Cited by 1,125Chronic Disease Management StrategiesPrimary Care and Health OutcomesPharmaceutical Practices and Patient Outcomes

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Prevalence, Determinants and Patterns of Multimorbidity in Primary Care: A Systematic Review of Observational Studies

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Violan, Concepció, Foguet-Boreu, Quintí, Flores-Mateo, Gemma, Salisbury, Chris, Blom, Jeanet, Freitag, Michael, Glynn, Liam, Muth, Christiane, Valderas, Jose M.·2014·PLoS ONE

DOI 10.1371/journal.pone.0102149PMC PMC4105594

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Abstract

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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Additional file 4 of Classifying maternal deaths in Suriname using WHO ICD-MM: different interpretation by Physicians, National and International Maternal Death Review Committees
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Additional file 1 of Effects of family multi-generational relationship on multimorbidity and healthy life expectancy for second generations: insight from the China Health and Retirement Longitudinal Study
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Additional file 6 of Racial and socioeconomic disparities in multimorbidity and associated healthcare utilisation and outcomes in Brazil: a cross-sectional analysis of three million individuals
Hone, T., Stokes, J., Trajman, A., Saraceni, V., Coeli, C. M., Rasella, D., Durovni, B., & Millett, C. J. (2021) · Figshare · doi:10.6084/m9.figshare.14897392
Additional file 1 of Socioeconomic gradient in mortality of working age and older adults with multiple long-term conditions in England and Ontario, Canada
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Additional file 2 of Sex-specific patterns and lifetime risk of multimorbidity in the general population: a 23-year prospective cohort study
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Additional file 5 of Racial and socioeconomic disparities in multimorbidity and associated healthcare utilisation and outcomes in Brazil: a cross-sectional analysis of three million individuals
Hone, T., Stokes, J., Trajman, A., Saraceni, V., Coeli, C. M., Rasella, D., Durovni, B., & Millett, C. J. (2021) · Figshare · doi:10.6084/m9.figshare.14897389
Additional file 4 of Costs of multimorbidity: a systematic review and meta-analyses
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Additional file 1 of Trends in the use of health services and their relationship with multimorbidity in Brazil, 1998–2013
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Additional file 1 of Maternal multimorbidity and preterm birth in Scotland: an observational record-linkage study
Azcoaga-Lorenzo, A., Fagbamigbe, A. F., Agrawal, U., Black, M. E., Usman, M., Lee, S. I., Eastwood, K.-A., Moss, N., Plachcinski, R., Nelson-Piercy, C., et al. (2023) · Figshare · doi:10.6084/m9.figshare.24123947
Additional file 1 of Sleep disturbances and the speed of multimorbidity development in old age: results from a longitudinal population-based study
Sindi, S., Pérez, L. M., Vetrano, D. L., Triolo, F., Kåreholt, I., Sjöberg, L., Darin‐Mattsson, A., Kivipelto, M., Inzitari, M., & Calderón‐Larrañaga, A. (2020) · Figshare · doi:10.6084/m9.figshare.13339353
Additional file 8 of Maternal multimorbidity and preterm birth in Scotland: an observational record-linkage study
Azcoaga-Lorenzo, A., Fagbamigbe, A. F., Agrawal, U., Black, M. E., Usman, M., Lee, S. I., Eastwood, K.-A., Moss, N., Plachcinski, R., Nelson-Piercy, C., et al. (2023) · Figshare · doi:10.6084/m9.figshare.24123968
Additional file 1 of Costs of multimorbidity: a systematic review and meta-analyses
Tran, P. B., Kazibwe, J., Nikolaidis, G. F., Linnosmaa, I., Rijken, M., & van Olmen, J. (2022) · Figshare · doi:10.6084/m9.figshare.20336978
Additional file 3 of Implementation and evaluation of an individualized physical exercise promotion program in people with manifested risk factors for multimorbidity (MultiPill-Exercise): a study protocol for a pragmatic randomized controlled trial
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Additional file 1 of Has multimorbidity and frailty in adult hospital admissions changed over the last 15 years? A retrospective study of 107 million admissions in England
Faitna, P., Bottle, A., Klaber, B., & Aylin, P. P. (2024) · Figshare · doi:10.6084/m9.figshare.26982151
Additional file 2 of Trajectories of chronic multimorbidity patterns in older patients: MTOP study
Lleal, M., Baré, M., Herranz, S., Orús, J., Comet, R., Jordana, R., & Baré, M. (2024) · Figshare · doi:10.6084/m9.figshare.26727523
Additional file 6 of Maternal multimorbidity and preterm birth in Scotland: an observational record-linkage study
Azcoaga-Lorenzo, A., Fagbamigbe, A. F., Agrawal, U., Black, M. E., Usman, M., Lee, S. I., Eastwood, K.-A., Moss, N., Plachcinski, R., Nelson-Piercy, C., et al. (2023) · Figshare · doi:10.6084/m9.figshare.24123962
Additional file 4 of Network of doctors for multimorbidity and diabetes — the NOMAD intervention: protocol for feasibility trial of multidisciplinary team conferences for people with diabetes and multimorbidity
Bugge, S. J., Henriksen, D. P., Damkier, P., Rahbek, M. T., Schousboe, K., Rothmann, M. J., Poulsen, M. K., Hansen, C., Nagarajah, S., Jensen, P. B., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26734359
Additional file 8 of Racial and socioeconomic disparities in multimorbidity and associated healthcare utilisation and outcomes in Brazil: a cross-sectional analysis of three million individuals
Hone, T., Stokes, J., Trajman, A., Saraceni, V., Coeli, C. M., Rasella, D., Durovni, B., & Millett, C. J. (2021) · Figshare · doi:10.6084/m9.figshare.14897398
Additional file 2 of Racial and socioeconomic disparities in multimorbidity and associated healthcare utilisation and outcomes in Brazil: a cross-sectional analysis of three million individuals
Hone, T., Stokes, J., Trajman, A., Saraceni, V., Coeli, C. M., Rasella, D., Durovni, B., & Millett, C. J. (2021) · Figshare · doi:10.6084/m9.figshare.14897380

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
ORCID: 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)
DOI: 10.1371/journal.pone.0102149
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
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (unspecified)
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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Prevalence, Determinants and Patterns of Multimorbidity in Primary Care: A Systematic Review of Observational Studies

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