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. 2020 Feb 18:368:m160.
doi: 10.1136/bmj.m160.

Measuring multimorbidity beyond counting diseases: systematic review of community and population studies and guide to index choice

Lucy E Stirland  1   2 , Laura González-Saavedra  3 , Donncha S Mullin  2   4 , Craig W Ritchie  5   2 , Graciela Muniz-Terrera  5   2 , Tom C Russ  5   6   7
Affiliations

Measuring multimorbidity beyond counting diseases: systematic review of community and population studies and guide to index choice

Lucy E Stirland et al. BMJ. .

Erratum in

Abstract

Objectives: To identify and summarise existing indices for measuring multimorbidity beyond disease counts, to establish which indices include mental health comorbidities or outcomes, and to develop recommendations based on applicability, performance, and usage.

Design: Systematic review.

Data sources: Seven medical research databases (Medline, Web of Science Core Collection, Cochrane Library, Embase, PsycINFO, Scopus, and CINAHL Plus) from inception to October 2018 and bibliographies and citations of relevant papers. Searches were limited to English language publications.

Eligibility criteria for study selection: Original articles describing a new multimorbidity index including more information than disease counts and not focusing on comorbidity associated with one specific disease. Studies were of adults based in the community or at population level.

Results: Among 7128 search results, 5560 unique titles were identified. After screening against eligibility criteria the review finally included 35 papers. As index components, 25 indices used conditions (weighted or in combination with other parameters), five used diagnostic categories, four used drug use, and one used physiological measures. Predicted outcomes included mortality (18 indices), healthcare use or costs (13), hospital admission (13), and health related quality of life (7). 29 indices considered some aspect of mental health, with most including it as a comorbidity. 12 indices are recommended for use.

Conclusions: 35 multimorbidity indices are available, with differing components and outcomes. Researchers and clinicians should examine existing indices for suitability before creating new ones.

Systematic review registration: PROSPERO CRD42017074211.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work. LES reports a grant from the Medical Research Foundation and Medical Research Council (MR/J000914/1) under the Psychiatry: Scottish Training in Academic Research (PsySTAR) scheme, during the conduct of the study. All authors had full access to all of the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. Contributors: LES performed the literature search; screened the titles, abstracts, and full texts; wrote the first draft of the article; and is the guarantor. LG-S and DSM acted as independent second reviewers in the screening process. LES and DSM independently extracted all the data and assessed the reporting quality of all full texts. GM-T provided statistical guidance. TCR, CWR, and GM-T developed the idea for the article with LES and supervised the research process. LES is the guarantor. All authors edited the manuscript. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

Figures

Fig 1
Fig 1
Screening process according to PRISMA
Fig 2
Fig 2
Spider diagram summarising index components. *Paper appears under more than one category
Fig 3
Fig 3
Flowchart of recommended indices organised by components and original outcomes
See this image and copyright information in PMC

References

    1. The Academy of Medical Sciences. Multimorbidity: a priority for global health research. 2018. https://acmedsci.ac.uk/file-download/39787360
    1. Xu X, Mishra GD, Jones M. Mapping the global research landscape and knowledge gaps on multimorbidity: a bibliometric study. J Glob Health 2017;7:010414. 10.7189/jogh.07.010414. - 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. Huntley AL, Johnson R, Purdy S, Valderas JM, Salisbury C. Measures of multimorbidity and morbidity burden for use in primary care and community settings: a systematic review and guide. Ann Fam Med 2012;10:134-41. 10.1370/afm.1363. - DOI - PMC - PubMed
    1. Johnston MC, Crilly M, Black C, Prescott GJ, Mercer SW. Defining and measuring multimorbidity: a systematic review of systematic reviews. Eur J Public Health 2019;29:182-9. 10.1093/eurpub/cky098. - DOI - PubMed

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