A systematic review of prevalence studies on multimorbidity: toward a more uniform methodology

Abstract

Purpose: We sought to identify and compare studies reporting the prevalence of multimorbidity and to suggest methodologic aspects to be considered in the conduct of such studies.

Methods: We searched the literature for English- and French-language articles published between 1980 and September 2010 that described the prevalence of multimorbidity in the general population, in primary care, or both. We assessed quality of included studies with a modified version of the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Results of individual prevalence studies were adjusted so that they could be compared graphically.

Results: The final sample included 21 articles: 8 described studies conducted in primary care, 12 in the general population, and 1 in both. All articles were of good quality. The largest differences in prevalence of multimorbidity were observed at age 75 in both primary care (with prevalence ranging from 3.5% to 98.5% across studies) and the general population (with prevalence ranging from 13.1% to 71.8% across studies). Apart from differences in geographic settings, we identified differences in recruitment method and sample size (primary care: 980-60,857 patients; general population: 1,099-316,928 individuals), data collection, and the operational definition of multimorbidity used, including the number of diagnoses considered (primary care: 5 to all; general population: 7 to all). This last aspect seemed to be the most important factor in estimating prevalence.

Conclusions: Marked variation exists among studies of the prevalence of multimorbidity with respect to both methodology and findings. When undertaking such studies, investigators should carefully consider the specific diagnoses included and their number, as well as the operational definition of multimorbidity.

Figure 1

Number of references identified at each stage of the systematic review.

Figure 2

Prevalence of multimorbidity (defined as ≥2 diseases) reported in primary care settings. Note: Data reported in the studies were adjusted to fit into the graph, as described in the Methods section.

Figure 3

Prevalence of multimorbidity (defined as ≥3 diseases) reported in primary care settings. Note: Data reported in the studies were adjusted to fit into the graph, as described in the Methods section.

Figure 4

Prevalence of multimorbidity (≥2 diseases) in the general population. LASA = Longitudinal Aging Study Amsterdam. Note: Data reported in the studies were adjusted to fit into the graph, as described in the Methods section