency unit to the medical wards.
The prevalence of multimorbidity in primary care and general populations also varies widely across studies in Western countries. In some countries those populations are very similar, whereas in other countries not all inhabitants are enrolled in primary care. An average prevalence of multimorbidity of 20–30% has been reported when considering the whole population, and 55–98% when only older people are included in the analyses. Looking at different (cross-sectional) studies, both higher prevalence and lower prevalence are reported in the literature. As pointed out in Chapter 1, the methodology used has a strong influence on the prevalence of multimorbidity found. However, the proportions are reasonably comparable if only studies are included that measure multimorbidity in a set of 12 or more diseases (Figure 2.1).
Figure 2.1 Multimorbidity reported in primary care settings.
Several studies have indicated an increase in multimorbidity prevalence during the first decade of this century, suggesting a likely further rise of multimorbidity prevalence in the coming years.
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