Family Medicine

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World Book of Family Medicine – European Edition 2015 unit of counting is organ systems instead of diseases. Furthermore, the number of conditions studied is of major importance for prevalence estimates: the higher the number, the higher the occurrence of multimorbidity. Apart from a disease count there are a number of validated indices, such as the Charlson Index and the Cumulative Index Rating Scale. Although some indices cover only a limited number of diseases, they all aim to weigh the presumed impact according to illness burden. As chronic conditions widely differ in terms if severity and effects on survival and functioning, the mere number of chronic conditions do not necessarily have a major impact on outcomes. We can reasonably hypothesize that disease severity, disease duration and interactions between acute and chronic conditions are probably much more important than the mere count of chronic morbidities in increasing mortality risk. On the other hand, all studies agree on the fact that persons with multiple diseases have significant medical needs, which raises issues of resource allocation, equality and prioritization (2). There is a serious distinction between data collection based on physician-diagnosed diseases (chart, paper files, EMR), administrative data, or patient self-reported diseases (questionnaires, interviews). The agreement between physiciandiagnosed and patient-reported diseases is limited. Based on availability / feasibility, data choices made should be optimally adjusted to the research question. In general, it can be stated that the more specialized the care setting the higher the prevalence of multimorbidity. Going from the general population to people in the waiting room in primary care, to a hospitalized population, the prevalence of multimorbidity is likely to increase gradually. Future Research It has been argued that future studies must begin to investigate multimorbidity across life course, to enable the distinction between real longitudinal changes and cohort effects. Furthermore, overlooking the field, knowledge on determinants of multimorbidity is still lacking for the greater part. Key Points Population prevalence of multimorbidity is 20-30%; with a sharp increase above 55 years; in absolute numbers of all patients with multimorbidity, more than half are over 65 years of age. Older age, female sex and lower level of education are apparent determinants of multimorbidity. Different definitions of multimorbidity and other methodological decisions have an influence on the reported multimorbidity. Take Home Messages Population prevalence of multimorbidity is 20-30%; with a sharp increase above 55 years; in absolute numbers of all patients with multimorbidity more than half are older than 65 years. Older age, female sex and lower level of education are apparent determinants of multimorbidity. Different definitions of multimorbidity and other methodological decisions have an influence on the reported multimorbidity. Original Abstract http://www.woncaeurope.org/content/determinants-multi-morbidity References Full list of references is available on request from the first author. 1. Van den Akker M, Buntinx F, Knottnerus JA. Co-morbidity or multimorbidity: what's in a name? A review of literature. Eur J Gen Pract. 1996;2:65-70. 2. Marengoni A, Angelman S, Melis R, Mangialasche F, Karp A, Garmen A, et al. Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev. 2011;10:430-9. 3. Barnett K, Mercer S, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;379. 4. Khanam M, Streatfield P, Kabir Z, Qiu C, Cornelius C, Wahlin A. Prevalence and patterns of multimorbidity among elderly people in rural Bangladesh: a cross-sectional study. J Health Popul Nutr. 2011;29(4):406-14. 5. Andrade L, Bensenor I, Viana M, Andreoni S, Wang Y. Clustering of psychiatric and somatic illness in the general 74
World Book of Family Medicine – European Edition 2015 population: multimorbidity and socioeconomic correlates. Braz J Med Biolog Res. 2010;43(5):483-91. 6. Van den Akker M, Vos R, Knottnerus J. In an exploratory prospective study on multimorbidity general and disease related susceptibility could be distinguished. J Clin Epidemiol. 2006;59(9):934-9. 7. Quinones A, Liang J, Bennett J, Xu X, Ye W. How does the trajectory of multimorbidity vary across black, white, and Mexican Americans in middle and old age? Journals of Gerontology, Series B, Psychological Sciences and Social Sciences. 2011;66(6):739-49. 8. Van den Akker M, Buntinx F, Roos S, Knottnerus J. Problems in determining occurrence rates of multimorbidity. J Clin Epidemiol. 2001;54(7):675-9. 75
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