Review ArticleSystematic Review

A Systematic Review of Prevalence Studies on Multimorbidity: Toward a More Uniform Methodology

Martin Fortin, Moira Stewart, Marie-Eve Poitras, José Almirall and Heather Maddocks
The Annals of Family Medicine March 2012, 10 (2) 142-151; DOI: https://doi.org/10.1370/afm.1337

Article Figures & Data

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Tables

  • Table 1

    Studies Reporting Prevalence of Multimorbidity in Primary Care Settings

    SampleMethods
    Study (Year)CountryNo. of PatientsAge, yRecruitmentData CollectionNo. of Diagnoses Considered
    Schellevis et al (1993)15The Netherlands23,534AllPatients registered in 7 general practicesMedical history from patient records5
    van den Akker et al (1998)1The Netherlands60,857AllPatients included in the Registration Network of Family Practices (15 practices)Medical history from computerized databaseICPC codes related to diagnostic categories
    Macleod et al (2004)16United Kingdom7,286≥18Patients registered in a practiceMedical history from computerized database8 major diseases
    Fortin et al (2005)13Canada980≥18Patients in the waiting room of 21 family physiciansMedical history from patient recordsAll
    Kadam et al (2007)14United Kingdom9,439≥50Responders to a survey who consulted their GP before the surveyMedical history from patient records185 morbidities categorized on 4 ordinal scales of severity
    Schram et al (2008)30The Netherlands2,895 (setting 1), 5,610 (setting 2)≥55Patients from 2 GP registries, 1 of 4 general practices with 10 GPs and another of 4 general practices with 20 GPsMedical history from patient records68 morbidities (setting 1) and 83 morbidities (setting 2), with >2% prevalence
    Uijen and van de Lisdonk (2008)2The Netherlands13,584AllPatients included in the Primary Care Research Network, 4 practices (10 GPs)Medical history from patient recordsAll chronic diseases with an ICHPPC code except very rare conditions
    Britt et al (2008)12Australia9,156AllPatients attending 305 GPsGPs recorded morbidity, using their knowledge of patients, patient self-report, and medical records18 morbidities or categories classified into 8 CIRS morbidity domains and 1 additional domain for malignancies
    Minas et al (2010)17Greece20,299>14Patients visiting 4 primary health care centers and willing to participateStructured questionnaires completed by study coordinators who also checked medical recordsAll chronic diseases; diseases recorded were included in their respective organ system according to ICPC codes

    • CIRS = Cumulative Illness Rating Scale; GP = general practitioner; ICHPPC = International Classification of Health Problems in Primary Care; ICPC = International Classification of Primary Care.

  • Table 2

    Studies Reporting Prevalence of Multimorbidity in the General Population

    SampleMethods
    Study (Year)CountryNo. of IndividualsAge, yRecruitmentData CollectionNo. of Diagnoses Considered
    Verbrugge et al (1989)27United States16,148≥551984 National Health Interview Survey, the Supplement on AgingQuestionnaire completed by interview13
    Newacheck et al (1991)24United States7,46510–171988 National Health Interview Survey on Child HealthQuestionnaire completed by interview>50
    Hoffman et al (1996)22United States27,505All1987 National Medical Expenditure SurveyQuestionnaire completed by interviewAll chronic conditions classified in ICD-9 codes
    Fuchs et al (1998)26Israel1,48775–94A national random stratified sampleQuestionnaire completed by interview14
    Menotti et al (2001)20Finland, The Netherlands, Italy716 (Finland), 887 (the Netherlands), and 682 (Italy)Men 65–84Cohorts recruited in particular locationsClinical examination7
    Rapoport et al (2004)25Canada17,244>201999 National Population Health SurveyQuestionnaire completed by interview22
    Partnership for Solutions (2004)29United States(Not reported)All2001 National Medical Expenditure SurveyQuestionnaire completed by interviewAll chronic conditions classified in ICD-9 codes
    Naughton et al (2006)23Ireland316,928Individuals from a national pharmacy claims databaseConditions identified from ≥3 dispensed items associated with a specific chronic condition9
    Nagel et al (2008)21Germany13,78150–75Participants in the EPIC subcohort of Heidelberg recruited from the general populationQuestionnaire completed by interview13 diagnostic groups
    Marengoni et al (2008)19Sweden1,09977–100Inhabitants of the Kungsholmen area in StockholmClinical assessment, medical history, laboratory data, and current drug useAll chronic conditions
    Schram et al (2008)30The Netherlands1,691+1,002 (LASA), 7,983 (Rotterdam), and 599 (Leiden)55–94 (LASA), ≥65 (Rotterdam), 85 (Leiden)Inhabitants of the different geographic locationsMedical history from self-reports as well as from the GP (LASA); an extensive physical examination (Rotterdam); medical history obtained from GP or treating nursing home physician (Leiden)Varied by location: 12 diagnoses (LASA), 12 diagnoses (Rotterdam), and 13 diagnoses (Leiden)
    Cazale and Dumitru (2008)28Canada~26,000≥12Quebec residents included in the 2005 National Population Health SurveyQuestionnaire completed by interview7
    Loza et al (2009)18Spain2,192>20National random sample taking into account the Spanish rural-urban ratioQuestionnaire completed by interviewAll diseases

    • EPIC = European Prospective Investigation into Cancer and Nutrition; GP = general practitioner; ICD-9=International Classification of Diseases, Ninth Revision; LASA=Longitudinal Aging Study Amsterdam.

Additional Files

  • Supplemental Appendixes

    Supplemental Appendix 1. Electronic Literature Search of the MEDLINE and MANTIS Databases (1980-2010); Supplemental Appendix 2. Quality Assessment of the Studies Retained in the Review, Based on a Modified (Shorter) Version of STROBE

    Files in this Data Supplement:

  • The Article in Brief

    A Systematic Review of Prevalence Studies on Multimorbidity: Toward a More Uniform Methodology

    Martin Fortin , and colleagues

    Background This systematic review identifies and compares studies reporting the prevalence of multimorbidity (multiple medical conditions) in patients and suggests methodological aspects to be considered in the conduct of such studies.

    What This Study Found In studies looking at the prevalence of multimorbidity, there is a great deal of variation in both methods and findings. The largest differences in prevalence, in both primary care and the general population, are seen at the age of 75 years. In addition to differing geographic settings, the studies differ in recruitment method and sample size, data collection, and operational definitions of multimorbidity, including the number of conditions and the conditions selected. All of these differences affect prevalence estimates.

    Implications

    • Use of more uniform methodology should permit more accurate estimation of the prevalence of multimorbidity and facilitate comparisons across settings and populations.
    • Investigators designing future studies should consider the number of diagnoses to be assessed (with 12 or more frequent diagnoses of chronic diseases appearing ideal) and should attempt to report results for differing definitions of multimorbidity (both 3 or more diseases and the classic 2 or more diseases).
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