Prevalence of multimorbidity in the adult population attending primary care in Portugal: a cross-sectional study

Abstract

Objectives: To determine the prevalence of multimorbidity in the adult population attending primary care in Portugal, to identify associated sociodemographic factors, and to reveal combinations of chronic health problems.

Design: Cross-sectional, analytical study.

Setting: Primary Care Centres in mainland Portugal across the five Portuguese Healthcare Administrative Regions.

Participants: 1279 women and 714 men agreed to participate. The mean age was 56.3 years (59.0 years for men; 54.8 years for women). The most frequent marital status was married/cohabiting (69.5%). The most predominant living arrangement was living as a couple (57.2%). A considerable proportion consisted of pensioners/retirees (41.5%) and adults with a low educational level (48.7%). Sufficient monthly income was reported in 54.4% of the cases.

Primary outcome measures: For each patient, multimorbidity was measured either by the presence of ≥2 or ≥3 chronic health problems, from a list of 147 chronic health problems. Clinical data were collected using the general practitioner's knowledge of the patient's history, patient's self-report and medical records. Cluster analyses were performed to reveal distinct patterns of multimorbidity.

Secondary outcome measures: Patient social and demographic data (sex, age, residence area, current marital status, number of years of formal education, living arrangements, professional status and self-perceived economic status). Logistic regression analyses were performed to determine the association between sociodemographic factors and multimorbidity.

Results: Multimorbidity (2 or more chronic health problems) was present in 72.7%. When a cut-off of three or more was used, an expressive percentage of multimorbidity (57.2%) remained present. The likelihood of having multimorbidity increased significantly with age. Pensioners/retirees and adults with low levels of education were significantly more likely to suffer from multimorbidity. Cardiometabolic and mental disorders were the most common chronic health problems. Six multimorbidity clusters have been identified.

Conclusions: Multimorbidity was found to be a common occurrence in the Portuguese primary care users. Future primary healthcare policies should take multimorbidity into consideration.

Keywords: EPIDEMIOLOGY; PRIMARY CARE; PUBLIC HEALTH.

Figure 1

Dendogram resulting from cluster analysis.