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. 2022 Jul 27;1(1):e000247.
doi: 10.1136/bmjmed-2022-000247. eCollection 2022.

Measuring multimorbidity in research: Delphi consensus study

Iris S S Ho  1 , Amaya Azcoaga-Lorenzo  2 , Ashley Akbari  3 , Jim Davies  4 , Kamlesh Khunti  5 , Umesh T Kadam  5 , Ronan A Lyons  6 , Colin McCowan  2 , Stewart W Mercer  1 , Krishnarajah Nirantharakumar  7 , Sophie Staniszewska  8 , Bruce Guthrie  1
Affiliations

Measuring multimorbidity in research: Delphi consensus study

Iris S S Ho et al. BMJ Med. .

Abstract

Objective: To develop international consensus on the definition and measurement of multimorbidity in research.

Design: Delphi consensus study.

Setting: International consensus; data collected in three online rounds from participants between 30 November 2020 and 18 May 2021.

Participants: Professionals interested in multimorbidity and people with long term conditions were recruited to professional and public panels.

Results: 150 professional and 25 public participants completed the first survey round. Response rates for rounds 2/3 were 83%/92% for professionals and 88%/93% in the public panel, respectively. Across both panels, the consensus was that multimorbidity should be defined as two or more long term conditions. Complex multimorbidity was perceived to be a useful concept, but the panels were unable to agree on how to define it. Both panels agreed that conditions should be included in a multimorbidity measure if they were one or more of the following: currently active; permanent in their effects; requiring current treatment, care, or therapy; requiring surveillance; or relapsing-remitting conditions requiring ongoing care. Consensus was reached for 24 conditions to always include in multimorbidity measures, and 35 conditions to usually include unless a good reason not to existed. Simple counts were preferred for estimating prevalence and examining clustering or trajectories, and weighted measures were preferred for risk adjustment and outcome prediction.

Conclusions: Previous multimorbidity research is limited by inconsistent definitions and approaches to measuring multimorbidity. This Delphi study identifies professional and public panel consensus guidance to facilitate consistency of definition and measurement, and to improve study comparability and reproducibility.

Keywords: epidemiology; medicine; primary health care; public health; research design.

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Conflict of interest statement

Competing interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: support from Health Data Research UK 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.

Figures

Figure 1
Figure 1
Process of participant recruitment
Figure 2
Figure 2
Summary of findings and recommendations on multimorbidity definition. Professional panel consensus was >6 months; patient panel consensus was >12 months
Figure 3
Figure 3
Reporting recommendations on multimorbidity
See this image and copyright information in PMC

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