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Cited by 987Chronic Disease Management StrategiesPrimary Care and Health OutcomesPharmaceutical Practices and Patient Outcomes

Prevalence of multimorbidity among adults seen in family practice

Open access
Fortin, M.·2005·The Annals of Family Medicine
DOI 10.1370/afm.272PMC PMC1466875
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Abstract

PURPOSE: There are few valid data that describe the extent of multimorbidity in primary care patients. The purpose of this study was to estimate its prevalence in family practice patients by counting the number of chronic medical conditions and using a measure that considers the severity of these conditions, the Cumulative Illness Rating Scale (CIRS). METHODS: The study was carried out in the Saguenay region (Québec, Canada) in 2003. The participation of adult patients from 21 family physicians was solicited during consecutive consultation periods. A research nurse reviewed medical records and extracted the data regarding chronic illnesses. For each chronic condition, a severity rating was determined in accordance with the CIRS scoring guidelines. RESULTS: The sample consisted of 320 men and 660 women. Overall, 9 of 10 patients had more than 1 chronic condition. The prevalence of having 2 or more medical conditions in the 18- to 44-year, 45- to 64-year, and 65-year and older age-groups was, respectively, 68%, 95%, and 99% among women and 72%, 89%, and 97% among men. The mean number of conditions and mean CIRS score also increased significantly with age. CONCLUSIONS: Whether measured by simply counting the number of conditions or using the CIRS, the prevalence of multimorbidity is quite high and increases significantly with age in both men and women. Patients with multimorbidity seen in family practice represent the rule rather than the exception.

AI snapshot

Written from the paper’s full text.

TL;DR

In a 2003 family practice sample in Quebec, multimorbidity was highly prevalent: 9 of 10 adults had more than 1 chronic condition, and prevalence increased with age. Whether measured by condition count or CIRS severity, multimorbidity was the rule rather than the exception.

Key findings

  • Among 980 adult patients (320 men, 660 women), 9 of 10 had more than 1 chronic condition, and approximately 50% had 5 or more.
  • Prevalence of 2 or more chronic conditions by age and sex was: women 68% (18–44 years), 95% (45–64 years), and 99% (65+ years); men 72%, 89%, and 97%, respectively.
  • Mean CIRS scores increased significantly with age in both men and women (P < .001), rising from 6.3 to 13.1 in men and from 5.1 to 12.9 in women across the three age groups.
  • The most common diagnoses were hypertension, hyperlipidemia, and rheumatologic diseases; the 3 most common diagnoses did not differ in frequency between men and women.

Methods

  • Two-level survey in the Saguenay region of Quebec, Canada, in 2003. Of 119 eligible family physicians contacted, 27 volunteered and 21 participated after 6 dropped out; adult patients were recruited during consecutive consultation periods.
  • Of 1,085 patients contacted, 980 (90.3%) agreed to participate. Research nurses reviewed medical records, extracted chronic diagnoses using the WHO definition of chronic conditions, and assigned severity scores using the CIRS-G; inter-rater reliability was ICC 0.91 (95% CI, 0.84–0.95).
  • Analyses used SPSS version 8 with significance at 0.05; prevalence was reported by age and sex, means and medians were calculated for number of conditions and CIRS scores, CIRS means were compared with Kruskal-Wallis tests, proportions with chi-square tests, and 95% CIs were calculated. Clustering by physician was not accounted for because the intraclass correlation coefficient was very low (0.03).

Limitations

  • The paper states that the data are only estimates of actual prevalence in the population consulting family physicians; a random sample of each physician’s patients would have been required for more precise measurement. The sample was probably overrepresented by patients who see their physicians often because of multiple conditions, volunteer practices may have introduced unknown biases, and duration of the doctor-patient relationship was not recorded or controlled.
  • The paper also states that generalizability may be reduced by the limited number of participating physicians, a female-to-male ratio exceeding that of the general population, possible recruitment bias, and exclusion criteria (pregnancy, illiteracy, or lack of decision-making capacity). Participating and nonparticipating physicians seemed comparable, but few characteristics were compared. Socioeconomic status was not assessed.
  • Evident from the text: the profile of patients who refused participation could not be determined, so refusal bias cannot be quantified.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1370/afm.272

Cites

21 of 21 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 8 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Approximately 50% of the study patients had 5 or more chronic conditions.

    “approximately 50% had 5 or more.”
    Quote in the paperNot a substantial claim
  • Findingown data

    A sex difference was found only in the number of conditions in the intermediate age-group.

    “A sex difference was found only in the number of conditions in the intermediate age-group.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Overall, 9 of 10 patients had more than 1 chronic condition.

    “Overall, 9 of 10 patients had more than 1 chronic condition.”
    • Also stated in: § RESULTS · plain
      “Nine of 10 had more than 1 chronic condition”
    Quote in the paperSubstantial claim
  • Findingown data

    The proportion of patients with a high CIRS score rises with age in both men and women.

    “the proportion of patients with a high CIRS score rises with age in both men (P <.001) and women (P <.001).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Nearly 50% of patients between 45 and 64 years of age had 5 or more chronic conditions.

    “Nearly 50% of the patients between 45 and 64 years of age had 5 or more chronic conditions.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 17
  • May combine two claims. 9

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The study sample consisted of 320 men and 660 women.

    “The sample consisted of 320 men and 660 women.”
    • Also stated in: § RESULTS · plain
      “Of these, 980 (90.3%) agreed to participate: 320 men and 660 women.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The most common diagnoses were hypertension, hyperlipidemia, and rheumatologic diseases.

    “the most common diagnoses were hypertension, hyperlipidemia, and rheumatologic diseases.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The 3 most common diagnoses did not differ in frequency between men and women.

    “The 3 most common diagnoses did not differ in frequency between men and women.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The volunteer nature of the practices may have introduced unknown biases.

    “That the practices were volunteer may also have introduced unknown biases.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The prevalence of multimorbidity is high and increases significantly with age in both men and women, whether measured by counting the number of conditions or using the CIRS.

    “Whether measured by simply counting the number of conditions or using the CIRS, the prevalence of multimorbidity is quite high and increases signifi cantly with age in both men and women.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The exclusion of pregnant, illiterate, or decisionally incapacitated patients likely had negligible consequences.

    “Even so, the consequences of excluding the small minority of patients who were pregnant, illiterate, or lacked decision-making capacity should have been negligible.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The duration of the doctor-patient relationship could not be controlled for because it was not recorded.

    “Moreover, the duration of doctorpatient relationship could not be controlled for because it was not recorded in this study.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisenone given

    There is no cutoff score above which one can conclude that multimorbidity is present on the CIRS.

    “As there is no cutoff score above which one can conclude that multimorbidity is present, various cutoff points were used in this study.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    The high prevalence of multimorbidity calls into question the organization of health services.

    “Such a high prevalence of multiple chronic conditions calls into question the very organization of our health services.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    The results offer additional support to the current trend in family medicine residency programs to concentrate on patients with multimorbidity.

    “The results of this study offer additional support to the current trend in family medicine residency programs to concentrate on patients with multimorbidity.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The Saguenay region has 9.0 medical specialists per 10,000 people, representing only 60% of its estimated staffing needs.

    “In terms of specialized care, the Saguenay region is similar to the Canadian average, with 9.0 medical specialists per 10,000 people.15 This fi gure represents only 60% of its estimated staffi ng needs.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    A CIRS score of 10 or higher seems adequate for discriminating between younger and older patients.

    “A score 10 or higher seems adequate for discriminating between younger and older patients”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The generalizability of results is limited by the limited number of participating physicians, a female-to-male ratio exceeding that of the general population, and possible recruitment bias.

    “Other factors that may reduce the generalizability of our results include the limited number of participating physicians, a female-to-male ratio exceeding that of the general population, and possible recruitment bias.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Information about chronic medical conditions is more likely to be found in medical records than in other data sources, so a review of medical records seems a better way of estimating prevalence and may produce higher estimates.

    “Information about chronic medical conditions is more likely to be found in medical records than in other data sources, such as administrative data or surveys; therefore, a review of medical records seems to be a better way of estimating the prevalence of multimorbidity and may produce higher estimates.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The relative lack of medical specialists in the Saguenay region could help explain the high prevalence of multimorbidity observed.

    “Another factor that could help explain the high prevalence of multimorbidity observed here is the relative lack of medical specialists in the Saguenay region.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisereasoning

    The CIRS cutoff scores of 5 and 10 used in this study indicate disease in at least 2 or 3 systems and 4 or 5 systems, respectively.

    “Although the CIRS does not have a cutoff score to determine multimorbidity, the cutoff scores of 5 and 10 used in this study indicate disease in at least 2 or 3 systems and 4 or 5 systems, respectively.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The socioeconomic status of Saguenay residents is comparable to that of other Canadians, except for a higher unemployment rate.

    “The socioeconomic status (SES) of residents is comparable to that of those in the rest of Canada, except for a higher unemployment rate (12% vs 8% in 2001).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14]

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    The intraclass correlation coefficient for clustering of patients by physician was 0.03, justifying patient-level analysis.

    “The very low intraclass correlation coeffi cient (0.03) justifi es the analysis of morbidity at the patient level only.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The ratio of general practitioners to patients in Saguenay (8.7 per 10,000) is a little less than the Canadian average of 9.5.

    “The ratio of general practitioners to patients (8.7 per 10,000) is a little less than the average 9.5 for Canada.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Interventions that suit patients with a single disease may not be appropriate for patients with many comorbid conditions.

    “Interventions that suit patients with a single disease may not be appropriate for patients with many comorbid conditions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The wide extent of multimorbidity strongly supports the development of innovative interventions focused on collaborative practices.

    “The wide extent of multimorbidity also strongly supports the development of innovative interventions focused on collaborative practices to better share the burden.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The ratio of medical specialists in the Saguenay region is similar to the Canadian average and midway between that of large urban centers and rural regions.

    “Nevertheless, the ratio of medical specialists in the Saguenay region (9 per 10,000 people) is similar to the Canadian average 14 and midway between that of large urban centers and rural regions.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [14]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The CIRS has undergone several validation studies.

    “The CIRS has undergone several validation studies.11,18,19”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [11]

      Not checked in the free run.

    • cites [18]

      Not checked in the free run.

    • cites [19]

      Not checked in the free run.

23 of 23

  • The paper relies on this without support.

    Patients who refused to participate did not differ systematically from participants in a way that would affect prevalence estimates.

    “The profi le of the patients who refused to participate could not be determined.”

  • The paper relies on this without support.

    Medical records accurately and completely reflect patients' chronic conditions.

    “A research nurse reviewed medical records and extracted the data regarding chronic illnesses.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • In the UK, one in six patients have more than one chronic condition, and these patients account for approximately one-third of all general practice consultations.

    “In the UK, for example, recent estimates suggest that one in six patients have more than one chronic condition, and these patients account for approximately one-third of all general practice consultations.13”

    From Artificial intelligence: opportunities and implications for the health workforce (2020) · cites this paper as [13]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • CIRS score of 10 does not require disease in four systems

    Minor

    The paper says a CIRS score of 10 indicates disease in at least 4 or 5 systems. Because each domain can contribute up to 4 points, three affected domains can produce a score of 10.

  • Age range for the youngest group conflicts within Table 1

    Minor

    Table 1 labels the youngest group as 18-14 years for the average number of conditions, but as 18-44 years for prevalence. The former range also ends before it begins.

2 of 2

Cites

Flagged first, then by citations

1 of the 22 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Fortin M, Lapointe L, Hudon C, Vanasse A. Multimorbidity in medical literature: Is it commonly researched? Can Fam Physician. 2005;51:244-245.

Cited by

Sorted by citations

Related

Authors
Fortin, M.
Affiliations
Université de Sherbrooke (CA)
Corresponding author
Fortin, M.
ORCID
Fortin, M.
Venue
The Annals of Family Medicine
Publisher
Annals of Family Medicine
Published
2005-05-01
Volume
3
Issue
3
Pages
223-228
ISSN
  • 1544-1709 (ISSN-L)
  • 1544-1717
DOI
10.1370/afm.272
PMC
PMC1466875
OpenAlex
W2133526648
Cited by
987
References
22
Citations by year
2026: 14 · 2025: 21 · 2024: 32 · 2023: 47 · 2022: 52 · 2021: 67 · 2020: 54 · 2019: 66 · 2018: 55 · 2017: 69 · 2016: 59 · 2015: 71 · 2014: 66 · 2013: 75 · 2012: 67
FWCI
14.34
Type
journal article
Language
en
Open access
Locations
  • The Annals of Family Medicine (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Keywords
multimorbidity, chronic disease, Cumulative Illness Rating Scale, disease severity, prevalence, general practice, primary care patients, age differences, sex differences
MeSH terms
Family Practice, Female, Humans, Male, Middle Aged, Comorbidity, Prevalence

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