Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Oct 14;8(1):2235042X18804063.
doi: 10.1177/2235042X18804063. eCollection 2018 Jan-Dec.

Multimorbidity and mortality: A 15-year longitudinal registry-based nationwide Danish population study

T G Willadsen  1 , V Siersma  1 , D R Nicolaisdóttir  1 , R Køster-Rasmussen  1 , D E Jarbøl  2 , S Reventlow  1 , S W Mercer  3 , N de Fine Olivarius  1
Affiliations

Multimorbidity and mortality: A 15-year longitudinal registry-based nationwide Danish population study

T G Willadsen et al. J Comorb. .

Abstract

Background: Knowledge about prevalent and deadly combinations of multimorbidity is needed.

Objective: To determine the nationwide prevalence of multimorbidity and estimate mortality for the most prevalent combinations of one to five diagnosis groups. Furthermore, to assess the excess mortality of the combination of two groups compared to the product of mortality associated with the single groups.

Design: A prospective cohort study using Danish registries and including 3.986.209 people aged ≥18 years on 1 January, 2000. Multimorbidity was defined as having diagnoses from at least 2 of 10 diagnosis groups: lung, musculoskeletal, endocrine, mental, cancer, neurological, gastrointestinal, cardiovascular, kidney, and sensory organs. Logistic regression (odds ratios, ORs) and ratio of ORs (ROR) were used to study mortality and excess mortality.

Results: Prevalence of multimorbidity was 7.1% in the Danish population. The most prevalent combination was the musculoskeletal-cardiovascular (0.4%), which had double the mortality (OR, 2.03) compared to persons not belonging to any of the diagnosis groups but showed no excess mortality (ROR, 0.97). The neurological-cancer combination had the highest mortality (OR, 6.35), was less prevalent (0.07%), and had no excess mortality (ROR, 0.94). Cardiovascular-lung was moderately prevalent (0.2%), had high mortality (OR, 5.75), and had excess mortality (ROR, 1.18). Endocrine-kidney had high excess mortality (ROR, 1.81) and cancer-mental had low excess mortality (ROR, 0.66). Mortality increased with the number of groups.

Conclusions: All combinations had increased mortality risk with some of them having up to a six-fold increased risk. Mortality increased with the number of diagnosis groups. Most combinations did not increase mortality above that expected, that is, were additive rather than synergistic.

Keywords: Multimorbidity; chronic conditions; cohort study; mortality; prevalence; register study.

PubMed Disclaimer

Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
The population cohort through study.
Figure 2.
Figure 2.
Prevalence (size of the circles), mortality (grey scale), and interaction or relative excess mortality or the ROR (border color of the circles) for all possible pairs of multimorbidity (adjusted for age, sex, socioeconomic status, cohabitation status, and degree of urbanization). ROR: ratio of odds ratio.
See this image and copyright information in PMC

References

    1. 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. - PubMed
    1. 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. - PubMed
    1. van den Akker MBF, Knottnerus JA. Comorbidity or multimorbidity: what’s in a name? A review of literature. Eur J Gen Practice 1996; 2: 65–70.
    1. Diederichs C, Berger K, Bartels DB. The measurement of multiple chronic diseases—a systematic review on existing multimorbidity indices. J Gerontol A Biol Sci Med Sci 2011; 66(3): 301–311. - PubMed
    1. Willadsen TG, Bebe A, Koster-Rasmussen R, et al. The role of diseases, risk factors and symptoms in the definition of multimorbidity—a systematic review. Scand J Prim Health Care 2016; 34(2): 112–121. - PMC - PubMed

LinkOut - more resources