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Prevalence, Determinants and Patterns of Multimorbidity in Primary Care: A Systematic Review of Observational Studies
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INTRODUCTION: Multimorbidity is a major concern in primary care. Nevertheless, evidence of prevalence and patterns of multimorbidity, and their determinants, are scarce. The aim of this study is to systematically review studies of the prevalence, patterns and determinants of multimorbidity in primary care. METHODS: Systematic review of literature published between 1961 and 2013 and indexed in Ovid (CINAHL, PsychINFO, Medline and Embase) and Web of Knowledge. Studies were selected according to eligibility criteria of addressing prevalence, determinants, and patterns of multimorbidity and using a pretested proforma in primary care. The quality and risk of bias were assessed using STROBE criteria. Two researchers assessed the eligibility of studies for inclusion (Kappa= 0.86). RESULTS: We identified 39 eligible publications describing studies that included a total of 70,057,611 patients in 12 countries. The number of health conditions analysed per study ranged from 5 to 335, with multimorbidity prevalence ranging from 12.9% to 95.1%. All studies observed a significant positive association between multimorbidity and age (odds ratio [OR], 1.26 to 227.46), and lower socioeconomic status (OR, 1.20 to 1.91). Positive associations with female gender and mental disorders were also observed. The most frequent patterns of multimorbidity included osteoarthritis together with cardiovascular and/or metabolic conditions. CONCLUSIONS: Well-established determinants of multimorbidity include age, lower socioeconomic status and gender. The most prevalent conditions shape the patterns of multimorbidity. However, the limitations of the current evidence base means that further and better designed studies are needed to inform policy, research and clinical practice, with the goal of improving health-related quality of life for patients with multimorbidity. Standardization of the definition and assessment of multimorbidity is essential in order to better understand this phenomenon, and is a necessary immediate step.
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“as Violan et al 4 highlight, multimorbidity is now considered the norm rather than exception in primary care patients”
From Investigating the effectiveness of an online acceptance and commitment therapy (ACT) intervention versus a waiting list control condition on pain interference and quality of life in adults with chronic pain and multimorbidity: Protocol for a randomised controlled trial (2019) · cites this paper as [4]
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Metadata
- Authors
- Violan, C., Foguet-Boreu, Q., Flores-Mateo, G., Salisbury, C., Blom, J., Freitag, M., Glynn, L., Muth, C., & Valderas, J. M.
- Affiliations
- University of Bristol (GB)
- Leiden University Medical Center (NL)
- Jena University Hospital (DE)
- Ollscoil na Gaillimhe – University of Galway (IE)
- Goethe University Frankfurt (DE)
- Corresponding author
- Salisbury, Chris
- Blom, Jeanet
- Freitag, Michael
- Glynn, Liam
- Muth, Christiane
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2014-07-21
- Volume
- 9
- Issue
- 7
- Pages
- e102149
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4105594
- OpenAlex
- W2080696239
- Cited by
- 1,125
- References
- 59
- Citations by year
- 2026: 69 · 2025: 80 · 2024: 101 · 2023: 137 · 2022: 151 · 2021: 163 · 2020: 116 · 2019: 102 · 2018: 72 · 2017: 56 · 2016: 40 · 2015: 35 · 2014: 3
- FWCI
- 5.96
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Open Research Exeter (University of Exeter) (publishedVersion, other-oa)
- Explore Bristol Research (publishedVersion)
- Arrow@dit (Dublin Institute of Technology) (acceptedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Dipòsit Digital de Documents de la UAB (Universitat Autònoma de Barcelona) (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Figshare (submittedVersion, cc-by-nc-sa)
- Publication Server of Goethe University Frankfurt am Main (Goethe University Frankfurt) (submittedVersion, cc-by)
- University of Limerick Institutional Repository (University of Limerick) (submittedVersion, cc-by-nc-sa)
- Funders
- National Institute for Health and Care Research (NIHR/CS/010/024)
- Ministerio de Ciencia e Innovación
- Topics
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- multimorbidity, prevalence, primary care, socioeconomic status, age, gender differences, mental illness, osteoarthritis, cardiovascular conditions, metabolic disorders
- MeSH terms
- Age Factors, Female, Humans, Male, Primary Health Care, Quality of Life, Sex Factors, Socioeconomic Factors, Comorbidity, Prevalence, Observational Studies as Topic
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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