Journal of multimorbidity and comorbidity最新文献

{"title":"Childhood socioeconomic disadvantage and adult multimorbidity: A systematic review and meta-analysis.","authors":"Philip Broadbent, Alistair Carr, Erik Igelström, Valerie Wells, Anna Pearce, Daniel Kopasker, Srinivasa Vittal Katikireddi","doi":"10.1177/26335565261447702","DOIUrl":"https://doi.org/10.1177/26335565261447702","url":null,"abstract":"<p><strong>Background: </strong>Childhood socioeconomic disadvantage is linked to individual chronic diseases in adulthood, but its relationship with multimorbidity remains unclear. Understanding this is crucial for informing prevention strategies and the economic case for investment. This review and meta-analysis evaluated the association between childhood disadvantage and adult multimorbidity.</p><p><strong>Methods: </strong>Following pre-registration (PROSPERO: CRD42024588657), we searched MEDLINE, SocIndex, ASSIA, and ProQuest Public Health to March 2025 for studies assessing childhood socioeconomic circumstances (SECs) and adult multimorbidity (≥2 chronic conditions). Risk of bias was assessed using ROBINS-E and evidence certainty using GRADE. Random-effects meta-analysis and synthesis without meta-analysis (SWiM) were conducted. Subgroup analyses explored heterogeneity by region, design, and exposure type.</p><p><strong>Results: </strong>From 5,617 records, 10 studies met inclusion criteria. Most were cross-sectional, using retrospective reports of exposure and self-reported outcomes. Exposures included perceived childhood economic adversity (n=6), parental education (n=4), parental occupation (n=1), and composite measures (n=3). Meta-analyses found no clear associations for perceived adversity (OR 1.08, 95% CI 0.87-1.23; I² = 94.4%) or parental education (father's (Odds ratio (OR) 0.95, 95% CI 0.66-1.37; I² = 66.8%); mother's (OR 1.07, 95% CI 0.70-1.61; I² = 36.9%)). Relative Index of Inequality estimates generally indicated higher mortality risk with greater childhood disadvantage, though effect sizes varied widely and some studies suggested the reverse.. All studies were high/very high risk of bias with very low certainty.</p><p><strong>Conclusions: </strong>Evidence for an association between childhood socioeconomic disadvantage and adult multimorbidity is limited and uncertain. Findings suggest possible harmful effects but remain constrained by methodological weaknesses and heterogeneity. High-quality longitudinal studies with standardised multimorbidity definitions are needed.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"16 ","pages":"26335565261447702"},"PeriodicalIF":3.0,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13145020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of multiple long-term conditions on engaging with and maintaining behaviour change in older people with mild frailty: A qualitative study.","authors":"Tasmin Alanna Rookes, Jessica Catchpole, Kate Walters, Yolanda Barrado-Martín, Sarah Kalwarowsky, Christina Avgerinou, Benjamin Gardner, Rebecca L Gould, Paul Chadwick, Jane Hopkins, Vari M Drennan, Kalpa Kharicha, Louise Marston, Claire Jowett, Rashmi Kumar, Rekha Elaswarapu, Rachael Frost","doi":"10.1177/26335565261448335","DOIUrl":"https://doi.org/10.1177/26335565261448335","url":null,"abstract":"<p><p>Managing multiple long-term conditions (MLTCs) is a growing priority for health and social care systems, as MLTCs often lead to frailty and reduced resilience to adverse health events. Behaviour change interventions for this population have shown limited effectiveness. We developed HomeHealth, a home-based behaviour change intervention for older adults with mild frailty and evaluated it in a randomised controlled trial in England. As part of the process evaluation, we conducted a qualitative sub-study to examine barriers and facilitators to engagement, approaches to goal setting, and strategies for tailoring future interventions. Forty-nine participants with MLTCs who received HomeHealth were interviewed, within 6-months of their final intervention session. Participants had an average age of 80.3 years, 65% female, 76% white British, and lived with an average of 5.1 health conditions (range 2-11). Data were thematically analysed. Three themes were developed: (1) prioritising symptoms over conditions; (2) coping with and adapting to symptoms; and (3) tailoring goal setting for MLTCs. Impacts were driven by cumulative symptom burden rather than diagnoses, with mobility-related impairment being the primary concern. Symptom-focused goal setting supported engagement, but symptom fluctuations hindered progress. Findings underscore the importance of person-centred approaches. Targeting goals around functional impairment and symptom management may improve engagement compared to condition-focused strategies. Supporting adaptive behaviours during symptom exacerbations and providing positive feedback on effort, rather than completion, could sustain motivation and promote long-term behaviour change.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"16 ","pages":"26335565261448335"},"PeriodicalIF":3.0,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13145010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimorbidity and health related quality of life in U.S. adults: A population-based study.","authors":"Monira Alwhaibi, Bander Balkhi","doi":"10.1177/26335565261446084","DOIUrl":"https://doi.org/10.1177/26335565261446084","url":null,"abstract":"<p><strong>Background: </strong>Multimorbidity, having two or more chronic conditions, is a growing public health concern associated with substantial health and societal burdens. However, evidence on its impact on health-related quality of life (HRQoL) among U.S. adults remains limited. This study fills a major research gap by examining the association between multimorbidity and HRQoL among U.S. adults, a population often overlooked in prior research and provides evidence to inform policies aligned with national and global health goals for reducing the chronic disease burden.</p><p><strong>Methods: </strong>A cross-sectional study was conducted among adults aged 18 to 64 years. Data from the Medical Expenditure Panel Survey was used in this study for years 2019 to 2021. The primary study outcome was the HRQoL; it was evaluated using the 12-item Veterans RAND 12. Descriptive analysis was used to describe the characteristics of the study sample. The adjusted relationship between Multimorbidity and HRQoL was assessed using the multivariable linear regression after other factors were adjusted in the regression analysis.</p><p><strong>Results: </strong>The study sample consists of 30,827 adults. Multimorbidity was prevalent among 23.4% of adults. It was higher among women, unemployed, poor, and physically inactive adults. Adults with multimorbidity had a lower mean HRQoL score than those without multimorbidity (Physical health = 46.06 vs. 53.29, Mental health = 47.62 vs. 52.37). Results from the adjusted linear regression model found that adults with multimorbidity have a significantly lower HRQoL in both the physical domain (β = -2.658, p-value<0.0001), and the mental domain (β = -3.119, p-value<0.0001).</p><p><strong>Conclusions: </strong>Multimorbidity has a substantial negative impact on both physical and mental aspects of HRQoL in U.S. adults. These findings highlight the need for targeted public health strategies and clinical interventions, such as promoting integrated chronic disease management to address the burden of multimorbidity. Future research should explore specific condition clusters most strongly associated with reduced HRQoL to better inform policy and care models.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"16 ","pages":"26335565261446084"},"PeriodicalIF":3.0,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13110340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient and public involvement in clinical trials to improve outcomes for adults with multimorbidity in primary care and community settings: A systematic review protocol.","authors":"Elizabeth A O'Donnell, Zara Khwaja, Susan M Smith, Carmel P Geoghegan, Martin Quinn, Laura J Sahm, Edel Burton, Ann Sinéad Doherty, Emma Wallace","doi":"10.1177/26335565261427228","DOIUrl":"10.1177/26335565261427228","url":null,"abstract":"<p><strong>Background: </strong>Patient and public involvement (PPI) in clinical trials for adults with multimorbidity (multiple long-term conditions) in primary care is essential to ensure research is person-centred. However, PPI is often underreported, limiting understanding of its application and impact. This protocol describes a systematic review examining the uptake, impact and reporting quality of PPI in clinical trials of interventions to improve mental health, clinical or quality-of-life outcomes for adults with multimorbidity in primary care.</p><p><strong>Methods: </strong>The review will be guided by the Cochrane Handbook and reported according to PRISMA-P guidelines. Eligible studies include completed and ongoing randomised and non-randomised controlled trials. Multimorbidity is defined as the co-existence of two or more long-term conditions. Electronic databases (MEDLINE, CINAHL, Embase, Cochrane) will be searched from 2019 to update Smith et al. (2021) without language restrictions. Trial registries and grey literature will identify protocols and supplementary data. Inclusion criteria - Population: adults with multimorbidity; Interventions: targeted at this population; Comparison: usual care; Outcomes: mental health, clinical or quality-of-life; Setting: primary or community care. Studies will be included irrespective of whether PPI was reported. Data extraction will capture PPI presence, characteristics, activities, training and acknowledgement. A narrative synthesis will describe reported PPI in clinical trials. Two PPI partners will contribute throughout the review. The protocol is registered with PROSPERO (CRD420251090082).</p><p><strong>Discussion/conclusion: </strong>This review will enhance understanding of PPI in trials aiming to improve outcomes for adults with multimorbidity in primary and community care, identify gaps in reporting, and inform future trials to support person-centred research.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"16 ","pages":"26335565261427228"},"PeriodicalIF":3.0,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13022320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimorbidity patterns and their associations with patient-perceived treatment burden: A latent class analysis of 14,344 Danish adults.","authors":"Marie Hauge Pedersen, Mathias Lasgaard, Camilla Palmhøj Nielsen, Anders Prior, Polly Duncan, Stine Schramm, Finn Breinholt Larsen","doi":"10.1177/26335565261417433","DOIUrl":"https://doi.org/10.1177/26335565261417433","url":null,"abstract":"<p><strong>Objectives: </strong>To identify population groups with distinct multimorbidity patterns and to examine their associations with high treatment burden.</p><p><strong>Methods: </strong>Latent class analysis was conducted using cross-sectional, self-reported data on 16 long-term conditions from Danish adults aged 25 years and older in treatment (N = 14,344), drawn from the Danish National Health Survey. Treatment burden was assessed using the Multimorbidity Treatment Burden Questionnaire, and associations between identified multimorbidity patterns and high treatment burden (score ≥22) were examined using a bias-adjusted three-step approach.</p><p><strong>Results: </strong>Eight latent classes were identified: 1 <i>Hypertension</i> (31% of the study population); 2 <i>Mental health disorders</i> (21%); 3 <i>Musculoskeletal disorders</i> (17%); 4 <i>Complex</i> <i>cardiometabolic-</i> <i>musculoskeletal</i> <i>disorders</i> (10%); 5 <i>Complex</i> <i>headache-mental-back-disorders</i> (7%); 6 <i>Asthma-</i> <i>allergy</i> (6%); 7 <i>Cataract-</i> <i>respiratory</i> <i>disorders</i> (5%); and 8 <i>Complex</i> <i>respiratory-</i> <i>musculoskeletal</i> <i>disorders</i> (3%). Overall, 13% experienced a high treatment burden. This proportion varied from 0.5% in Class 3 to 48% in Class 5, with the highest proportions associated with Classes 4 (27%), 5 (48%), and 8 (26%). The three complex multimorbidity groups averaged more than four conditions per individual and, compared to Class 1, were associated with a non-Danish background, being temporarily or permanently out of work, low social support, and difficulties engaging with healthcare providers. The prevalence of high treatment burden and the strength of its association with disease patterns decreased with age, while no substantial differences were observed across sexes.</p><p><strong>Conclusion: </strong>Specific multimorbidity patterns were strongly associated with high treatment burden. These findings may inform healthcare planning, resource allocation, and tailored interventions to reduce treatment burden.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"16 ","pages":"26335565261417433"},"PeriodicalIF":3.0,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12957603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between treatment burden, socio-demographics, clinical factors and use of medicines in adults with polypharmacy: A cross-sectional study.","authors":"Polly Duncan, Chloe Gamlin, Deborah McCahon, Daisy Gaunt, Beenish Ashfaq, Rupert A Payne","doi":"10.1177/26335565261420367","DOIUrl":"https://doi.org/10.1177/26335565261420367","url":null,"abstract":"<p><strong>Background: </strong>Understanding relationships between polypharmacy, treatment burden and other factors (e.g. age, knowledge of medicines), could inform interventions to reduce treatment burden.</p><p><strong>Aim: </strong>To explore sociodemographic, clinical and medication factors associated with high treatment burden.</p><p><strong>Design and setting: </strong>Secondary analysis of multi-centre UK primary care baseline clinical trial data.</p><p><strong>Methods: </strong>Participants were ≥18 years, prescribed ≥5 repeat medicines with ≥1 indicator of potentially inappropriate prescribing (PIP). Survey data captured treatment burden (13-item Multimorbidity Treatment Burden Questionnaire; dichotomised with high burden ≥22), sociodemographic characteristics, quality of life, self-reported knowledge of medicines, and medication adherence. Electronic health records provided data on age, gender, long-term conditions, PIP, medicines use (last 3 months), and consultations (last 12 months). Associations between treatment burden and other factors were modelled using multivariable logistic regression.</p><p><strong>Results: </strong>1711 adults from 37 general practices were included (mean age 72 years, 51% male). 381 (23%) reported high treatment burden. Multivariable analysis found high treatment burden was associated with younger age, being unemployed or in paid work, university or high education, multimorbidity, anxiety/depression, polypharmacy (≥8 medicines), lower medication adherence, knowledge of medicines, and quality of life. There was strong evidence (p<0.005) that the association between high treatment burden and polypharmacy was greater in people aged <60 years, those with poor knowledge of medicines, more multimorbidity, and those with low/moderate medication adherence.</p><p><strong>Conclusion: </strong>High treatment burden was more common in adults with polypharmacy who were younger, had multimorbidity, poor medication knowledge, or low adherence. This should inform design of interventions addressing treatment burden.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"16 ","pages":"26335565261420367"},"PeriodicalIF":3.0,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12957598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Focusing on burden and capacity to support self-management of chronic health conditions: A pilot trial of care coordination in rural Australia.","authors":"Ruth Hardman, Stephen Begg, Evelien Spelten","doi":"10.1177/26335565261417400","DOIUrl":"https://doi.org/10.1177/26335565261417400","url":null,"abstract":"<p><strong>Introduction: </strong>Managing multiple health conditions can create a demanding workload, especially when capacity is limited. This can lead to disengagement and poor health outcomes. Our pilot trial explored the feasibility of care coordination using a minimally-disruptive medicine approach.</p><p><strong>Methods: </strong>The setting was a community health service in rural Victoria, Australia. People with multimorbidity and complex life demands were linked to care coordinators who evaluated and addressed burden and capacity imbalance, informed by client priorities. Clinicians underwent training in capacity-burden assessment and participated in ongoing case conferencing. A mixed-methods evaluation was undertaken guided by Bowen's feasibility framework with treatment burden and quality of life as quantitative outcomes.</p><p><strong>Results: </strong>26 clients (mean age 66.5 years) engaged with 3 care coordinators. Clients reported high treatment burden with a mean of 11 chronic conditions each, dominated by mental health and chronic pain conditions. The program was highly acceptable to clients, who reported increased control over their health and life demands. Six-month outcomes showed a significant reduction in treatment burden level (MMTBQ) p=0.019, Phi=0.524 and improvement in quality-of-life scores (EQ-VAS) p=0.019. Clinicians valued the program and highlighted the importance of putting aside one's discipline lens and focusing on the client priorities, aided by the assessment tools and training.</p><p><strong>Discussion: </strong>A burden-capacity model of care coordination is feasible in the community health setting and may lead to reduced treatment burden. Barriers identified were related to community health funding and structures favouring single diseases and disciplinary boundaries, which may not reflect the lived experience of clients.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"16 ","pages":"26335565261417400"},"PeriodicalIF":3.0,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12953959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of the Short Treatment Burden Questionnaire (STBQ) including a Global Treatment Burden Question (GTBQ): Cognitive interviews with adults living with multimorbidity.","authors":"Rebecca Goulding, Polly Duncan, Anastasiia G Kovalenko, Chloe Gamlin, Simon Chilcott, Simon D S Fraser, Jose M Valderas, Rachel Johnson","doi":"10.1177/26335565261417393","DOIUrl":"https://doi.org/10.1177/26335565261417393","url":null,"abstract":"<p><strong>Background: </strong>A short patient reported outcome measure (PROM) could help identify people experiencing high treatment burden.</p><p><strong>Objectives: </strong>To develop the Short Treatment Burden Questionnaire (STBQ), a novel PROM comprising a Global Treatment Burden Question (GTBQ) and items to identify areas of difficulty; improve its understandability and face validity; and explore patient views on using it in clinical practice.</p><p><strong>Methods: </strong>Prototype development drew on the validated Multimorbidity Treatment Burden Questionnaire (MTBQ) and a single-item global measure. Adults, aged 18-65, living with multimorbidity were recruited from English general practices. Three rounds of cognitive interviews, with think-aloud and prompts, were conducted (July-October 2023). After each round, data were analysed, suggested changes and uncertainties discussed and modifications made. Public contributors were involved throughout.</p><p><strong>Results: </strong>Participants (n = 15) were predominantly female (67%) and White British (87%). Issues were identified with the layout, instructions, and order and wording of response options, with some aspects interpreted in unintended ways. The number of issues and consequent changes reduced with each round of interviews. Participants highlighted potential benefits of using the STBQ in clinical practice, including encouraging patients to mention things they may not otherwise bring up. They suggested the STBQ could inform both individual patient care and practice-level service improvement.</p><p><strong>Conclusions: </strong>Robust qualitative methods were used to develop a novel PROM for use in clinical practice and research. The STBQ demonstrated face validity and was relatively easy to use. Further work has been undertaken to validate the GTBQ. Guidance will outline how the STBQ could support patient care.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"16 ","pages":"26335565261417393"},"PeriodicalIF":3.0,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12946401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147328374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges for the design of randomised trials for interventions for people with multiple long-term conditions: Recruitment and outcome selection.","authors":"Sally J Singh, Rod S Taylor","doi":"10.1177/26335565251376613","DOIUrl":"https://doi.org/10.1177/26335565251376613","url":null,"abstract":"<p><p>The burden of multiple long-term conditions is significant for the individual and society. Exploring interventions to alleviate disease progression, accumulation of long-term conditions and symptom burden is crucial. This commentary debates two important considerations for intervention design and subsequent recruitment approaches.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"16 ","pages":"26335565251376613"},"PeriodicalIF":3.0,"publicationDate":"2026-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12923924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147273277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimorbidity combinations among older adults in Singapore: A cross-sectional study using polyclinic data.","authors":"Victoria Koh, Shilpa Tyagi, Gerald Choon-Huat Koh, Sai Zhen Sim, Meena Sundram, Lawrence Lam, Ngiap Chuan Tan, Eng Sing Lee","doi":"10.1177/26335565261417399","DOIUrl":"https://doi.org/10.1177/26335565261417399","url":null,"abstract":"<p><strong>Background: </strong>Multimorbidity, the co-occurrence of multiple chronic conditions, is commonly managed in primary care and increasingly prevalent. Researchers are increasingly studying the unique combinations of chronic conditions and their associations with health service utilisation. However, published studies largely focus on common dyads and triads of chronic conditions. This study aims to determine the prevalence and combinations of multimorbidity among older adults managed in Singapore's primary care.</p><p><strong>Methods: </strong>A cross-sectional analysis of all Singapore citizens and permanent residents aged ≥50 years who visited any polyclinic between July 2017 to June 2018 was conducted. Patient diagnoses up to year 2012 were reviewed using 23 chronic condition categories to define multimorbidity. All multimorbidity combinations and their prevalence were analysed.</p><p><strong>Results: </strong>Among 502,036 polyclinic patients aged ≥50 years, 59.9% had multimorbidity. Of 4,194,050 possible multimorbidity combinations, 13,959 were observed. Combinations comprised between three to 13 chronic conditions. The most prevalent and costly combinations consisted three to four chronic conditions: (1) hyperlidaemia/hypertension/diabetes; (2) hyperlidaemia/hypertension/diabetes/functional limitation; (3) hyperlidaemia/hypertension/functional limitation; (4) hyperlipidaemia/hypertension/diabetes/cardiovascular disease; (5) hyperlipidaemia/hypertension/diabetes/arthritis; (6) hyperlipidaemia/hypertension/arthritis; (7) hyperlipidaemia/hypertension/cardiovascular disease; (8) hyperlipidaemia/hypertension/diabetes/obesity; (9) hyperlipidaemia/hypertension/diabetes/stroke; (10) hyperlipidaemia/hypertension/arthritis/functional limitation; (11) hyperlipidaemia/hypertension/diabetes/kidney.</p><p><strong>Conclusion: </strong>Although a wide variety of combinations were observed, hyperlipidaemia and hypertension were common in the most prevalent and costly combinations. As current management of chronic conditions focusses on disease-specific clinical outcomes, findings from this study suggest a need to optimise clinical outcomes for common multimorbidity combinations rather than simply aggregating outcomes for all conditions within the combination.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"16 ","pages":"26335565261417399"},"PeriodicalIF":3.0,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12914068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146230023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}