Abstract
BackgroundMultimorbidity is increasingly recognized as a major public health challenge of modern societies. However, knowledge about the size of the population suffering from multimorbidity and the type of multimorbidity is scarce. The objective of this study was to present an overview of the prevalence of multimorbidity and comorbidity of chronic diseases in the Dutch population and to explore disease clustering and common comorbidities.MethodsWe used 7 years data (2002–2008) of a large Dutch representative network of general practices (212,902 patients). Multimorbidity was defined as having two or more out of 29 chronic diseases. The prevalence of multimorbidity was calculated for the total population and by sex and age group. For 10 prevalent diseases among patients of 55 years and older (N = 52,014) logistic regressions analyses were used to study disease clustering and descriptive analyses to explore common comorbid diseases.ResultsMultimorbidity of chronic diseases was found among 13% of the Dutch population and in 37% of those older than 55 years. Among patients over 55 years with a specific chronic disease more than two-thirds also had one or more other chronic diseases. Most disease pairs occurred more frequently than would be expected if diseases had been independent. Comorbidity was not limited to specific combinations of diseases; about 70% of those with a disease had one or more extra chronic diseases recorded which were not included in the top five of most common diseases.ConclusionMultimorbidity is common at all ages though increasing with age, with over two-thirds of those with chronic diseases and aged 55 years and older being recorded with multimorbidity. Comorbidity encompassed many different combinations of chronic diseases. Given the ageing population, multimorbidity and its consequences should be taken into account in the organization of care in order to avoid fragmented care, in medical research and healthcare policy.
Highlights
Multimorbidity is increasingly recognized as a major public health challenge of modern societies
For a selection of 10 specific diseases we present a detailed picture of the comorbidity, i.e. the type and prevalence of additional diseases among that specific disease
For prevalence calculations the data from general practices should meet standards for completeness, i.e. for each general practice the percentage of valid International Classification of Primary Care (ICPC) codes should be 60% or more and the registration of morbidity and prescriptions must have occurred continuously over each year [10]
Summary
Multimorbidity is increasingly recognized as a major public health challenge of modern societies. The objective of this study was to present an overview of the prevalence of multimorbidity and comorbidity of chronic diseases in the Dutch population and to explore disease clustering and common comorbidities. The presence of multiple coexistent chronic diseases is increasingly recognized as a major public health challenge of modern societies [1,2]. In this paper we analyze the prevalence of multimorbidity of chronic diseases by age and sex and the clustering of chronic diseases on the basis of electronic medical records in a representative sample of Dutch general practices. Episodes were constructed by EPICON, an algorithm to group ICPC-coded contact records from electronic medical records in general practice into episodes of care [13,14]. For prevalence calculations the data from general practices should meet standards for completeness, i.e. for each general practice the percentage of valid ICPC codes should be 60% or more and the registration of morbidity and prescriptions must have occurred continuously over each year [10]
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