Multimorbidity Trends in United States Adults, 1988–2014

Abstract

Importance:The simultaneous presence of multiple conditions in one patient (multi-morbidity) is a key challenge facing primary care.Objective: The purpose of this study was to determine the prevalence of multi-morbidity and to document changes in prevalence during the last 25 years.Design/Setting: Cross-sectional study using multiple years (1988 -2014) Results: A total of 57,303 individuals were surveyed regarding the presence of multi-morbidity in separate surveys spanning 1988 -2014. The overall current prevalence in 2013-2014 of >2 morbidities was 59.6% (95% CI 58.1%-61.1%), 38.5% had 3 or more, and 22.7% had 4 or more morbidities, which was significantly higher than in 1988 (45.7%, 95% CI 43.5%-47.8%, with >2 morbidities). Among individuals with 2 or more morbidities, 54.1% have obesity compared to 41.9% in 1988. Among adults age >65, prevalence was 91.8% for 2 or more morbidities. Whites and Blacks had significantly higher prevalence (59.2% and 60.1%) than Hispanic or "other" race (45.0%, P < .0001). Women (58.4%) had more current multi-morbidities (>2) than men (55.9%, P ‫؍‬ .01). The simultaneous presence of multiple conditions in one patient (multimorbidity) is a key challenge in primary care. Multimorbidity adds to the complexity of care and threatens the quality, coordination, continuity, and safety of care in the United States health care system and elsewhere. Despite the seriousness and far-reaching impacts of this phenomenon, characterization of this population in recent studies has focused on older populations, include a limited number of chronic conditions, and often do not include obesity as a chronic condition. [1][2][3][4][5][6][7][8] The burden on patients with multimorbidity is considerable and is associated with increased mortality. Conclusions and9-12 A recent meta-analysis by Nunes and colleagues 10 included 5806 multimorbidity studies, and mortality (26 studies were included) demonstrated a hazard ratio of 1.73 (95% CI, 1.41-2.13) and 2.72 (95% CI, 1.81-4.08) for people with 2 or more and 3 or more morbidities, respectively. This article was externally peer reviewed.

Era of geriatric medical challenges: Multimorbidity among older patients

“…1 The US National Health and Nutrition Examination Survey 2013-2014 found that among 5541 people aged ≥20 years, the prevalence of multimorbidity (two or more chronic diseases) was 59.6% overall, 37.5% in those aged 20-44 years, 70.6% in those aged 45-64 years and 91.5% in those aged ≥65 years. 2 In addition, the proportion with four or more chronic diseases was 6.0%, 26.4% and 55.6% for those aged 0-44 years, 45-64 years and ≥65 years, respectively. According to a survey of 3737 people aged ≥45 years in China, the prevalence of multimorbidity (two or more chronic diseases) was 34.9% in those aged 45-59 years, 54.9% in those aged 60-69 years and 60.6% in those aged ≥70 years.…”

“…Developed countries have experienced increases in the older adult population, as well as in life expectancy. The prevalence of various chronic diseases increases with age, and the number of older adults who simultaneously have multiple chronic diseases (multimorbidity) is increasing . In older adults, functional decline is observed in most organs, including the cardiac, respiratory and renal functions.…”

“…For example, a report from Scotland based on a database of 1 751 841 people aged 0–85 years showed 23.2% of people had two or more chronic diseases, and this percentage increased with age (64.9% in those aged 65–84 years and 81.5% in those aged ≥85 years) . The US National Health and Nutrition Examination Survey 2013–2014 found that among 5541 people aged ≥20 years, the prevalence of multimorbidity (two or more chronic diseases) was 59.6% overall, 37.5% in those aged 20–44 years, 70.6% in those aged 45–64 years and 91.5% in those aged ≥65 years . In addition, the proportion with four or more chronic diseases was 6.0%, 26.4% and 55.6% for those aged 0–44 years, 45–64 years and ≥65 years, respectively.…”

“…The prevalence of various chronic diseases increases with age, and the number of older adults who simultaneously have multiple chronic diseases (multimorbidity) is increasing. [1][2][3][4] In older adults, functional decline is observed in most organs, including the cardiac, respiratory and renal functions. This age-related functional decline occurs even without organ-specific diseases.…”

The Potpourri of Family Medicine, in Sickness and in Health

“…1 During 2013 to 2014, data from the National Health and Nutrition Examination Survey (NHANES) indicated an overall prevalence of Ն2 comorbidities was 60%; 39% had Ն3, and 23% had Ն4 -significantly higher than the prevalence in 1988 (46% with Ͼ2 comorbidities). Whites had the greatest increase, and obesity, its causes, and its comorbidities are likely substantial underlying factors.…”