Multimorbidity: Prevalence, Effect on Quality of Life and Daily Functioning, and Variation of This Effect When one Condition Is a Rheumatic Disease

doi:10.1016/j.semarthrit.2008.01.004

Seminars in Arthritis and Rheumatism

Volume 38, Issue 4, February 2009, Pages 312-319

https://doi.org/10.1016/j.semarthrit.2008.01.004 Get rights and content

Objectives

To examine the prevalence and effect of multimorbidity on health-related quality of life (HRQoL) and daily functioning in the general population, and to analyze the influence on HRQoL and daily functioning of multimorbidity including a rheumatic disease.

Methods

A national health survey was conducted on 2192 randomly selected adults in Spain. Multimorbidity was defined as the co-occurrence of at least 2 chronic diseases, as defined by self-report. All subjects completed the 12-item short form (SF-12) health survey and the Health Assessment Questionnaire (HAQ). Estimates and 95% confidence intervals (CI) of the prevalence of multimorbidity were obtained. The effect on HAQ and SF-12 scores is presented as β-coefficients obtained from multiple linear regressions.

Results

The estimated prevalence of multimorbidity was 30% (95% CI 25 to 34), and the prevalence of multimorbidity including a rheumatic disease was 17% (95% CI 13 to 20). Multimorbidity was associated with impaired daily functioning [HAQ β = 0.07 (95% CI 0.02 to 0.11)], and lower HRQoL [SF-12_{physical component} β = −4.2 (95% CI −5.2 to −3.22); SF-12_{mental dimension} β = −3.3 (95% CI −4.5 to −2.2)]. Subjects with multimorbidity including a rheumatic disease reported worse scores than those without a rheumatic disease: HAQ β 0.13 (95% CI 0.07 to 0.18) versus −0.03 (95% CI −0.08 to 0.02), and SF-12_{physical component} β −6.5 (95% CI −5.2 to -3.2) versus 0.5 (95% CI −0.7 to 1.7).

Conclusions

Multimorbidity is frequent in the general population and can considerably impair daily functioning and HRQoL. Having a rheumatic disease worsens these outcomes.

Section snippets

Study Design

The EPISER study was a health survey conducted by the Spanish Society of Rheumatology in 1999 to 2000 to assess the prevalence and burden of musculoskeletal diseases in the general population of Spain. This study has been previously described in detail (22).

Sample and Data Collection

A random sample of subjects older than 20 years was drawn in 3 stages. First, the country, which is composed of 19 autonomous communities, was divided into 8 strata, according to geographical and cultural proximity, each of which was roughly

Results

A random sample of 2998 subjects was selected from an eligible population of 972,545. The final sample sized comprised 2192 subjects who completed the interview, giving a response rate of 73%. The estimated prevalence for the 9 groups of chronic diseases was as follows: rheumatic diseases, 23% (19-26); hypertension, 17% (15-19); hypercholesterolemia, 14% (10-17); digestive diseases, 10% (7-13); allergies, 8% (5-11); cardiac diseases, 6% (5-7); pulmonary diseases, 6% (5-7); diabetes, 5% (4-6);

Discussion

Our results highlight the importance of the co-occurrence of 2 or more chronic conditions in the same person (multimorbidity) as a major health problem in the general population. Multimorbidity is frequent and negatively affects HRQoL and daily functioning. We have also shown the additional negative effect of having a rheumatic disease as part of this multimorbidity.

Two major strengths of this study are the representativeness of the study sample, as previously shown (22), and the high response

Acknowledgments

EPISER was supported by a grant from the Fondo de Investigaciones de la Seguridad Social (FIS 99/0251) and sponsored by Merck Sharp and Dohme España. The authors appreciate the invaluable help of government personnel in the study cities and at the health centers that provided the time and space for the survey. Pharmaconsult (Madrid, Spain) was responsible for the study logistics.

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Quality of lifeMultimorbidity: Prevalence, Effect on Quality of Life and Daily Functioning, and Variation of This Effect When one Condition Is a Rheumatic Disease

Objectives

Methods

Results

Conclusions

Section snippets

Study Design

Sample and Data Collection

Results

Discussion

Acknowledgments

J Clin Epidemiol

J Clin Epidemiol

J Clin Epidemiol

Ann Epidemiol

J Clin Epidemiol

Heart Lung

J Clin Epidemiol

Gac Sanit

Gen Hosp Psychiatry

Persons with chronic conditionsTheir prevalence and costs

JAMA

Health-related quality of life associated with chronic conditions in eight countries: results from the International Quality of Life Assessment (IQOLA) Project

Qual Life Res

Morbidity, comorbidity, and their association with disability among community-dwelling oldest-old in Israel

J Gerontol A Biol Sci Med Sci

Prevalence of multimorbidity among adults seen in family practice

Ann Fam Med

Partnership for solutionsChronic Conditions: Making the case for ongoing care. Robert Wood Johnson Foundation and John Hopkins University

The importance of co-existent disease in the occurrence of postoperative complications and one-year recovery in patients undergoing total hip replacementComorbidity and outcomes after hip replacement

Med Care

Patient-related risk factors that predict poor outcome after total hip replacement

Health Serv Res

Patient, disease, and therapy-related factors that influence discontinuation of disease-modifying antirheumatic drugs: a population-based incidence cohort of patients with rheumatoid arthritis

J Rheumatol

The cost of diabetes in the presence of comorbid conditions

Manag Care Interface

Health and disability costs of depressive illness in a major U.S. corporation

Am J Psychiatry

Multimorbidity and quality of life in primary care: a systematic review

Health Qual Life Outcomes

Quality of life in dementia: more than just cognitionAn analysis of associations with quality of life in dementia

J Neurol Neurosurg Psychiatry

Quality of life
Multimorbidity: Prevalence, Effect on Quality of Life and Daily Functioning, and Variation of This Effect When one Condition Is a Rheumatic Disease