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 Nov 3;8(11):e023398.
doi: 10.1136/bmjopen-2018-023398.

Prevalence and patterns of multimorbidity in Amazon Region of Brazil and associated determinants: a cross-sectional study

Maria Elizete A Araujo  1   2 , Marcus T Silva  3   4 , Tais F Galvao  5 , Bruno P Nunes  6 , Mauricio G Pereira  7
Affiliations

Prevalence and patterns of multimorbidity in Amazon Region of Brazil and associated determinants: a cross-sectional study

Maria Elizete A Araujo et al. BMJ Open. .

Abstract

Objectives: To estimate the prevalence of multimorbidity and to identify factors associated with it in the adult population from the metropolitan region of Manaus.

Design: Cross-sectional population-based study.

Setting: Interviews conducted between May and August of 2015 in eight cities that compose the metropolitan region of Manaus, Amazonas, Brazil.

Participants: 4001 adults aged ≥18 years.

Primary outcome measures: Multimorbidity, measured by the occurrence of ≥2 and ≥3 chronic diseases, was the primary outcome. The associated factors were investigated by calculating the prevalence ratio (PR) obtained by Poisson regression, with robust adjustment of the variance in a hierarchical model. A factor analysis was conducted to investigate multimorbidity clusters.

Results: Half of the interviewees were women. The presence of a chronic disease was reported by 57.2% (95% CI 56.6% to 59.7%) of the interviewees, and the mean morbidity was 1.2 (1.1-1.2); 29.0% (95% CI 27.6% to 30.5%) reported ≥2 morbidities and 15.2% (95% CI 14.1% to 16.4%) reported ≥3 chronic conditions. Back pain was reported by one-third of the interviewees. Multimorbidity was highest in women, PR=1.66 (95% CI 1.50 to 1.83); the elderly, PR=5.68 (95% CI 4.51 to 7.15) and individuals with worse health perception, PR=3.70 (95% CI 2.73 to 5.00). Associated factors also included undergoing medical consultations, hospitalisation in the last year, suffering from dengue in the last year and seeking the same healthcare service. Factor analysis revealed a pattern of multimorbidity in women. The factor loading the most strength of association in women was heart disease. In men, an association was identified in two groups, and lung disease was the disease with the highest factorial loading.

Conclusion: Multimorbidity was frequent in the metropolitan region of Manaus. It occurred most often in women, in the elderly and in those with worse health perception.

Keywords: Brazil; cross-sectional studies; multimorbidity; population surveys; prevalence.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

References

    1. van den Akker M, Buntinx F, Knottnerus JA. Comorbidity or multimorbidity: what’s in a name? A review of literature. The European Journal of General Practice 1996;2:65–70.
    1. Le Reste JY, Nabbe P, Manceau B, et al. . The European General Practice Research Network presents a comprehensive definition of multimorbidity in family medicine and long term care, following a systematic review of relevant literature. J Am Med Dir Assoc 2013;14:319–25. 10.1016/j.jamda.2013.01.001 - DOI - PubMed
    1. Violan C, Foguet-Boreu Q, Flores-Mateo G, et al. . Prevalence, determinants and patterns of multimorbidity in primary care: a systematic review of observational studies. PLoS One 2014;9:e102149 10.1371/journal.pone.0102149 - DOI - PMC - PubMed
    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;66:301–11. 10.1093/gerona/glq208 - DOI - PubMed
    1. Fortin M, Stewart M, Poitras ME, et al. . A systematic review of prevalence studies on multimorbidity: toward a more uniform methodology. Ann Fam Med 2012;10:142–51. 10.1370/afm.1337 - DOI - PMC - PubMed

Publication types