Prevalence of multimorbidity in community settings: A systematic review and meta-analysis of observational studies

Abstract

Background: With ageing world populations, multimorbidity (presence of two or more chronic diseases in the same individual) becomes a major concern in public health. Although multimorbidity is associated with age, its prevalence varies. This systematic review aimed to summarise and meta-analyse the prevalence of multimorbidity in high, low- and middle-income countries (HICs and LMICs). Methods: Studies were identified by searching electronic databases (Medline, Embase, PsycINFO, Global Health, Web of Science and Cochrane Library). The term ‘multimorbidity’ and its various spellings were used, alongside ‘prevalence’ or ‘epidemiology’. Quality assessment employed the Newcastle-Ottawa scale. Overall and stratified analyses according to multimorbidity operational definitions, HICs/LMICs status, gender and age were performed. A random-effects model for meta-analysis was used. Results: Seventy community-based studies (conducted in 18 HICs and 31 LMICs) were included in the final sample. Sample sizes ranged from 264 to 162,464. The overall pooled prevalence of multimorbidity was 33.1% (95% confidence interval (CI): 30.0–36.3%). There was a considerable difference in the pooled estimates between HICs and LMICs, with prevalence being 37.9% (95% CI: 32.5–43.4%) and 29.7% (26.4–33.0%), respectively. Heterogeneity across studies was high for both overall and stratified analyses ( I 2 > 99%). A sensitivity analysis showed that none of the reviewed studies skewed the overall pooled estimates. Conclusion: A large proportion of the global population, especially those aged 65+, is affected by multimorbidity. To allow accurate estimations of disease burden, and effective disease management and resources distribution, a standardised operationalisation of multimorbidity is needed.

Associations between complex multimorbidity, activities of daily living and mortality among older Norwegians. A prospective cohort study: the HUNT Study, Norway

“…There was a weaker association between men with complex multimorbidity and IADL disability compared with women with complex multimorbidity. This is in line with a previous meta-analysis and systematic reviews that have found women to have higher prevalence and to be more strongly associated with multimorbidity compared with men [12,15,16]. The results from this study can be generalized to community-dwelling older populations comparable to the Norwegian setting with low mortality and a high number of older persons.…”

“…Multimorbidity has in systematic reviews been found to be associated with functional decline [9], poor quality of life [10] and increased mortality [11] amongst older persons. There has been found gender and socioeconomic differences where women and lower educated groups have higher prevalence of multimorbidity than men and higher educated groups [12][13][14][15][16]. Both country specific and common global disease combination patterns have been found [17][18][19][20].…”

Patterns of Multimorbidity in Adults: An Association Rules Analysis Using the Korea Health Panel

“…Researchers have investigated the prevalence of multimorbidity across countries or regions such as the United States, Australia, Canada, Europe, the Netherlands, Iran, and Mexico, and found that its prevalence varies widely across studies from 12.9% to 95.1% [4][5][6][7][8][9][10][11]. A meta-analysis of research based on 70 community-based studies demonstrated that the overall pooled prevalence of multimorbidity was 33.1% [12]. The burden of medical expenses is growing with the increase in the prevalence of multimorbidity due to the rise in the aging population [13].…”

Multimorbidity Analysis of 13 Systemic Diseases in Northeast China

“…To date, most studies have focused on single diseases while ignoring multimorbidity [15][16][17]. Some studies on the prevalence of multimorbidity did not consider the significance of the connection between diseases [18,19]. According to a literature review, most of the recent studies were based on self-reporting of prevalence by specific populations in specific environments, and the sample size was not large enough.…”