Global Multimorbidity Patterns: A Cross-Sectional, Population-Based, Multi-Country Study.

BackgroundMultimorbidity among older adults, which is associated with added functional decline and higher health care utilization and mortality, has become increasingly common with the dramatic acceleration of ageing in China. The purpose of this study was to reveal age, sex, residence, and region- specific prevalence and patterns of multimorbidity among older adults in China.MethodsThis study is based on the 2018 Chinese Longitudinal Health Longevity Survey (CLHLS), the most recent edition of this national survey, and involved analysis of 15,275 participants aged 65 years and older. Multimorbidity was defined as an individual who has two or more chronic diseases or conditions and was divided into two types for analysis: ≥2 (MM2+) and ≥ 3 (MM3+). Fourteen chronic diseases or conditions surveyed were used to assess patterns of multimorbidity through association rule mining.ResultsAmong the 15,275 participants, the largest proportion (39.9%) was 90 years old and over, while the distribution of sex and residence is roughly the same. Overall, the prevalence of multimorbidity was 44.1% for MM2+ and 22.9% for MM3+. The most frequently occurring patterns were two or three combinations between hypertension, cardiovascular diseases and affective disorders. Cardiovascular diseases combined with diabetes or dyslipidemia showed the most predominant association in different age groups. Moreover, the prevalence of the hypertension +diabetes pattern decreased with age. The strongest associations were found for the clustering of hypertension + cardiovascular diseases + respiratory diseases in males, however, among females it was the cardiovascular diseases + diabetes cluster. Cardiovascular diseases + rheumatoid arthritis + visual impairment was observed in urban areas and hypertension + cardiovascular diseases + affective disorders in rural areas. The most distinctive association rule in Northern China was {cardiovascular diseases, hypertension, visual impairment} = > {diabetes}. Respiratory disease was more prevalent in combination with other systemic disorders in Western China, and affective disorders in Southern China.ConclusionsThe prevalence of multimorbidity among older Chinese was substantial, and patterns of multimorbidity varied by age, sex, residence, and region. Future efforts are needed to identify possible prevention strategies and guidelines that consider differences in demographic characteristics of multimorbid patients to promote health in older adults.

Emerging evidence suggests that sex and gender may influence the development, expression, and impact of multimorbidity through a range of mechanisms. This review aimed to examine the differences between women and men in the prevalence, risk factors, and patterns of multimorbidity, and sex differences regarding the impact of multimorbidity on health outcomes. A systematic literature search was conducted in Ovid Medline and Embase from inception until June 2025. Studies in human beings which reported data separately for women and men related to multimorbidity were included. Where possible, estimates from the included studies were pooled using inverse-variance weighted meta-analysis. Where available, the sex differential was quantified as the women-to-men ratio of prevalence, relative risks, hazard ratios or odds ratios. This review is registered at PROSPERO, CRD42024553043. This review identified 37 studies of 5,828,856 individuals (60% women) from 24 countries. We summarised the findings on sex differences according to: (1) prevalence of multimorbidity, (2) risk factors for multimorbidity, (3) patterns of multimorbidity, and (4) the impact of multimorbidity on health outcomes. The pooled multimorbidity prevalence in the 31 general population studies were 0.45 (95%CI 0.35-0.56) in women and 0.39 (95%CI 0.30-0.50) in men, pooled women-to-men prevalence ratio for multimorbidity was 1.12 (95%CI 1.02-1.23). In studies in populations with an index disease, the prevalence of multimorbidity was much higher: 0.83 (95%CI 0.63-0.93) in women and 0.82 (95%CI 0.48-0.96) in men. There were limited studies examining sex differences in the patterns and risk factors for multimorbidity, and on the impact of multimorbidity on outcomes. Our systematic review reveals a higher prevalence of multimorbidity in women than men. The increased likelihood of multimorbidity in women compared to men is a complex issue influenced by multiple factors and highlights the need for further research on this topic.

Population aging challenges health care systems due to the high prevalence and impact of multimorbidity in older adults. Studies on multimorbidity in Shenzhen have primarily focused on the quantity of multimorbidity, lacking in-depth exploration of multimorbidity patterns. Based on baseline data from the Shenzhen aging-related disease cohort, this study analyzed information from 8,911 people aged 60 and above after excluding missing and abnormal values from interview results. Using self-organizing map combined with weighted k-means, the distribution of diseases in the population was visualized, dividing the overall population into four clusters. The study also analyzed comorbidity and association rules for each cluster. This study found a high prevalence of cardiometabolic comorbidities among the older adult in Shenzhen, reaching 15.83%, and detailed the distribution of specific comorbidity combinations. Hypertension had a high prevalence and was the most common factor in comorbidities among Shenzhen's older adult. Additionally, hyperuricemia was included as a disease to explore its multimorbidity patterns with other chronic conditions. The study found that multimorbidity is prevalent among the older adult in Shenzhen and explored their patterns, suggesting that Shenzhen should enhance screening and integrated management of high-risk groups and implement public health interventions to alleviate the multimorbidity burden.

Multimorbidity influences the management of symptoms, treatment, and health outcomes for older adults with multiple myeloma. Our study characterized patient profiles defined by discrete chronic condition patterns and examined the distribution of their sociodemographic factors in older adults at time of diagnosis with multiple myeloma. Using the Surveillance, Epidemiology and End Results (SEER) Program database linked with Medicare insurance claims (2007-2017), we examined 11,926 individuals diagnosed with multiple myeloma at age ≥ 65 years. Hierarchical cluster analysis was conducted to identify prevalent patterns of multimorbidity from thirty-three chronic conditions, and sociodemographic factors associated with the identified patterns were examined. The median age of the cohort was 77 years and 48% were women. Three patient groups with distinct patterns of multimorbidity were identified: minimal multimorbidity featuring minor burden of comorbid conditions (54.3%), psychiatric and musculoskeletal multimorbidity (21.5%), and a high multimorbidity group featuring cardiometabolic and multiple system disorders (20.7%). The remaining 3.5% did not have multimorbidity. Patients in the cardiometabolic and multisystem multimorbidity pattern were the oldest, more likely to reside in geographic areas with high poverty levels and comprised more men and Hispanic individuals than the other two patterns. The psychiatric and musculoskeletal multimorbidity pattern comprised the largest proportion of women and lowest proportion of non-Hispanic Black individuals. Those with relatively minimal multimorbidity burden were the most likely to be married. Identifying patterns of multimorbidity in older adults newly diagnosed with multiple myeloma provides insight into the burden and clustering tendency of chronic conditions within similar patient groups. Our findings can inform tailored disease management and treatment programs that take these unique multimorbidity profiles into account.

Frailty is associated with multimorbidities due to decreased physical reserve independent of age

BackgroundThe prevalence, patterns, and impact of multimorbidity on health-related quality of life (HRQoL) remain inadequately understood among rural populations in southwest China. This study seeks to fill this knowledge gap by systematically examining these aspects.MethodsParticipants were recruited from the China Multi-Ethnic Cohort (CMEC) study. Incident cases of 13 chronic conditions were documented. Multimorbidity was defined as the presence of two or more chronic conditions in an individual. Principal component factor analysis (PCFA) was performed to identify patterns of multimorbidity. Tobit regression analysis and restricted cubic spline were employed to assess the correlation between multimorbidity patterns and HRQoL.ResultsA total of 2,998 participants were enrolled, with a mean age of 50.65 years (SD = 11.99). The prevalence of multimorbidity was 48.50%. Four multimorbidity patterns were identified by PCFA: circulatory system pattern, digestive system pattern, metabolic syndrome pattern, and hepatobiliary system pattern. All four patterns were negatively correlated with HRQoL, as demonstrated by tobit regression analysis (β = −0.024, β = −0.020, β = −0.007, β = −0.018; all p < 0.001). Restricted cubic spline also demonstrated the negative correlation between different multimorbidity patterns and HRQoL, after adjusting for potential confounding factors. Subgroup analysis in different gender, age, and average yearly family total income also demonstrated these negative correlations.ConclusionThe prevalence of multimorbidity is relatively high in rural southwest China. Distinct multimorbidity patterns were correlated with poorer HRQoL. These findings enhance the understanding of multimorbidity patterns and may inform the development of tailored primary healthcare services.

Mammography examination among women aged 40 years or older in Ghana: evidence from wave 2 of the World Health Organization’s study on global AGEing and adult health multicountry longitudinal study

Multimorbidity is a common problem in aged populations with a wide range of individual and societal consequences. The objective of the study was to explore patterns of comorbidity and multimorbidity in an elderly population using different analytical approaches. Data were gathered from the population-based KORA-Age project, which included 4,127 persons aged 65–94 years living in the city of Augsburg and its two surrounding counties in Southern Germany. Information on the presence of 13 chronic conditions was collected in a standardized telephone interview and a self-administered questionnaire. Patterns of comorbidity and multimorbidity were analyzed using prevalence figures, logistic regression models and exploratory tetrachoric factor analysis. The prevalence of multimorbidity (≥2 diseases) was 58.6% in the total sample. Hypertension and diabetes (Odds Ratio [OR] 2.95, 99.58% confidence interval [CI] [2.19–3.96]), as well as hypertension and stroke (OR 2.00, 99.58% CI [1.26–3.16]) most often occurred in combination. This association was independent of age, sex and the presence of other conditions. Using factor analysis, we identified four patterns of multimorbidity: the first pattern includes cardiovascular and metabolic diseases, the second includes joint, liver, lung and eye diseases, the third covers mental and neurologic diseases and the fourth pattern includes gastrointestinal diseases and cancer. 44% of the persons were assigned to at least one of the four multimorbidity patterns; 14% could be assigned to both the cardiovascular/metabolic and the joint/liver/lung/eye pattern. Further common pairs were the mental/neurologic pattern combined with the cardiovascular/metabolic pattern (7.2%) or the joint/liver/lung/eye pattern (5.3%), respectively. Our results confirmed the existence of co-occurrence of certain diseases in elderly persons, which is not caused by chance. Some of the identified patterns of multimorbidity and their overlap may indicate common underlying pathological mechanisms.

The impacts of multimorbidity trajectories and patterns on functional limitations over time in middle-aged and older adults.

IntroductionMultimorbidity defined as the simultaneous presence of two or more chronic conditions in an individual is on the rise in low- and middle-income countries such as India. With India aiming to achieve universal health coverage, it is imperative to address the inequalities in accessing healthcare, especially among vulnerable groups such as tribal. Moreover, changing lifestyle has led to the emergence of multimorbidity among tribals in India. We aimed to estimate the prevalence and assess the correlates of multimorbidity among tribal older adults in India.MethodsWe employed nationally representative data from the World Health Organization's Study on Global AGEing and Adult Health conducted in 2015. We included 522 participants aged ≥50 years who reported their caste to be ‘Scheduled Tribe' in the survey. A multivariable regression model assessed the association between multimorbidity and various attributes.ResultsArthritis, cataract, and hypertension were the most common chronic conditions. The overall prevalence of multimorbidity was ~22.61%. We observed a higher likelihood of having multimorbidity among respondents aged ≥80 years [AOR: 4.08 (1.17–14.18)] than the younger age groups, and among the most affluent group [AOR: 2.64 (1.06–6.56)] than the most deprived class.ConclusionThe prevalence of multimorbidity among tribal older adults is emerging which cannot be overlooked. Health and wellness centers may be a window of opportunity to provide egalitarian and quality preventive and curative services to achieve universal health coverage. Future studies should explore the outcomes of multimorbidity in terms of healthcare utilization, expenditure, and quality of life in this group.

Establishing associations between residential greenness and markers of adiposity among middle-aged and older Chinese adults through multilevel structural equation models.

The impact of intensive hypertension criteria on multimorbidity prevalence and patterns remains understudied. We investigated the prevalence and patterns of multimorbidity using both the current (140/90 mmHg) and intensive (130/80 mmHg) hypertension criteria within a multi-ethnic Chinese population. Data were obtained from the baseline survey of the Regional Ethnic Cohort Study in Northwest China, conducted from June 2018 to May 2019, which enrolled adults aged 35-74 years from five provinces. A total of 114,299 participants were included in this study. Multimorbidity was defined as the presence of at least two chronic diseases or conditions from a list of 26, ascertained through self-report and physical examination. Agglomerative hierarchical cluster analysis was employed to identify multimorbidity patterns. A hypertension-related multimorbidity pattern was identified and further analyzed. The prevalence of multimorbidity and hypertension-related pattern were analyzed in different subgroups, and subgroup cluster analyses were conducted stratified by sex, age, and ethnicity. Applying the intensive 130/80 mmHg hypertension criteria resulted in an increase in multimorbidity prevalence from 17.6% (20,128 participants) to 21.7% (24,805 participants) compared to the 140/90 mmHg criteria. Four distinct multimorbidity patterns were consistently identified: cardiometabolic, digestive-bone-kidney, respiratory, and mental-cancer. Hypertension consistently clustered within the cardiometabolic pattern alongside diabetes, acute myocardial infarction, angina, and stroke/TIA, with relatively stable proportions observed even under the 130/80 mmHg threshold. The revision of hypertension criteria significantly expands the population identified as having multimorbidity, without altering the identified multimorbidity patterns. Hypertension commonly co-occurs within the cardiometabolic cluster. These findings highlight the need for improved treatment and management strategies specifically targeting cardiometabolic multimorbidity.

Multimorbidity (≥ 2 chronic diseases) is associated with greater disability and higher treatment burden, as well as difficulty coordinating self-management tasks for adults with complex multimorbidity patterns. Comparatively little work has focused on assessing multimorbidity patterns among patients seeking care in community health centers (CHCs). To identify and characterize prevalent multimorbidity patterns in a multi-state network of CHCs over a 5-year period. A cohort study of the 2014-2019 ADVANCE multi-state CHC clinical data network. We identified the most prevalent multimorbidity combination patterns and assessed the frequency of patterns throughout a 5-year period as well as the demographic characteristics of patient panels by prevalent patterns. The study included data from 838,642 patients aged ≥ 45years who were seen in 337 CHCs across 22 states between 2014 and 2019. Prevalent multimorbidity patterns of somatic, mental health, and mental-somatic combinations of 22 chronic diseases based on the U.S. Department of Health and Human Services Multiple Chronic Conditions framework: anxiety, arthritis, asthma, autism, cancer, cardiac arrhythmia, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), congestive heart failure, coronary artery disease, dementia, depression, diabetes, hepatitis, human immunodeficiency virus (HIV), hyperlipidemia, hypertension, osteoporosis, post-traumatic stress disorder (PTSD), schizophrenia, substance use disorder, and stroke. Multimorbidity is common among middle-aged and older patients seen in CHCs: 40% have somatic, 6% have mental health, and 24% have mental-somatic multimorbidity patterns. The most frequently occurring pattern across all years is hyperlipidemia-hypertension. The three most frequent patterns are various iterations of hyperlipidemia, hypertension, and diabetes and are consistent in rank of occurrence across all years. CKD-hyperlipidemia-hypertension and anxiety-depression are both more frequent in later study years. CHCs are increasingly seeing more complex multimorbidity patterns over time; these most often involve mental health morbidity and advanced cardiometabolic-renal morbidity.

IntroductionMultimorbidity has become a global public health concern that can cause serious damage to the health status of older adults. This study aimed to investigate the impact of socioeconomic status (SES) and sleep quality on the prevalence of multimorbidity in older adults, thus providing a reference for reducing the risk of the prevalence of multimorbidity and improving the health of older adults.MethodsA multi-stage random sampling method was used to conduct a questionnaire survey on 3,250 older adults aged 60 years and above in Shanxi Province, China. The chi-square test and multiple logistic regression models were used to analyze the association of SES and sleep quality with the prevalence of multimorbidity of older adults.ResultsThe prevalence of multimorbidity was 30.31% in older adults aged 60 years and above in Shanxi Province, China. After adjusting for confounders, very low SES (OR = 1.440, 95% CI: 1.083–1.913) and poor sleep quality (OR = 2.445, 95% CI: 2.043–2.927) were associated with the prevalence of multimorbidity. Older adults with low SES and poor sleep quality had the highest risk of the prevalence of multimorbidity (OR = 3.139, 95% CI: 2.288–4.307).ConclusionsSES and sleep quality are associated with the prevalence of multimorbidity in older adults, and older adults with lower SES and poorer sleep quality are at higher risk for the prevalence of multimorbidity.

Association of back pain with major depressive disorder among older adults in six low- and middle-income countries: A cross-sectional study.