Patterns and Consequences of Multimorbidity in the General Population: There is No Chronic Disease Management Without Rheumatic Disease Management.

Abstract

To identify empirical model-based patterns of multimorbidity from chronic noncommunicable diseases in the general population, with a focus on the contribution of rheumatic and musculoskeletal diseases (RMDs), and to quantify their association with adverse health outcomes. Cross-sectional data from the Portuguese Fourth National Health Survey were analyzed (n = 23,754). Latent class analysis was used to identify patterns of coexistence of 11 chronic noncommunicable diseases (RMDs, diabetes mellitus, hypertension, chronic obstructive pulmonary disease, stroke, depression, myocardial infarction, cancer, osteoporosis, asthma, and renal failure). Based on the Outcome Measures in Rheumatology, filter 2.0, health outcomes included life impact, pathophysiologic manifestations, and resource use. We assessed the association between patterns and adverse health outcomes, through sex-, age-, and body mass index-adjusted prevalence ratios with 95% confidence intervals, obtained using Poisson regression. Four patterns of chronic noncommunicable diseases co-occurrence were identified and labeled as low disease probability, cardiometabolic conditions, respiratory conditions, and RMDs and depression. RMDs were highly prevalent in patients with chronic diseases (from 38.6% in cardiometabolic conditions to 66.7% in RMDs and depression). While negative self-rated health, short-term disability, and chronic pain were more strongly associated with cardiometabolic conditions and respiratory conditions, all multimorbidity patterns were similarly associated with long-term disability, frequent health care utilization, and out-of-pocket health care expenses. Our study emphasizes RMDs as a major presence in multimorbidity in the general population. All multimorbidity patterns were associated with a wide set of adverse health outcomes. Management strategies for the patient with chronic cardiometabolic, respiratory, or depressive conditions should also target RMDs.