Objectives: To estimate the prevalence and patterns of multimorbidity in a sample of patients attending general practice, in the population who attended general practice in 2005, and in the Australian population.
Design, setting and participants: Secondary analyses of data from a study of prevalence of selected conditions (a substudy of the BEACH [Bettering the Evaluation And Care of Health] program); data were provided by 305 general practitioners for 9156 patients seen in July–November 2005, based on knowledge of the patient, patient self-report, and medical records. Listed conditions were classified according to the Cumulative Illness Rating Scale morbidity domains.
Results: Prevalence of multimorbidity was estimated as 37.1% of surveyed patients, 29.0% of people who attended a GP in 2005, and 25.5% of the Australian population. Prevalence and complexity (number of domains present) increased with age: 83.2% of surveyed patients aged 75 years or older had multimorbidity, 58.2% had morbidity in three or more domains, and 33.4% in four or more. Prevalence of multimorbidity did not differ between the sexes. The most common morbidity combinations were arthritis/chronic back pain + vascular disease (15.0% of sample), a psychological problem + vascular disease (10.6%) and arthritis/chronic back pain + a psychological problem (10.6%). We estimate that 10.6% of people attending a GP in 2005 and 9.3% of the population have arthritis/chronic back pain + vascular disease (± other morbidity types studied), and this group accounted for about 15.2 million Medicare-claimed general practice encounters in 2005.
Conclusions: This study provides the first insight into prevalence and patterns of multimorbidity in Australia. Knowledge of the common combinations of multimorbidity may help in planning the health services needed in the future by an ageing population with an increasing burden of multimorbidity.
- 1. Australian Government Department of Health and Ageing. Medicare Benefits Schedule book. Canberra: DoHA, 2006.
- 2. Valderas JM, Starfield B, Roland M. Multimorbidity’s many challenges: a research priority in the UK. BMJ 2007; 334: 1128.
- 3. Vogeli C, Shields AE, Lee TA, et al. Multiple chronic conditions: prevalence, health consequences, and implications for quality, care management, and costs. J Gen Intern Med 2007; 22 Suppl 3: 391-395.
- 4. Starfield B. Threads and yarns: weaving the tapestry of comorbidity. Ann Fam Med 2006; 4: 101-103.
- 5. Starfield B. Global health, equity, and primary care. J Am Board Fam Med 2007; 20: 511-513.
- 6. Ritchie C. Health care quality and multimorbidity: the jury is still out. Med Care 2007; 45: 477-479.
- 7. van den Akker M, Buntinx F, Roos S, et al. Problems in determining occurrence rates of multimorbidity. J Clin Epidemiol 2001; 54: 675-679.
- 8. Feinstein AR. Clinical judgment. Williams and Wilkins, 1967.
- 9. Fortin M, Bravo G, Hudon C, et al. Relationship between multimorbidity and health-related quality of life of patients in primary care. Qual Life Res 2006; 15: 83-91.
- 10. Fortin M, Dubois MF, Hudon C, et al. Multimorbidity and quality of life: a closer look. Health Qual Life Outcomes 2007; 5: 52.
- 11. Bayliss EA, Ellis JL, Steiner JF. Subjective assessments of comorbidity correlate with quality of life health outcomes: initial validation of a comorbidity assessment instrument. Health Qual Life Outcomes 2005; 3: 51.
- 12. Starfield B, Lemke KW, Herbert R, et al. Comorbidity and the use of primary care and specialist care in the elderly. Ann Fam Med 2005; 3: 215-222.
- 13. Lee TA, Shields AE, Vogeli C, et al. Mortality rate in veterans with multiple chronic conditions. J Gen Intern Med 2007; 22 Suppl 3: 403-407.
- 14. van den Akker M, Buntinx F, Metsemakers JF, et al. Multimorbidity in general practice: prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases. J Clin Epidemiol 1998; 51: 367-375.
- 15. Fortin M, Lapointe L, Hudon C, et al. Multimorbidity is common to family practice: is it commonly researched? Can Fam Physician 2005; 51: 244-245.
- 16. Fortin M, Bravo G, Hudon C, et al. Prevalence of multimorbidity among adults seen in family practice. Ann Fam Med 2005; 3: 223-228.
- 17. Australian Institute of Health and Welfare. Australia’s health 2006: the tenth biennial health report of the Australian Institute of Health and Welfare. Canberra: AIHW, 2006.
- 18. Knox SA, Harrison CM, Britt HC, Henderson JV. Estimating prevalence of common chronic morbidities in Australia. Med J Aust 2008; 189: 66-70.
- 19. Preen DB, Holman CD, Lawrence DM, et al. Hospital chart review provided more accurate comorbidity information than data from a general practitioner survey or an administrative database. J Clin Epidemiol 2004; 57: 1295-1304.
- 20. Britt H, Miller GC, Knox S, et al. General practice activity in Australia 2003–04. Canberra: Australian Institute of Health and Welfare, 2004.
- 21. Britt H, Miller GC, Henderson J, Bayram C. Patient-based substudies from BEACH: abstracts and research tools 1999–2006. Canberra: Australian Institute of Health and Welfare, 2007.
- 22. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373-383.
- 23. Hudon C, Fortin M, Soubhi H. Abbreviated guidelines for scoring the Cumulative Illness Rating Scale (CIRS) in family practice. J Clin Epidemiol 2007; 60: 212.
- 24. Fortin M, Hudon C, Dubois MF, et al. Comparative assessment of three different indices of multimorbidity for studies on health-related quality of life. Health Qual Life Outcomes 2005; 3: 74.
- 25. Hudon C, Fortin M, Vanasse A. Cumulative Illness Rating Scale was a reliable and valid index in a family practice context. J Clin Epidemiol 2005; 58: 603-608.
- 26. Australian Government Department of Health and Ageing. Medicare statistics. http://www.health.gov.au/internet/wcms/publishing.nsf/Content/medstat-jun07-tables-b (accessed Oct 2007).
- 27. O’Halloran J, Miller GC, Britt H. Defining chronic conditions for primary care with ICPC-2. Fam Pract 2004; 21: 381-386.
- 28. Britt H, Miller GC, Charles J, et al. General practice activity in Australia 2005–06. Canberra: Australian Institute of Health and Welfare, 2007.
- 29. Fortin M, Soubhi H, Hudon C, et al. Multimorbidity’s many challenges. BMJ 2007; 334: 1016-1017.
- 30. Hudon C, Fortin M, Soubhi H. Chronic musculoskeletal conditions and comorbidities in primary care settings. Can Fam Physician 2008; 54: 74-75.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.