Top

Published in:

01-11-2019 | REVIEW

Do replicable profiles of multimorbidity exist? Systematic review and synthesis

Authors: Ljoudmila Busija, Karen Lim, Cassandra Szoeke, Kerrie M. Sanders, Marita P. McCabe

Published in: European Journal of Epidemiology | Issue 11/2019

Abstract

This systematic review aimed to synthesise multimorbidity profiling literature to identify replicable and clinically meaningful groupings of multimorbidity. We searched six electronic databases (Medline, EMBASE, PsycINFO, CINAHL, Scopus, and Web of Science) for articles reporting multimorbidity profiles. The identified profiles were synthesised with multidimensional scaling, stratified by type of statistical analysis used in the derivation of profiles. The 51 studies that met inclusion criteria reported results of 98 separate analyses of multimorbidity profiling, with a total of 407 multimorbidity profiles identified. The statistical techniques used to identify multimorbidity profiles were exploratory factor analysis, cluster analysis of diseases, cluster analysis of people, and latent class analysis. Reporting of methodological details of statistical methods was often incomplete. The discernible groupings of multimorbidity took the form of both discrete categories and continuous dimensions. Mental health conditions and cardio-metabolic conditions grouped along identifiable continua in the synthesised results of all four methods. Discrete groupings of chronic obstructive pulmonary disease with asthma, falls and fractures with sensory deficits and of Parkinson’s disease and cognitive decline where partially replicable (identifiable in the results of more than one method), while clustering of musculoskeletal conditions and clustering of reproductive systems were each observed only in one statistical approach. The two most replicable multimorbidity profiles were mental health conditions and cardio-metabolic conditions. Further studies are needed to understand aetiology and evolution of these multimorbidity groupings. Guidelines for strengthening the reporting of multimorbidity profiling studies are proposed.

Available only for authorised users

van den Akker M, Buntinx F, Roos S, Knottnerus JA. Problems in determining occurrence rates of multimorbidity. J Clin Epidemiol. 2001;54(7):675–9.CrossRefPubMed

The Academy of Medical Sciences. Multimorbidity: a priority for global health research. London: The Academy of Medical Sciences; 2018.

Britt HC, Harrison CM, Miller GC, Knox SA. Prevalence and patterns of multimorbidity in Australia. Med J Aust. 2008;189(2):72–7.CrossRefPubMed

Garin N, Koyanagi A, Chatterji S, et al. Global multimorbidity patterns: a cross-sectional, population-based, multi-country study. J Gerontol A Biol Sci Med Sci. 2016;71(2):205–14. https://doi.org/10.1093/gerona/glv128.CrossRefPubMed

Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37–43. https://doi.org/10.1016/S0140-6736(12)60240-2.CrossRefPubMed

Lehnert T, Heider D, Leicht H, et al. Review: health care utilization and costs of elderly persons with multiple chronic conditions. Med Care Res Rev. 2011;68(4):387–420. https://doi.org/10.1177/1077558711399580.CrossRefPubMed

Guthrie B, Payne K, Alderson P, McMurdo ME, Mercer SW. Adapting clinical guidelines to take account of multimorbidity. BMJ (Clin Res Ed). 2012;345:e6341. https://doi.org/10.1136/bmj.e6341.CrossRef

Muth C, Glasziou PP. Guideline recommended treatments in complex patients with multimorbidity. BMJ (Clin Res Ed). 2015;351:h5145. https://doi.org/10.1136/bmj.h5145.CrossRef

Uijen AA, van de Lisdonk EH. Multimorbidity in primary care: prevalence and trend over the last 20 years. Eur J Gen Pract. 2008;14(Suppl 1):28–32. https://doi.org/10.1080/13814780802436093.CrossRefPubMed

10.

Ward BW, Schiller JS. Prevalence of multiple chronic conditions among US adults: estimates from the National Health Interview Survey, 2010. Prev Chronic Dis. 2013;10:E65. https://doi.org/10.5888/pcd10.120203.CrossRefPubMedPubMedCentral

11.

Huntley AL, Johnson R, Purdy S, Valderas JM, Salisbury C. Measures of multimorbidity and morbidity burden for use in primary care and community settings: a systematic review and guide. Ann Fam Med. 2012;10(2):134–41. https://doi.org/10.1370/afm.1363.CrossRefPubMedPubMedCentral

12.

Lefevre T, d’Ivernois JF, De Andrade V, Crozet C, Lombrail P, Gagnayre R. What do we mean by multimorbidity? An analysis of the literature on multimorbidity measures, associated factors, and impact on health services organization. Rev Epidemiol Sante Publique. 2014;62(5):305–14. https://doi.org/10.1016/j.respe.2014.09.002.CrossRefPubMed

13.

Harrison C, Britt H, Miller G, Henderson J. Examining different measures of multimorbidity, using a large prospective cross-sectional study in Australian general practice. BMJ Open. 2014. https://doi.org/10.1136/bmjopen-2013-004694.CrossRefPubMedPubMedCentral

14.

Prados-Torres A, Calderon-Larranaga A, Hancco-Saavedra J, Poblador-Plou B, van den Akker M. Multimorbidity patterns: a systematic review. J Clin Epidemiol. 2014;67(3):254–66. https://doi.org/10.1016/j.jclinepi.2013.09.021.CrossRefPubMed

15.

Diaz E, Poblador-Pou B, Gimeno-Feliu LA, Calderon-Larranaga A, Kumar BN, Prados-Torres A. Multimorbidity and its patterns according to immigrant origin. A Nationwide Register-Based Study in Norway. PLoS ONE. 2015;10(12):e0145233. https://doi.org/10.1371/journal.pone.0145233.CrossRefPubMedPubMedCentral

16.

Poblador-Plou B, van den Akker M, Vos R, Calderon-Larranaga A, Metsemakers J, Prados-Torres A. Similar multimorbidity patterns in primary care patients from two European regions: results of a factor analysis. PLoS ONE. 2014;9(6):e100375. https://doi.org/10.1371/journal.pone.0100375.CrossRefPubMedPubMedCentral

17.

Prados-Torres A, Poblador-Plou B, Calderon-Larranaga A, et al. Multimorbidity patterns in primary care: interactions among chronic diseases using factor analysis. PLoS ONE. 2012;7(2):e32190. https://doi.org/10.1371/journal.pone.0032190.CrossRefPubMedPubMedCentral

18.

Daskalakis N, McGill M, Lehrner A, Yehuda R. Endocrine aspects of PTSD: hypothalamic–pituitary–adrenal (HPA) axis and beyond. In: Martin C, Preedy V, Patel V, editors. Comprehensive guide to post-traumatic stress disorders. Geneva: Springer; 2016.

19.

Alberti KGMM, Zimmet P, Shaw J. Metabolic syndrome—a new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med. 2006;23(5):469–80. https://doi.org/10.1111/j.1464-5491.2006.01858.x.CrossRefPubMed

20.

Kruskal JB. Multidimensional-scaling by optimizing goodness of fit to a nonmetric hypothesis. Psychometrika. 1964;29(1):1–27. https://doi.org/10.1007/Bf02289565.CrossRef

21.

Borg I, Mair P. The choice of initial configurations in multidimensional scaling: local minima, fit, and interpretability. Austrian J Stat. 2017;46(2):19–32.CrossRef

22.

Aoki T, Yamamoto Y, Ikenoue T, Onishi Y, Fukuhara S. Multimorbidity patterns in relation to polypharmacy and dosage frequency: a nationwide, cross-sectional study in a Japanese population. Sci Rep. 2018;8(1):3806. https://doi.org/10.1038/s41598-018-21917-6.CrossRefPubMedPubMedCentral

23.

Barile JP, Mitchell SA, Thompson WW, et al. Patterns of chronic conditions and their associations with behaviors and quality of life, 2010. Prev Chronic Dis. 2015;12:E222. https://doi.org/10.5888/pcd12.150179.CrossRefPubMedPubMedCentral

24.

Cigolle C, Blaum C, Ye W, Lee Y, Liang J. Geriatric conditions and chronic diseases and their disability and mortality outcomes: a new approach to older adult comorbidity. J Am Geriatr Soc. 2011;59:S141.

25.

Clerencia-Sierra M, Calderon-Larranaga A, Martinez-Velilla N, et al. Multimorbidity patterns in hospitalized older patients: associations among chronic diseases and geriatric syndromes. PLoS ONE. 2015;10(7):e0132909. https://doi.org/10.1371/journal.pone.0132909.CrossRefPubMedPubMedCentral

26.

Collerton J, Jagger C, Yadegarfar ME, et al. Deconstructing complex multimorbidity in the very old: findings from the newcastle 85+ study. Biomed Res Int. 2016;2016:8745670. https://doi.org/10.1155/2016/8745670.CrossRefPubMedPubMedCentral

27.

Cornell J, Pugh J, Williams J Jr, et al. Multimorbidity clusters: clustering binary data from a large administrative medical database. Appl Multivar Res. 2007;12(3):163–82.CrossRef

28.

Dong HJ, Wressle E, Marcusson J. Multimorbidity patterns of and use of health services by Swedish 85-year-olds: an exploratory study. BMC Geriatr. 2013;13:120. https://doi.org/10.1186/1471-2318-13-120.CrossRefPubMedPubMedCentral

29.

Foguet-Boreu Q, Violan C, Rodriguez-Blanco T, et al. Multimorbidity patterns in elderly primary health care patients in a South Mediterranean European region: a cluster analysis. PLoS ONE. 2015;10(11):e0141155. https://doi.org/10.1371/journal.pone.0141155.CrossRefPubMedPubMedCentral

30.

Formiga F, Ferrer A, Sanz H, et al. Patterns of comorbidity and multimorbidity in the oldest old: the Octabaix study. Eur J Intern Med. 2013;24(1):40–4. https://doi.org/10.1016/j.ejim.2012.11.003.CrossRefPubMed

31.

Garin N, Olaya B, Perales J, et al. Multimorbidity patterns in a national representative sample of the Spanish adult population. PLoS ONE. 2014;9(1):e84794. https://doi.org/10.1371/journal.pone.0084794.CrossRefPubMedPubMedCentral

32.

Gellert P, von Berenberg P, Zahn T, Neuwirth J, Kuhlmey A, Drager D. Multimorbidity profiles in German centenarians: a latent class analysis of health insurance data. J Aging Health. 2017. https://doi.org/10.1177/0898264317737894.CrossRefPubMed

33.

Goldstein G, Luther JF, Haas GL, Gordon AJ, Appelt C. Comorbidity between psychiatric and general medical disorders in homeless veterans. Psychiatr Q. 2009;80(4):199–212. https://doi.org/10.1007/s11126-009-9106-6.CrossRefPubMedPubMedCentral

34.

Gomez-Rubio P, Rosato V, Marquez M, et al. A systems approach identifies time-dependent associations of multimorbidities with pancreatic cancer risk. Ann Oncol. 2017;28(7):1618–24. https://doi.org/10.1093/annonc/mdx167.CrossRefPubMed

35.

Gonsoulin ME, Durazo-Arvizu RA, Goldstein KM, et al. A health profile of senior-aged women veterans: a latent class analysis of condition clusters. Innov Aging. 2017. https://doi.org/10.1093/geroni/igx024.CrossRefPubMedPubMedCentral

36.

Gu J, Chao J, Chen W, et al. Multimorbidity in the community-dwelling elderly in urban China. Arch Gerontol Geriatr. 2017;68:62–7. https://doi.org/10.1016/j.archger.2016.09.001.CrossRefPubMed

37.

Guisado-Clavero M, Roso-Llorach A, Lopez-Jimenez T, et al. Multimorbidity patterns in the elderly: a prospective cohort study with cluster analysis. BMC Geriatr. 2018;18(1):16. https://doi.org/10.1186/s12877-018-0705-7.CrossRefPubMedPubMedCentral

38.

Holden L, Scuffham PA, Hilton MF, Muspratt A, Ng SK, Whiteford HA. Patterns of multimorbidity in working Australians. Popul Health Metr. 2011;9(1):15. https://doi.org/10.1186/1478-7954-9-15.CrossRefPubMedPubMedCentral

39.

Islam MM, McRae IS, Yen L, Jowsey T, Valderas JM. Time spent on health-related activities by senior Australians with chronic diseases: what is the role of multimorbidity and comorbidity? Aust N Z J Public Health. 2015;39(3):277–83. https://doi.org/10.1111/1753-6405.12355.CrossRefPubMed

40.

Islam MM, Valderas JM, Yen L, Dawda P, Jowsey T, McRae IS. Multimorbidity and comorbidity of chronic diseases among the senior Australians: prevalence and patterns. PLoS ONE. 2014;9(1):e83783. https://doi.org/10.1371/journal.pone.0083783.CrossRefPubMedPubMedCentral

41.

Jackson CA, Dobson AJ, Tooth LR, Mishra GD. Lifestyle and socioeconomic determinants of multimorbidity patterns among mid-aged women: a longitudinal study. PLoS ONE. 2016;11(6):e0156804. https://doi.org/10.1371/journal.pone.0156804.CrossRefPubMedPubMedCentral

42.

Jackson CA, Jones M, Tooth L, Mishra GD, Byles J, Dobson A. Multimorbidity patterns are differentially associated with functional ability and decline in a longitudinal cohort of older women. Age Ageing. 2015;44(5):810–6. https://doi.org/10.1093/ageing/afv095.CrossRefPubMed

43.

John R, Kerby DS, Hennessy CH. Patterns and impact of comorbidity and multimorbidity among community-resident American Indian elders. Gerontologist. 2003;43(5):649–60. https://doi.org/10.1093/geront/43.5.649.CrossRefPubMed

44.

Jovic D, Vukovic D, Marinkovic J. Prevalence and patterns of multi-morbidity in Serbian adults: a cross-sectional study. PLoS ONE. 2016;11(2):e0148646. https://doi.org/10.1371/journal.pone.0148646.CrossRefPubMedPubMedCentral

45.

Kirchberger I, Meisinger C, Heier M, et al. Patterns of multimorbidity in the aged population. Results from the KORA-age study. PLoS ONE. 2012;7(1):e30556. https://doi.org/10.1371/journal.pone.0030556.CrossRefPubMedPubMedCentral

46.

Kuwornu JP, Lix LM, Shooshtari S. Multimorbidity disease clusters in Aboriginal and non-Aboriginal Caucasian populations in Canada. Chronic Dis Inj Can. 2013;34(4):218–25.

47.

Lenzi J, Avaldi VM, Rucci P, Pieri G, Fantini MP. Burden of multimorbidity in relation to age, gender and immigrant status: a cross-sectional study based on administrative data. BMJ Open. 2016;6(12):e012812. https://doi.org/10.1136/bmjopen-2016-012812.CrossRefPubMedPubMedCentral

48.

Marengoni A, Bonometti F, Nobili A, et al. In-hospital death and adverse clinical events in elderly patients according to disease clustering: the REPOSI study. Rejuvenation Res. 2010;13(4):469–77. https://doi.org/10.1089/rej.2009.1002.CrossRefPubMed

49.

Marengoni A, Nobili A, Pirali C, et al. Comparison of disease clusters in two elderly populations hospitalized in 2008 and 2010. Gerontology. 2013;59(4):307–15. https://doi.org/10.1159/000346353.CrossRefPubMed

50.

Marengoni A, Rizzuto D, Wang HX, Winblad B, Fratiglioni L. Patterns of chronic multimorbidity in the elderly population. J Am Geriatr Soc. 2009;57(2):225–30. https://doi.org/10.1111/j.1532-5415.2008.02109.x.CrossRefPubMed

51.

Marventano S, Ayala A, Gonzalez N, Rodríguez-Blázquez C, Garcia-Gutierrez S, Forjaz MJ. Multimorbidity and functional status in institutionalized older adults. Eur Geriatr Med. 2016;7(1):34–9. https://doi.org/10.1016/j.eurger.2015.10.011.CrossRef

52.

Marventano S, Ayala A, Gonzalez N, et al. Multimorbidity and functional status in community-dwelling older adults. Eur J Intern Med. 2014;25(7):610–6. https://doi.org/10.1016/j.ejim.2014.06.018.CrossRefPubMed

53.

Mino-Leon D, Reyes-Morales H, Doubova SV, Perez-Cuevas R, Giraldo-Rodriguez L, Agudelo-Botero M. Multimorbidity patterns in older adults: an approach to the complex interrelationships among chronic diseases. Arch Med Res. 2017;48(1):121–7. https://doi.org/10.1016/j.arcmed.2017.03.001.CrossRefPubMed

54.

Newcomer SR, Steiner JF, Bayliss EA. Identifying subgroups of complex patients with cluster analysis. Am J Manag Care. 2011;17(8):e324–32.PubMed

55.

Nunes BP, Camargo-Figuera FA, Guttier M, et al. Multimorbidity in adults from a southern Brazilian city: occurrence and patterns. Int J Public Health. 2016;61(9):1013–20. https://doi.org/10.1007/s00038-016-0819-7.CrossRefPubMed

56.

Nunes BP, Chiavegatto Filho ADP, Pati S, et al. Contextual and individual inequalities of multimorbidity in Brazilian adults: a cross-sectional national-based study. BMJ Open. 2017;7(6):e015885. https://doi.org/10.1136/bmjopen-2017-015885.CrossRefPubMedPubMedCentral

57.

Olaya B, Moneta MV, Caballero FF, et al. Latent class analysis of multimorbidity patterns and associated outcomes in Spanish older adults: a prospective cohort study. BMC Geriatr. 2017;17(1):186. https://doi.org/10.1186/s12877-017-0586-1.CrossRefPubMedPubMedCentral

58.

Prazeres F, Santiago L. Prevalence of multimorbidity in the adult population attending primary care in Portugal: a cross-sectional study. BMJ Open. 2015;5(9):e009287. https://doi.org/10.1136/bmjopen-2015-009287.CrossRefPubMedPubMedCentral

59.

Pugh MJ, Finley EP, Copeland LA, et al. Complex comorbidity clusters in OEF/OIF veterans: the polytrauma clinical triad and beyond. Med Care. 2014;52(2):172–81. https://doi.org/10.1097/MLR.0000000000000059.CrossRefPubMed

60.

Schafer I, von Leitner EC, Schon G, et al. Multimorbidity patterns in the elderly: a new approach of disease clustering identifies complex interrelations between chronic conditions. PLoS ONE. 2010;5(12):e15941. https://doi.org/10.1371/journal.pone.0015941.CrossRefPubMedPubMedCentral

61.

Sibley KM, Voth J, Munce SE, Straus SE, Jaglal SB. Chronic disease and falls in community-dwelling Canadians over 65 years old: a population-based study exploring associations with number and pattern of chronic conditions. BMC Geriatr. 2014;14:22. https://doi.org/10.1186/1471-2318-14-22.CrossRefPubMedPubMedCentral

62.

Simoes D, Araujo FA, Severo M, et al. Patterns and consequences of multimorbidity in the general population: there is no chronic disease management without rheumatic disease management. Arthritis Care Res (Hoboken). 2017;69(1):12–20. https://doi.org/10.1002/acr.22996.CrossRef

63.

Teh RO, Menzies OH, Connolly MJ, et al. Patterns of multi-morbidity and prediction of hospitalisation and all-cause mortality in advanced age. Age Ageing. 2018;47(2):261–8. https://doi.org/10.1093/ageing/afx184.CrossRefPubMed

64.

Van Cleave JH, Egleston BL, Abbott KM, Hirschman KB, Rao A, Naylor MD. Multiple chronic conditions and hospitalizations among recipients of long-term services and supports. Nurs Res. 2016;65(6):425–34. https://doi.org/10.1097/NNR.0000000000000185.CrossRefPubMedPubMedCentral

65.

Walker V, Perret-Guillaume C, Kesse-Guyot E, et al. Effect of multimorbidity on health-related quality of life in adults aged 55 years or older: results from the SU.VI.MAX 2 cohort. PLoS ONE. 2016;11(12):e0169282. https://doi.org/10.1371/journal.pone.0169282.CrossRefPubMedPubMedCentral

66.

Wang R, Yan Z, Liang Y, et al. Prevalence and patterns of chronic disease pairs and multimorbidity among older Chinese adults living in a rural area. PLoS ONE. 2015;10(9):e0138521. https://doi.org/10.1371/journal.pone.0138521.CrossRefPubMedPubMedCentral

67.

Wang XX, Lin WQ, Chen XJ, et al. Multimorbidity associated with functional independence among community-dwelling older people: a cross-sectional study in Southern China. Health Qual Life Outcomes. 2017;15(1):73. https://doi.org/10.1186/s12955-017-0635-7.CrossRefPubMedPubMedCentral

68.

Whitson HE, Johnson KS, Sloane R, et al. Identifying patterns of multimorbidity in older Americans: application of latent class analysis. J Am Geriatr Soc. 2016;64(8):1668–73. https://doi.org/10.1111/jgs.14201.CrossRefPubMedPubMedCentral

69.

Kulmala J, Viljanen A, Sipila S, et al. Poor vision accompanied with other sensory impairments as a predictor of falls in older women. Age Ageing. 2009;38(2):162–7. https://doi.org/10.1093/ageing/afn228.CrossRefPubMed

70.

Shaw FE. Falls in cognitive impairment and dementia. Clin Geriatr Med. 2002;18(2):159–73. https://doi.org/10.1016/s0749-0690(02)00003-4.CrossRefPubMed

71.

Rahman S, Griffin HJ, Quinn NP, Jahanshahi M. Quality of life in Parkinson’s disease: the relative importance of the symptoms. Mov Disord. 2008;23(10):1428–34. https://doi.org/10.1002/mds.21667.CrossRefPubMed

72.

Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):617–27. https://doi.org/10.1001/archpsyc.62.6.617.CrossRefPubMedPubMedCentral

73.

Kessler RC, Ormel J, Petukhova M, et al. Development of lifetime comorbidity in the World Health Organization world mental health surveys. Arch Gen Psychiatry. 2011;68(1):90–100. https://doi.org/10.1001/archgenpsychiatry.2010.180.CrossRefPubMedPubMedCentral

74.

Zhang D, Tang X, Shen P, et al. Multimorbidity of cardiometabolic diseases: prevalence and risk for mortality from one million Chinese adults in a longitudinal cohort study. BMJ Open. 2019;9(3):e024476. https://doi.org/10.1136/bmjopen-2018-024476.CrossRefPubMedPubMedCentral

75.

Andrews G, Slade T, Issakidis C. Deconstructing current comorbidity: data from the Australian National Survey of Mental Health and Well-Being. Br J Psychiatry. 2002;181(4):306–14. https://doi.org/10.1192/bjp.181.4.306.CrossRefPubMed

76.

Kivimäki M, Kuosma E, Ferrie JE, et al. Overweight, obesity, and risk of cardiometabolic multimorbidity: pooled analysis of individual-level data for 120 813 adults from 16 cohort studies from the USA and Europe. Lancet Public Health. 2017;2(6):e277–85. https://doi.org/10.1016/S2468-2667(17)30074-9.CrossRefPubMedPubMedCentral

77.

Auerbach RP, Mortier P, Bruffaerts R, et al. Mental disorder comorbidity and suicidal thoughts and behaviors in the World Health Organization World Mental Health Surveys International College Student initiative. Int J Methods Psychiatr Res. 2018. https://doi.org/10.1002/mpr.1752.CrossRefPubMedPubMedCentral

78.

Johnston MC, Crilly M, Black C, Prescott GJ, Mercer SW. Defining and measuring multimorbidity: a systematic review of systematic reviews. Eur J Public Health. 2019;29(1):182–9. https://doi.org/10.1093/eurpub/cky098.CrossRefPubMed

79.

Vetrano DL, Calderón-Larrañaga A, Marengoni A, et al. An international perspective on chronic multimorbidity: approaching the elephant in the room. J Gerontol A Biol Sci Med Sci. 2018;73(10):1350–6. https://doi.org/10.1093/gerona/glx178.CrossRefPubMed

80.

Zwick WR, Velicer WF. Comparison of five rules for determining the number of components to retain. Psychol Bull. 1986;99(3):432–42.CrossRef

81.

Kowal P, Arokiasamy P, Afshar S, Pati S, Snodgrass JJ. Multimorbidity: health care that counts “past one” for 1.2 billion older adults. Lancet. 2015;385(9984):2252–3. https://doi.org/10.1016/s0140-6736(15)61062-5.CrossRefPubMed

82.

Banerjee S. Multimorbidity—older adults need health care that can count past one. Lancet. 2015;385(9968):587–9. https://doi.org/10.1016/s0140-6736(14)61596-8.CrossRefPubMed

83.

Azais B, Bowis J, Wismar M. Facing the challenge of multimorbidity. J Comorb. 2016;6(1):1–3. https://doi.org/10.15256/joc.2016.6.71.CrossRefPubMedPubMedCentral

84.

US Department of Health and Human Services. Multiple chronic conditions—a strategic framework: optimum health and quality of life for individuals with multiple chronic conditions. Washington: US Department of Health and Human Services; 2010.

85.

National Guideline Centre. Multimorbidity: clinical assessment and management. London: National Institute for Health and Care Excellence; 2016.

86.

Palmer K, Marengoni A, Forjaz MJ, et al. Multimorbidity care model: recommendations from the consensus meeting of the Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS). Health Policy. 2018;122(1):4–11. https://doi.org/10.1016/j.healthpol.2017.09.006.CrossRefPubMed

87.

Royal College of General Practitioners. Online services: multimorbidity guidance for general practice. London: RCG; 2017.

88.

Treadwell J. Coping with Complexity: working beyond the guidelines for patients with multimorbidities. J Comorb. 2015;5(1):11–4. https://doi.org/10.15256/joc.2015.5.49.CrossRefPubMedPubMedCentral

89.

Salisbury C, Man MS, Bower P, et al. Management of multimorbidity using a patient-centred care model: a pragmatic cluster-randomised trial of the 3D approach. Lancet. 2018;392(10141):41–50. https://doi.org/10.1016/S0140-6736(18)31308-4.CrossRefPubMedPubMedCentral

90.

Hopman P, de Bruin SR, Forjaz MJ, et al. Effectiveness of comprehensive care programs for patients with multiple chronic conditions or frailty: a systematic literature review. Health Policy. 2016;120(7):818–32. https://doi.org/10.1016/j.healthpol.2016.04.002.CrossRefPubMed

91.

Smith SM, Wallace E, O’Dowd T, Fortin M. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochrane Database Syst Rev. 2016;3:CD006560. https://doi.org/10.1002/14651858.cd006560.pub3.CrossRefPubMed

92.

World Health Organization. Multimorbidity: Technical Series on Safer Primary Care. Geneva: World Health Organization. 2016. Report No.: Licence: CC BY-NC-SA 3.0 IGO.

Title: Do replicable profiles of multimorbidity exist? Systematic review and synthesis
Authors: Ljoudmila Busija
Karen Lim
Cassandra Szoeke
Kerrie M. Sanders
Marita P. McCabe
Publication date: 01-11-2019
Publisher: Springer Netherlands
Published in: European Journal of Epidemiology / Issue 11/2019
Print ISSN: 0393-2990
Electronic ISSN: 1573-7284
DOI: https://doi.org/10.1007/s10654-019-00568-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Do replicable profiles of multimorbidity exist? Systematic review and synthesis

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 11/2019

Validated inference of smoking habits from blood with a finite DNA methylation marker set

Statin use, hyperlipidemia, and risk of glioma

Assisted reproductive technology and risk of ovarian cancer and borderline tumors in parous women: a population-based cohort study

Interaction between co-morbidities and cancer survival

Commonly used estimates of the genetic contribution to disease are subject to the same fallacies as bad luck estimates

A meta-analysis of cohort studies including dose-response relationship between shift work and the risk of diabetes mellitus