Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2012

Open Access 01-12-2012 | Research article

Multimorbidity and comorbidity in the Dutch population – data from general practices

Authors: Sandra H van Oostrom, H Susan J Picavet, Boukje M van Gelder, Lidwien C Lemmens, Nancy Hoeymans, Christel E van Dijk, Robert A Verheij, François G Schellevis, Caroline A Baan

Published in: BMC Public Health | Issue 1/2012

Login to get access

Abstract

Background

Multimorbidity is increasingly recognized as a major public health challenge of modern societies. However, knowledge about the size of the population suffering from multimorbidity and the type of multimorbidity is scarce. The objective of this study was to present an overview of the prevalence of multimorbidity and comorbidity of chronic diseases in the Dutch population and to explore disease clustering and common comorbidities.

Methods

We used 7 years data (2002–2008) of a large Dutch representative network of general practices (212,902 patients). Multimorbidity was defined as having two or more out of 29 chronic diseases. The prevalence of multimorbidity was calculated for the total population and by sex and age group. For 10 prevalent diseases among patients of 55 years and older (N = 52,014) logistic regressions analyses were used to study disease clustering and descriptive analyses to explore common comorbid diseases.

Results

Multimorbidity of chronic diseases was found among 13% of the Dutch population and in 37% of those older than 55 years. Among patients over 55 years with a specific chronic disease more than two-thirds also had one or more other chronic diseases. Most disease pairs occurred more frequently than would be expected if diseases had been independent. Comorbidity was not limited to specific combinations of diseases; about 70% of those with a disease had one or more extra chronic diseases recorded which were not included in the top five of most common diseases.

Conclusion

Multimorbidity is common at all ages though increasing with age, with over two-thirds of those with chronic diseases and aged 55 years and older being recorded with multimorbidity. Comorbidity encompassed many different combinations of chronic diseases. Given the ageing population, multimorbidity and its consequences should be taken into account in the organization of care in order to avoid fragmented care, in medical research and healthcare policy.
Appendix
Available only for authorised users
Literature
1.
Fortin M, Soubhi H, Hudon C, Bayliss EA, van den Akker M: Multimorbidity's many challenges. BMJ. 2007, 334 (7602): 1016-1017. 10.1136/bmj.39201.463819.2C.CrossRefPubMedPubMedCentral
2.
Mercer SW, Smith SM, Wyke S, O'Dowd T, Watt GC: Multimorbidity in primary care: developing the research agenda. Fam Pract. 2009, 26 (2): 79-80. 10.1093/fampra/cmp020.CrossRefPubMed
3.
Fortin M, Bravo G, Hudon C, Vanasse A, Lapointe L: Prevalence of multimorbidity among adults seen in family practice. Ann Fam Med. 2005, 3 (3): 223-228. 10.1370/afm.272.CrossRefPubMedPubMedCentral
4.
Laux G, Kuehlein T, Rosemann T, Szecsenyi J: Co- and multimorbidity patterns in primary care based on episodes of care: results from the German CONTENT project. BMC Health Serv Res. 2008, 8: 14-10.1186/1472-6963-8-14.CrossRefPubMedPubMedCentral
5.
van den Akker M, Buntinx F, Metsemakers JF, Roos S, Knottnerus JA: Multimorbidity in general practice: prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases. J Clin Epidemiol. 1998, 51 (5): 367-375. 10.1016/S0895-4356(97)00306-5.CrossRefPubMed
6.
Britt HC, Harrison CM, Miller GC, Knox SA: Prevalence and patterns of multimorbidity in Australia. Med J Aust. 2008, 189 (2): 72-77.PubMed
7.
Uijen AA, van de Lisdonk EH: Multimorbidity in primary care: prevalence and trend over the last 20 years. Eur J Gen Pract. 2008, 14: 28-32. 10.1080/13814780802436093.CrossRefPubMed
8.
Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, Meinow B, Fratiglioni L: Aging with multimorbidity: A systematic review of the literature. Ageing Res Rev. 2011, 10 (4): 430-439. 10.1016/j.arr.2011.03.003.CrossRefPubMed
9.
Lehnert T, Heider D, Leicht H, Heinrich S, Corrieri S, Luppa M, Riedel-Heller S, Konig HH: Review: health care utilization and costs of elderly persons with multiple chronic conditions. Med Care Res Rev. 2011, 68 (4): 387-420. 10.1177/1077558711399580.CrossRefPubMed
10.
Verheij RA, van Dijk CE, Abrahamse H, Davids R, van den Hoogen H, Braspenning J, van Althuis T: Landelijk Informatienetwerk Huisartsenzorg. Feiten en cijfers over huisartsenzorg in Nederland. (Netherlands Information Network of General Practice: facts and figures of general practice in the Netherlands). 2009, NIVEL/WOK, Utrecht/Nijmegen
11.
Lamberts H, Wood M: The birth of the International Classification of Primary Care (ICPC). Serendipity at the border of Lac Leman. Fam Pract. 2002, 19 (5): 433-435. 10.1093/fampra/19.5.433.CrossRefPubMed
12.
An international glossary for general/family practice: WONCA Classification Committee. Fam Pract. 1995, 12 (3): 341-369. 10.1093/fampra/12.3.341.CrossRef
13.
Biermans MC, de Bakker DH, Verheij RA, Gravestein JV, van der Linden MW, de Vries Robbe PF: Development of a case-based system for grouping diagnoses in general practice. Int J Med Inform. 2008, 77 (7): 431-439. 10.1016/j.ijmedinf.2007.08.002.CrossRefPubMed
14.
Biermans MC, Verheij RA, de Bakker DH, Zielhuis GA, de Vries Robbe PF: Estimating morbidity rates from electronic medical records in general practice. Evaluation of a grouping system. Methods Inf Med. 2008, 47 (2): 98-106.PubMed
15.
van den Akker M, Buntinx F, Knottnerus JA: Comorbidity or multimorbidity: what's in a name? A review of literature . Eur J Gen Pract. 1996, 2 (2): 65-70. 10.3109/13814789609162146.CrossRef
16.
Feinstein AR: The pre-therapeutic classification of co-morbidity in chronic disease. J Chron Dis. 1970, 23: 455-468. 10.1016/0021-9681(70)90054-8.CrossRefPubMed
17.
18.
Gijsen R, Hoeymans N, Schellevis FG, Ruwaard D, Satariano WA, van den Bos GA: Causes and consequences of comorbidity: a review. J Clin Epidemiol. 2001, 54 (7): 661-674. 10.1016/S0895-4356(00)00363-2.CrossRefPubMed
19.
Fortin M, Bravo G, Hudon C, Lapointe L, Dubois MF, Almirall J: Psychological distress and multimorbidity in primary care. Ann Fam Med. 2006, 4 (5): 417-422. 10.1370/afm.528.CrossRefPubMedPubMedCentral
20.
Kadam UT, Croft PR: Clinical multimorbidity and physical function in older adults: a record and health status linkage study in general practice. Fam Pract. 2007, 24 (5): 412-419. 10.1093/fampra/cmm049.CrossRefPubMed
21.
Schram MT, Frijters D, van de Lisdonk EH, Ploemacher J, de Craen AJ, de Waal MW, van Rooij FJ, Heeringa J, Hofman A, Deeg DJ, et al: Setting and registry characteristics affect the prevalence and nature of multimorbidity in the elderly. J Clin Epidemiol. 2008, 61 (11): 1104-1112. 10.1016/j.jclinepi.2007.11.021.CrossRefPubMed
22.
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): 134-141. 10.1370/afm.1363.CrossRefPubMedPubMedCentral
23.
Boyd CM, Fortin M: Future of multimorbidity research: how should understanding of multimorbidity inform health system design?. Public Health Reviews. 2010, 32 (2): 451-474.
24.
Fortin M, Stewart M, Poitras ME, Almirall J, Maddocks H: A systematic review of prevalence studies on multimorbidity: toward a more uniform methodology. Ann Fam Med. 2012, 10 (2): 142-151. 10.1370/afm.1337.CrossRefPubMedPubMedCentral
25.
Wolff JL, Starfield B, Anderson G: Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med. 2002, 162 (20): 2269-2276. 10.1001/archinte.162.20.2269.CrossRefPubMed
26.
Salisbury C, Johnson L, Purdy S, Valderas JM, Montgomery AA: Epidemiology and impact of multimorbidity in primary care: a retrospective cohort study. Br J Gen Pract. 2011, 61 (582): e12-e21. 10.3399/bjgp11X548929.CrossRefPubMed
27.
Glynn LG, Valderas JM, Healy P, Burke E, Newell J, Gillespie P, Murphy AW: The prevalence of multimorbidity in primary care and its effect on health care utilization and cost. Fam Pract. 2011, 28 (5): 516-523. 10.1093/fampra/cmr013.CrossRefPubMed
28.
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): 225-230. 10.1111/j.1532-5415.2008.02109.x.CrossRefPubMed
29.
van den Bussche H, Koller D, Kolonko T, Hansen H, Wegscheider K, Glaeske G, von Leitner EC, Schafer I, Schon G: Which chronic diseases and disease combinations are specific to multimorbidity in the elderly? Results of a claims data based cross-sectional study in Germany. BMC Publ Health. 2011, 11: 101-10.1186/1471-2458-11-101.CrossRef
30.
Cornell JE, Pugh JA, Williams JW, Kazis L, Lee AFS, Parchman ML, Zeber J, Pederson T, Montgomery KA, Hitchcock P: Multimorbidity clusters: clustering binary data from multimorbidity clusters: clustering binary data from a large administrative medical database. Applied Multivariate Research. 2007, 12 (3): 163-182.
31.
Garcia-Olmos L, Salvador CH, Alberquilla A, Lora D, Carmona M, Garcia-Sagredo P, Pascual M, Munoz A, Monteagudo JL, Garcia-Lopez F: Comorbidity patterns in patients with chronic diseases in general practice. PLoS One. 2012, 7 (2): e32141-10.1371/journal.pone.0032141.CrossRefPubMedPubMedCentral
32.
Schafer I, Hansen H, Schon G, Maier W, Hofels S, Altiner A, Fuchs A, Gerlach FM, Petersen JJ, Gensichen J, et al: The German MultiCare-study: Patterns of multimorbidity in primary health care - protocol of a prospective cohort study. BMC Health Serv Res. 2009, 9: 145-10.1186/1472-6963-9-145.CrossRefPubMedPubMedCentral
33.
Fortin M, Contant E, Savard C, Hudon C, Poitras ME, Almirall J: Canadian guidelines for clinical practice: an analysis of their quality and relevance to the care of adults with comorbidity. BMC Fam Pract. 2011, 12 (1): 74-10.1186/1471-2296-12-74.CrossRefPubMedPubMedCentral
34.
van Weel C, Schellevis FG: Comorbidity and guidelines: conflicting interests. Lancet. 2006, 367 (9510): 550-551. 10.1016/S0140-6736(06)68198-1.CrossRefPubMed
35.
Smith SM, Soubhi H, Fortin M, Hudon C, O'Dowd T: Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochrane Database Syst Rev. 2012, 4: CD006560-PubMed
36.
Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW: Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005, 294 (6): 716-724. 10.1001/jama.294.6.716.CrossRefPubMed
37.
Tinetti ME, Studenski SA: Comparative effectiveness research and patients with multiple chronic conditions. N Engl J Med. 2011, 364 (26): 2478-2481. 10.1056/NEJMp1100535.CrossRefPubMed
38.
Ofman JJ, Badamgarav E, Henning JM, Knight K, Gano AD, Levan RK, Gur-Arie S, Richards MS, Hasselblad V, Weingarten SR: Does disease management improve clinical and economic outcomes in patients with chronic diseases? A systematic review. Am J Med. 2004, 117 (3): 182-192. 10.1016/j.amjmed.2004.03.018.CrossRefPubMed
39.
Greß S, Baan CA, Clanan M, Dedeu T, Groenewegen P, Howson H, Maroy L, Nolte E, Redaèlli M, Saarelma O, et al: Co-ordination and management of chronic conditions in Europe: The role of primary care - Position paper of the European forum for primary care. Quality in Primary Care. 2009, 17: 75-86.PubMed
40.
Wagner EH, Bennett SM, Austin BT, Greene SM, Schaefer JK, Vonkorff M: Finding common ground: patient-centeredness and evidence-based chronic illness care. J Altern Complement Med. 2005, 11 (Suppl 1): S7-S15.PubMed
41.
Bodenheimer T: Disease management–promises and pitfalls. N Engl J Med. 1999, 340 (15): 1202-1205. 10.1056/NEJM199904153401511.CrossRefPubMed
42.
43.
Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, Sylvia M, Boult C: A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med. 2008, 23 (5): 536-542. 10.1007/s11606-008-0529-9.CrossRefPubMedPubMedCentral
44.
Starfield B, Lemke KW, Bernhardt T, Foldes SS, Forrest CB, Weiner JP: Comorbidity: implications for the importance of primary care in 'case' management. Ann Fam Med. 2003, 1 (1): 8-14. 10.1370/afm.1.CrossRefPubMedPubMedCentral
Metadata
Title
Multimorbidity and comorbidity in the Dutch population – data from general practices
Authors
Sandra H van Oostrom
H Susan J Picavet
Boukje M van Gelder
Lidwien C Lemmens
Nancy Hoeymans
Christel E van Dijk
Robert A Verheij
François G Schellevis
Caroline A Baan
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2012
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-12-715

Other articles of this Issue 1/2012

BMC Public Health 1/2012 Go to the issue

Research article

Prevalence of low back pain and associated occupational factors among Chinese coal miners

Research article

Subjective health complaints in older adolescents are related to perceived stress, anxiety and gender – a cross-sectional school study in Northern Sweden

Research article

Pre-pregnancy care for women with pre-gestational diabetes mellitus: a systematic review and meta-analysis

Debate

Addressing the policy cacophony does not require more evidence: an argument for reframing obesity as caloric overconsumption

Research article

Patient- and provider-level risk factors associated with default from tuberculosis treatment, South Africa, 2002: a case-control study

Study protocol

The Prevention Of WEight Regain in diabetes type 2 (POWER) study: the effectiveness of adding a combined psychological intervention to a very low calorie diet, design and pilot data of a randomized controlled trial