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Review
. 2021 Jul 15:11:26335565211032880.
doi: 10.1177/26335565211032880. eCollection 2021 Jan-Dec.

The incidence of multimorbidity and patterns in accumulation of chronic conditions: A systematic review

Prtha Kudesia  1 , Banafsheh Salimarouny  1 , Meagan Stanley  2 , Martin Fortin  3 , Moira Stewart  4   5 , Amanda Terry  1   4   5 , Bridget L Ryan  4   5
Affiliations
Review

The incidence of multimorbidity and patterns in accumulation of chronic conditions: A systematic review

Prtha Kudesia et al. J Multimorb Comorb. .

Abstract

Multimorbidity, the presence of 1+ chronic condition in an individual, remains one of the greatest challenges to health on a global scale. Although the prevalence of multimorbidity has been well-established, its incidence is not fully understood. This systematic review determined the incidence of multimorbidity across the lifespan; the order in which chronic conditions accumulate to result in multimorbidity; and cataloged methods used to determine and report accumulation of chronic conditions resulting in multimorbidity. Studies were identified by searching MEDLINE, Embase, CINAHL, and Cochrane electronic databases. Two independent reviewers evaluated studies for inclusion and performed quality assessments. Of 36 included studies, there was high heterogeneity in study design and operational definitions of multimorbidity. Studies reporting incidence (n = 32) reported a median incidence rate of 30.7 per 1,000 person-years (IQR 39.5 per 1,000 person-years) and a median cumulative incidence of 2.8% (IQR 28.7%). Incidence was notably higher for persons with older age and 1+ chronic conditions at baseline. Studies reporting patterns in accumulation of chronic conditions (n = 5) reported hypertensive and heart diseases, and diabetes, as among the common starting conditions resulting in later multimorbidity. Methods used to discern patterns were highly heterogenous, ranging from the use of latent growth trajectories to divisive cluster analyses, and presentation using alluvial plots to cluster trajectories. Studies reporting the incidence of multimorbidity and patterns in accumulation of chronic conditions vary greatly in study designs and definitions used. To allow for more accurate estimations and comparison, studies must be transparent and consistent in operational definitions of multimorbidity applied.

Keywords: Multimorbidity; accumulation; epidemiology; incidence; systematic review.

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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.
PRISMA flow diagram for study selection.
See this image and copyright information in PMC

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