Multimorbidity, also known as multiple long-term conditions (MLTC), means living with two or more chronic illnesses.[1] For example, a person could have diabetes, heart disease and depression at the same time. Multimorbidity can have a significant impact on people's health and wellbeing. It also poses a complex challenge to healthcare systems which are traditionally focused on individual diseases.[1] Multiple long-term conditions can affect people of any age, but they are more common in older age, affecting more than half of people over 65 years old.[2][3]

Definition

The concept of multiple long-term conditions is not clearly defined[1][4][5] and may be referred to by various names.[6]

Difference from comorbidity

Multimorbidity is often referred to as comorbidity even though the two are considered distinct clinical scenarios.[6][7][8]

Comorbidity means that one 'index' condition is the focus of attention, and others are viewed in relation to this. In contrast, multimorbidity describes someone having two or more long-term (chronic) conditions without any of them holding priority over the others. This distinction is important in how the healthcare system treats people and helps making clear the specific settings in which the use of one or the other term can be preferred. Multimorbidity offers a more general and person-centered concept that allows focusing on all of the patient's symptoms and providing a more holistic care. In other settings, for example in pharmaceutical research, comorbidity might often be the more useful term to use.[2][8]

Definitions

The broad definition of multimorbidity, consistent with what is used by most researchers, the WHO and the UK's Academy of Medical Sciences is the "co-existence of two or more chronic conditions". These can be physical non-communicable diseases, infectious and mental health conditions in any possible combinations and they may or may not interact with each other.[6] When the co-existing conditions have similar origins or treatments the terms used is concordant multimorbidity, while discordant multimorbidity is used to refer to conditions that appear to be unrelated to each other.[6]

Definitions of multimorbidity usually differ in the minimum number of concurrent conditions they require (most often this is two or more) and in the types of conditions they consider.[9] For example the UK's National Institute for Health and Care Excellence (NICE) includes alcohol and substance misuse in their list of conditions considered to constitute multimorbidity.[10]

Naming

The most commonly used term to describe the concept is multimorbidity. However, scientific literature shows a diverse range of terms used with the same meaning. These include comorbidity, polymorbidity, polypathology, pluripathology, multipathology, multicondition.[11]

The UK's National Institute for Health and Care Research (NIHR) uses the term multiple long-term conditions (MLTC) as it is more accepted and understood by patients and the public.[12]

Causes

Risk factors

A range of biological, psychological, behavioural, socioeconomic and environmental factors affect the likelihood of having multimorbidity. How these risk factors interact to trigger multiple long-term conditions is complex and still not fully understood.[1]

One risk factor of multimorbidity in young people is being born premature.[13][14] Lifestyle factors that may increase the risk of multiple long-term conditions include obesity, poor diet, poor sleep, smoking, air pollution, alcohol; and lifestyles factors that may reduce the risk of MLTC includes eating a healthy diet, physical activity, and strong social networks.[1][15]

Lower socioeconomic status, measured by a combination of education, occupation and literacy indicators, seems to increase the risk of developing multimorbidity.[16] For instance, based on the Whitehall II Study, people in lower employment positions seem to have a 66% higher risk of developing multiple long-term conditions than people in higher positions. However, socioeconomic status does not appear to influence the risk of dying after the onset of multiple long-term conditions.[16] Another study showed an increase of almost 50% in the odds of multimorbidity occurring in those with the least wealth compared to those with the most wealth.[17] Therefore, reducing socioeconomic inequalities by improving working and living conditions and education to everyone is important to reduce the burden of multiple long-term conditions on population health.[16]

Diagnosis and impact

Multimorbidity is associated with reduced quality of life[18] and increased risk of death.[19] The risk of death is positively associated with individuals with greater number of chronic conditions and reversely associated with socioeconomic status.[19] People with multiple long-term conditions may have a four-fold increase in the risk of death in comparison with people without MLTC irrespective of their socioeconomic status.[16]

In some cases, specific combinations of diseases are associated with higher mortality.[20] For example, people with long-term conditions affecting the heart, lung, and urinary systems have strong effects on mortality.[20]

There are many additional issues associated with living with multiple long term conditions. One study from the US found that having more than 3 conditions significantly increased the chance of reduced quality of life and physical functioning. The researchers called for the holistic treatment of multimorbidities due to the complexities of multiple long-term conditions.[21]

Due to the higher prevalence of multimorbidity (55 - 98%),[2] a new concept of "complex multimorbidity (CMM)" has been proposed[22] CMM differs from the definition of conventional multimorbidity in that CMM is defined by the number of body systems affected by the diseases rather than the number of diseases. CMM is associated is mortality and long-term care needs in older adults.[23][24][25]

Mental health

Physical and mental health conditions can adversely impact the other through a number of pathways, and have significant impact on health and wellbeing.[26] For people whose long-term conditions include severe mental illness, the lifespan can be 10–20 years less than the general population.[27] For them, addressing the underlying risk factors for physical health problems is critical to good outcomes.[26]

There is considerable evidence that having multiple long-term physical conditions can lead to the development of both depression and anxiety.[28] There are many factors which might explain why physical multi-morbidity affects mental health including chronic pain,[29] frailty,[30][31] symptom burden,[32] functional impairment,[33] reduced quality of life,[18] increased levels of inflammation,[34] and polypharmacy.[35] Evidence from large population studies from the United Kingdom and China suggests that specific combinations of physical conditions increase the risk of developing depression and anxiety more than others, such as co-occurring respiratory disorders and co-occurring painful and gastrointestinal disorders.[36][37] There has been a scarcity of economic evaluations concerning interventions for managing individuals with mental-physical multimorbidity, including depression. A recent systematic review identified four intervention types (collaborative care, self-management, telephone-based, and antidepressant treatment)) that were assessed for cost-effectiveness in high-income countries.[38] However, such evaluations are currently lacking in low-income and middle-income countries.

Strategies to prevent the onset of depression or depressive episodes in people with long-term physical conditions include psychological interventions and pharmacological interventions, however the long-term effectiveness and benefits of these approaches is very uncertain.[39]

Healthcare

People with multimorbidity face many challenges because of the way health systems are organised. Most health systems are designed to cater for people with a single chronic condition.[40] Some of the difficulties experienced by people with multiple long-term conditions include: poor coordination of medical care, managing multiple medications (polypharmacy), high costs associated with treatment,[41] increases in their time spent managing illness,[42] difficulty managing multiple illness management regimes,[43] and aggravation of one condition by symptoms or treatment of another.[44]

There is growing recognition that living with multiple long-term conditions leads to complex and challenging burdens for people living with MLTC themselves but also health care professionals working in the health system looking after those with long-term conditions. Living with multiple-long term conditions can be burdensome in terms of managing the illness, particularly if the diagnoses results in polypharmacy (taking multiple medicines).[45]

Medication management

Older people and their family carers frequently find medication management a burden. This burden fluctuates and is often is hidden from health and social care practitioners.[46][47] For example, the burden, on the family carer, may increase if the older person is suffering from confusion or dementia.[48] In general there are five burdens that make managing medicines challenging for older people: when the purpose of reviewing medicines is not clear to the person; when a lack of information prevents the person contributing to decisions about their health; when people with MLTC don't see the same health care professional consistently; when people are seen by lots of different professionals working across different services; and when the health service does not recognise the experiences of people living with MLTC. To help older people and their family carers experiencing medication-related burden, medical professionals can consider this burden when changing or amending a medication.[49][46]

Multimorbidity often results in taking 5 or more medicines (polypharmacy) which can represent a burden and might come with potential harm. When the medications are not effective enough or the risks outweigh the benefits, stopping medicines (deprescribing) might be necessary. In people with multiple long-term conditions and polypharmacy this represents a complex challenge as clinical guidelines are usually developed for single conditions. In these cases tools and guidelines like the Beers Criteria and STOPP/START could be used safely by clinicians but not all patients might benefit from stopping their medication. Clarity about how much clinicians can do beyond the guidelines and the responsibility they need to take could help them prescribing and deprescribing for complex cases. Further factors that can help clinicians tailor their decisions to the individual are: access to detailed data on the people in their care (including their backgrounds and personal medical goals), discussing plans to stop a medicine already when it is first prescribed, and a good relationship that involves mutual trust and regular discussions on progress. Furthermore, longer appointments for prescribing and deprescribing would allow time explain the process of deprescribing, explore related concerns, and support making the right decisions.[50][51]

Prevention

There are well-evidenced prevention strategies for many of the component diseases of multiple condition clusters. For example:

An increased understanding of which conditions most commonly cluster, along with  their underlying risk factors, would help prioritise strategies for early diagnosis, screening and prevention.[1]

Epidemiology

Multimorbidity is common in older adults, estimated to affect over half of those aged 65 and over. This increased prevalence has been explained by older adults' "longer exposure and increased vulnerability to risk factors for chronic health problems".[2]

The prevalence of multimorbidity has been increasing in recent decades.[53][54][55] The high prevalence of multimorbidity has led to some describing it as "The most common chronic condition".[56] Multimorbidity is also more common among people from lower socioeconomic statuses.[2][57][58] Multimorbidity is a significant issue in low‐ and middle‐income countries, although prevalence is not as high as in high income countries.[59]

As a global health issue and in the demographic transition

Number of conditions ever recorded per individual (from 308 health conditions), stratified by age, sex, and ethnicity
Comparison of comorbidities for primary breast cancer by ethnicity (A), and asthma by sex (B)
This section is an excerpt from Global health § Multimorbidity, age-related diseases and aging.[edit]

Multimorbidity is "a growing public health problem worldwide", "likely driven by the ageing population but also by factors such as high body-mass index, urbanisation, and the growing burden of NCDs (such as type 2 diabetes) and tuberculosis in low- and middle-income countries (LMICs)".[60][61][62] Around the world, many people do not die from one isolated condition but from a multitude of factors and conditions. A study suggested there is a paucity of multimorbidity and comorbidity data globally and mapped comorbidity patterns.[63]

With aging populations, there is a rise of age-related diseases which puts major burdens on healthcare systems as well as contemporary economies or contemporary economics and their appendant societal systems. Healthspan extension and anti-aging research seek to extend the span of health in the old as well as slow aging or its negative impacts such as physical and mental decline. Modern anti-senescent and regenerative technology with augmented decision making could help "responsibly bridge the healthspan-lifespan gap for a future of equitable global wellbeing".[64] Aging is "the most prevalent risk factor for chronic disease, frailty and disability, and it is estimated that there will be over 2 billion persons age > 60 by the year 2050", making it a large global health challenge that demands substantial (and well-orchestrated or efficient) efforts, including interventions that alter and target the inborn aging process.[65]

Health inequalities

The likelihood of having multiple long-term conditions is increased by socioeconomic inequalities. Certain groups of disadvantaged or discriminated people are more likely to struggle with earlier and more severe multimorbidity.[66] Multimorbidity is also associated with factors that are related to socioeconomic disadvantage such as food insecurity,[67] low level of education, living in deprived areas and having unhealthy lifestyles.[68]

There are multiple theories on how socioeconomic inequality leads to multimorbidity but so far there is a lack of scientific evidence about the exact mechanism. Some of the potential links between the two are health-related behaviours (smoking, drinking, diet), lack of access to financial resources and housing, and the psychological response to living in difficult circumstances. Knowing the exact pathway would allow designing effective interventions that prevent or mitigate inequalities in multimorbidity.[66][69]

Deprivation and poverty

Living in poverty or deprived areas is associated with higher rates of multimorbidity.[66][70] Those with the lowest income have a 4 times higher chance of having multiple long-term conditions than those with the highest income.[71] Self-management is vital in coping with multimorbidity but people living in deprivation struggle more with managing their conditions. Self-management becomes more challenging due to financial barriers, health literacy (difficulties with understanding health information) and the combined weight of multimorbidity and deprivation.[72]

Research shows that in Scotland residents of deprived areas are affected by multiple long-term conditions 10 to 15 years earlier than people living in affluent neighborhoods. They also have a higher chance that their long-term conditions include mental health disorders.[73] In England, according to research, people from deprived neighborhoods had complex multimorbidity (3 or more conditions) 7 years earlier than the least deprived.[74] People living in deprived areas also have a higher risk of dying because of multimorbidity.[75]

Ethnicity and sexual orientation

Ethnic inequalities also affect who acquires multimorbidity.[76][77][78] In the United Kingdom, Indian, Pakistani, Bangladeshi, Black African, Black Caribbean people and those who identify as Black other, other Asian, and mixed ethnicity have a higher risk of developing multiple long-term conditions. In England, people from Pakistani and Bangladeshi backgrounds have the highest multimorbidity rates and they are twice as likely than people from the Chinese minority to have multimorbidity.[66][79] Pakistani, Black African, Black Caribbean and other black ethnic groups in England are also significantly more likely to die due to having multiple long-term conditions.[80]

Belonging to a sexual minority also means being disproportionately affected by multimorbidity, especially mental health conditions.[81][82][83]

Research directions

Research funders in the UK, including the Medical Research Council (MRC), the Wellcome Trust and the National Institute for Health and Care Research (NIHR) have published the "Cross-funder multimorbidity research framework" which sets out a vision for the research agenda of multiple long-term conditions. The framework aims to drive advances in the understanding of multiple long-term conditions and promote a change in research culture to tackle multimorbidity.[84][85] The NIHR also published its own strategic framework regarding MLTC which aligns with the cross-funder framework.[12]

As rehabilitation usually focuses on a single disease people with multiple long-term conditions are often excluded or not all their conditions are treated during rehabilitation. Researchers are looking for new models of rehabilitation that could be applied to people with multimorbidity.[86][87] For example the PERFORM (Personalised Exercise-Rehabilitation For people with Multiple long-term conditions) research group in the UK is developing and evaluating an exercise-based rehabilitation intervention that can be personalised for people with multiple long-term conditions.[88] The MOBILIZE group in Denmark are currently undertaking a randomised controlled trial of a rehabilitation intervention for people with multimorbidity co-developed with people with long-term conditions and clinicians.[89]

References

  1. 1 2 3 4 5 6 "Multiple long-term conditions (multimorbidity): making sense of the evidence". NIHR Evidence. National Institute for Health and Care Research. 30 March 2021. doi:10.3310/collection_45881. S2CID 243406561.
  2. 1 2 3 4 5 Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, et al. (September 2011). "Aging with multimorbidity: a systematic review of the literature". Ageing Research Reviews. 10 (4): 430–439. doi:10.1016/j.arr.2011.03.003. PMID 21402176. S2CID 40912813.
  3. ↑ Nguyen H, Manolova G, Daskalopoulou C, Vitoratou S, Prince M, Prina AM (1 January 2019). "Prevalence of multimorbidity in community settings: A systematic review and meta-analysis of observational studies". Journal of Comorbidity. 9: 2235042X19870934. doi:10.1177/2235042X19870934. PMC 6710708. PMID 31489279.
  4. ↑ Johnston MC, Crilly M, Black C, Prescott GJ, Mercer SW (February 2019). "Defining and measuring multimorbidity: a systematic review of systematic reviews". European Journal of Public Health. 29 (1): 182–189. doi:10.1093/eurpub/cky098. hdl:20.500.11820/fdedbe90-e4ec-43b8-bb78-a0f75efe6305. PMID 29878097.
  5. ↑ Xu X, Mishra GD, Jones M (August 2017). "Evidence on multimorbidity from definition to intervention: An overview of systematic reviews" (PDF). Ageing Research Reviews. 37: 53–68. doi:10.1016/j.arr.2017.05.003. PMID 28511964. S2CID 3665446.
  6. 1 2 3 4 Multimorbidity: a priority for global health research. Academy of Medical Sciences. 2018.
  7. ↑ Nicholson K, Makovski TT, Griffith LE, Raina P, Stranges S, van den Akker M (January 2019). "Multimorbidity and comorbidity revisited: refining the concepts for international health research". Journal of Clinical Epidemiology. 105: 142–146. doi:10.1016/j.jclinepi.2018.09.008. PMID 30253215. S2CID 52825086.
  8. 1 2 Harrison C, Fortin M, van den Akker M, Mair F, Calderon-Larranaga A, Boland F, et al. (1 January 2021). "Comorbidity versus multimorbidity: Why it matters". Journal of Comorbidity. 11: 2633556521993993. doi:10.1177/2633556521993993. PMC 7930649. PMID 33718251.
  9. ↑ Chua YP, Xie Y, Lee PS, Lee ES (February 2021). "Definitions and Prevalence of Multimorbidity in Large Database Studies: A Scoping Review". International Journal of Environmental Research and Public Health. 18 (4): 1673. doi:10.3390/ijerph18041673. PMC 7916224. PMID 33572441.
  10. ↑ "Multimorbidity: clinical assessment and management - Recommendations". National Institute for Health and Care Excellence (NICE). 21 September 2016. Retrieved 27 May 2022.
  11. ↑ Almirall J, Fortin M (January 2013). "The coexistence of terms to describe the presence of multiple concurrent diseases". Journal of Comorbidity. 3 (1): 4–9. doi:10.15256/joc.2013.3.22. PMC 5636023. PMID 29090140.
  12. 1 2 "NIHR Strategic Framework for Multiple Long-Term Conditions (Multimorbidity) MLTC-M Research". National Institute for Health and Care Research (NIHR). Retrieved 27 June 2022.
  13. ↑ Heikkilä, Katriina; Pulakka, Anna; Metsälä, Johanna; Alenius, Suvi; Hovi, Petteri; Gissler, Mika; Sandin, Sven; Kajantie, Eero (31 December 2021). "Preterm birth and the risk of chronic disease multimorbidity in adolescence and early adulthood: A population-based cohort study". PLOS ONE. 16 (12): e0261952. Bibcode:2021PLoSO..1661952H. doi:10.1371/journal.pone.0261952. ISSN 1932-6203. PMC 8719774. PMID 34972182.
  14. ↑ Heikkilä, Katriina; Metsälä, Johanna; Pulakka, Anna; Nilsen, Sara Marie; Kivimäki, Mika; Risnes, Kari; Kajantie, Eero (September 2023). "Preterm birth and the risk of multimorbidity in adolescence: a multiregister-based cohort study". The Lancet Public Health. 8 (9): e680–e690. doi:10.1016/S2468-2667(23)00145-7. hdl:11250/3103131. PMID 37633677. S2CID 261187781.
  15. ↑ Sindi S, Pérez LM, Vetrano DL, Triolo F, Kåreholt I, Sjöberg L, et al. (December 2020). "Sleep disturbances and the speed of multimorbidity development in old age: results from a longitudinal population-based study". BMC Medicine. 18 (1): 382. doi:10.1186/s12916-020-01846-w. PMC 7720467. PMID 33280611.
  16. 1 2 3 4 Dugravot A, Fayosse A, Dumurgier J, Bouillon K, Rayana TB, Schnitzler A, et al. (January 2020). "Social inequalities in multimorbidity, frailty, disability, and transitions to mortality: a 24-year follow-up of the Whitehall II cohort study". The Lancet. Public Health. 5 (1): e42–e50. doi:10.1016/S2468-2667(19)30226-9. PMC 7098476. PMID 31837974.
  17. ↑ Singer L, Green M, Rowe F, Ben-Shlomo Y, Morrissey K (August 2019). "Social determinants of multimorbidity and multiple functional limitations among the ageing population of England, 2002-2015". SSM - Population Health. 8: 100413. doi:10.1016/j.ssmph.2019.100413. PMC 6551564. PMID 31194123.
  18. 1 2 Makovski TT, Schmitz S, Zeegers MP, Stranges S, van den Akker M (August 2019). "Multimorbidity and quality of life: Systematic literature review and meta-analysis" (PDF). Ageing Research Reviews. 53: 100903. doi:10.1016/j.arr.2019.04.005. PMID 31048032. S2CID 139101266.
  19. 1 2 Nunes BP, Flores TR, Mielke GI, Thumé E, Facchini LA (November 2016). "Multimorbidity and mortality in older adults: A systematic review and meta-analysis". Archives of Gerontology and Geriatrics. 67: 130–138. doi:10.1016/j.archger.2016.07.008. PMID 27500661.
  20. 1 2 Gijsen R, Hoeymans N, Schellevis FG, Ruwaard D, Satariano WA, van den Bos GA (July 2001). "Causes and consequences of comorbidity: a review". Journal of Clinical Epidemiology. 54 (7): 661–674. doi:10.1016/s0895-4356(00)00363-2. PMID 11438406.
  21. ↑ Williams JS, Egede LE (July 2016). "The Association Between Multimorbidity and Quality of Life, Health Status and Functional Disability". The American Journal of the Medical Sciences. 352 (1): 45–52. doi:10.1016/j.amjms.2016.03.004. PMID 27432034. S2CID 3455192.
  22. ↑ Harrison C, Britt H, Miller G, Henderson J (July 2014). "Examining different measures of multimorbidity, using a large prospective cross-sectional study in Australian general practice". BMJ Open. 4 (7): e004694. doi:10.1136/bmjopen-2013-004694. PMC 4120329. PMID 25015470.
  23. ↑ Storeng SH, Vinjerui KH, Sund ER, Krokstad S (January 2020). "Associations between complex multimorbidity, activities of daily living and mortality among older Norwegians. A prospective cohort study: the HUNT Study, Norway". BMC Geriatrics. 20 (1): 21. doi:10.1186/s12877-020-1425-3. PMC 6974981. PMID 31964341.
  24. ↑ Kato D, Kawachi I, Saito J, Kondo N (August 2021). "Complex multimorbidity and mortality in Japan: a prospective propensity-matched cohort study". BMJ Open. 11 (8): e046749. doi:10.1136/bmjopen-2020-046749. PMC 8330573. PMID 34341044.
  25. ↑ Kato D, Kawachi I, Saito J, Kondo N (October 2021). "Complex Multimorbidity and Incidence of Long-Term Care Needs in Japan: A Prospective Cohort Study". International Journal of Environmental Research and Public Health. 18 (19): 10523. doi:10.3390/ijerph181910523. PMC 8508235. PMID 34639825.
  26. 1 2 Firth J, Siddiqi N, Koyanagi A, Siskind D, Rosenbaum S, Galletly C, et al. (August 2019). "The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness". The Lancet. Psychiatry. 6 (8): 675–712. doi:10.1016/S2215-0366(19)30132-4. hdl:10072/391717. PMID 31324560. S2CID 198134221.
  27. ↑ World Health Organization, issuing body (14 August 2018). Management of physical health conditions in adults with severe mental disorders : WHO guidelines. World Health Organization. ISBN 978-92-4-155038-3. OCLC 1089879045.
  28. ↑ Triolo F, Harber-Aschan L, Belvederi Murri M, Calderón-Larrañaga A, Vetrano DL, Sjöberg L, et al. (December 2020). "The complex interplay between depression and multimorbidity in late life: risks and pathways". Mechanisms of Ageing and Development. 192: 111383. doi:10.1016/j.mad.2020.111383. hdl:11392/2437730. PMID 33045250. S2CID 222233540.
  29. ↑ Sharpe L, McDonald S, Correia H, Raue PJ, Meade T, Nicholas M, Arean P (May 2017). "Pain severity predicts depressive symptoms over and above individual illnesses and multimorbidity in older adults". BMC Psychiatry. 17 (1): 166. doi:10.1186/s12888-017-1334-y. PMC 5418685. PMID 28472936.
  30. ↑ Vetrano DL, Palmer K, Marengoni A, Marzetti E, Lattanzio F, Roller-Wirnsberger R, et al. (April 2019). "Frailty and Multimorbidity: A Systematic Review and Meta-analysis". The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 74 (5): 659–666. doi:10.1093/gerona/gly110. PMID 29726918.
  31. ↑ Soysal P, Veronese N, Thompson T, Kahl KG, Fernandes BS, Prina AM, et al. (July 2017). "Relationship between depression and frailty in older adults: A systematic review and meta-analysis". Ageing Research Reviews. 36: 78–87. doi:10.1016/j.arr.2017.03.005. PMID 28366616. S2CID 205668529.
  32. ↑ Katon W, Lin EH, Kroenke K (1 March 2007). "The association of depression and anxiety with medical symptom burden in patients with chronic medical illness". General Hospital Psychiatry. 29 (2): 147–155. doi:10.1016/j.genhosppsych.2006.11.005. PMID 17336664.
  33. ↑ Calderón-Larrañaga A, Vetrano DL, Ferrucci L, Mercer SW, Marengoni A, Onder G, et al. (March 2019). "Multimorbidity and functional impairment-bidirectional interplay, synergistic effects and common pathways". Journal of Internal Medicine. 285 (3): 255–271. doi:10.1111/joim.12843. PMC 6446236. PMID 30357990.
  34. ↑ Miller AH, Raison CL (January 2016). "The role of inflammation in depression: from evolutionary imperative to modern treatment target". Nature Reviews. Immunology. 16 (1): 22–34. doi:10.1038/nri.2015.5. PMC 5542678. PMID 26711676.
  35. ↑ Holvast F, van Hattem BA, Sinnige J, Schellevis F, Taxis K, Burger H, Verhaak PF (September 2017). "Late-life depression and the association with multimorbidity and polypharmacy: a cross-sectional study". Family Practice. 34 (5): 539–545. doi:10.1093/fampra/cmx018. PMID 28369380.
  36. ↑ Yao SS, Cao GY, Han L, Huang ZT, Chen ZS, Su HX, et al. (September 2020). "Associations Between Somatic Multimorbidity Patterns and Depression in a Longitudinal Cohort of Middle-Aged and Older Chinese". Journal of the American Medical Directors Association. 21 (9): 1282–1287.e2. doi:10.1016/j.jamda.2019.11.028. PMID 31928934. S2CID 210191651.
  37. ↑ Ronaldson A, Arias de la Torre J, Prina M, Armstrong D, Das-Munshi J, Hatch S, et al. (September 2021). "Associations between physical multimorbidity patterns and common mental health disorders in middle-aged adults: A prospective analysis using data from the UK Biobank". The Lancet Regional Health. Europe. 8: 100149. doi:10.1016/j.lanepe.2021.100149. PMC 8447568. PMID 34557851.
  38. ↑ Banstola A, Pokhrel S, Hayhoe B, Nicholls D, Harris M, Anokye N (February 2023). "Economic evaluations of interventional opportunities for the management of mental-physical multimorbidity: a systematic review". BMJ Open. 13 (2): e069270. doi:10.1136/bmjopen-2022-069270. PMC 9980364. PMID 36854591.
  39. ↑ Kampling H, Baumeister H, Bengel J, Mittag O (March 2021). "Prevention of depression in adults with long-term physical conditions". The Cochrane Database of Systematic Reviews. 2021 (3): CD011246. doi:10.1002/14651858.CD011246.pub2. PMC 8092431. PMID 33667319.
  40. ↑ Salisbury C (July 2012). "Multimorbidity: redesigning health care for people who use it". Lancet. 380 (9836): 7–9. doi:10.1016/S0140-6736(12)60482-6. PMID 22579042. S2CID 12325320.
  41. ↑ Wang L, Si L, Cocker F, Palmer AJ, Sanderson K (February 2018). "A Systematic Review of Cost-of-Illness Studies of Multimorbidity" (PDF). Applied Health Economics and Health Policy. 16 (1): 15–29. doi:10.1007/s40258-017-0346-6. PMID 28856585. S2CID 21008606.
  42. ↑ Jowsey T, McRae IS, Valderas JM, Dugdale P, Phillips R, Bunton R, et al. (2013). "Time's up. descriptive epidemiology of multi-morbidity and time spent on health related activity by older Australians: a time use survey". PLOS ONE. 8 (4): e59379. Bibcode:2013PLoSO...859379J. doi:10.1371/journal.pone.0059379. PMC 3613388. PMID 23560046.
  43. ↑ Jowsey T, Dennis S, Yen L, Mofizul Islam M, Parkinson A, Dawda P (July 2016). "Time to manage: patient strategies for coping with an absence of care coordination and continuity". Sociology of Health & Illness. 38 (6): 854–873. doi:10.1111/1467-9566.12404. PMID 26871716.
  44. ↑ Bayliss EA, Steiner JF, Fernald DH, Crane LA, Main DS (2003). "Descriptions of barriers to self-care by persons with comorbid chronic diseases". Annals of Family Medicine. 1 (1): 15–21. doi:10.1370/afm.4. PMC 1466563. PMID 15043175.
  45. ↑ "Multiple long-term conditions (multimorbidity): making sense of the evidence". NIHR Evidence. National Institute for Health and Care Research. 30 March 2021. doi:10.3310/collection_45881. S2CID 243406561.
  46. 1 2 Maidment, Ian D.; Lawson, Sally; Wong, Geoff; Booth, Andrew; Watson, Anne; McKeown, Jane; Zaman, Hadar; Mullan, Judy; Bailey, Sylvia (June 2020). "Medication management in older people: the MEMORABLE realist synthesis". Health Services and Delivery Research. 8 (26): 1–128. doi:10.3310/hsdr08260. PMID 32579319. S2CID 225671789.
  47. ↑ Lawson S, Mullan J, Wong G, Zaman H, Booth A, Watson A, Maidment I (July 2022). "Family carers' experiences of managing older relative's medications: Insights from the MEMORABLE study" (PDF). Patient Education and Counseling. 105 (7): 2573–2580. doi:10.1016/j.pec.2021.12.017. PMID 35016779. S2CID 245620865.
  48. ↑ Maidment ID, Aston L, Moutela T, Fox CG, Hilton A (October 2017). "A qualitative study exploring medication management in people with dementia living in the community and the potential role of the community pharmacist". Health Expectations. 20 (5): 929–942. doi:10.1111/hex.12534. PMC 5600213. PMID 28105781.
  49. ↑ "Managing medication: older people and their families need support to deal with the hidden burden of medication". NIHR Evidence (Plain English summary). 24 November 2020. doi:10.3310/alert_42757. S2CID 240496292.
  50. ↑ "How to reduce medications for people with multiple long-term conditions". NIHR Evidence. 18 May 2023. doi:10.3310/nihrevidence_57904. S2CID 258801327.
  51. ↑ Reeve J, Maden M, Hill R, Turk A, Mahtani K, Wong G, et al. (July 2022). "Deprescribing medicines in older people living with multimorbidity and polypharmacy: the TAILOR evidence synthesis". Health Technology Assessment. 26 (32): 1–148. doi:10.3310/AAFO2475. PMC 9376985. PMID 35894932.
  52. ↑ Head A, Fleming K, Kypridemos C, Pearson-Stuttard J, O'Flaherty M (March 2021). "Multimorbidity: the case for prevention". Journal of Epidemiology and Community Health. 75 (3): 242–244. doi:10.1136/jech-2020-214301. PMC 7892394. PMID 33020144.
  53. ↑ King DE, Xiang J, Pilkerton CS (2018). "Multimorbidity Trends in United States Adults, 1988-2014". Journal of the American Board of Family Medicine. 31 (4): 503–513. doi:10.3122/jabfm.2018.04.180008. PMC 6368177. PMID 29986975.
  54. ↑ Pefoyo AJ, Bronskill SE, Gruneir A, Calzavara A, Thavorn K, Petrosyan Y, et al. (April 2015). "The increasing burden and complexity of multimorbidity". BMC Public Health. 15: 415. doi:10.1186/s12889-015-1733-2. PMC 4415224. PMID 25903064.
  55. ↑ Uijen AA, van de Lisdonk EH (2008). "Multimorbidity in primary care: prevalence and trend over the last 20 years". The European Journal of General Practice. 14 (sup1): 28–32. doi:10.1080/13814780802436093. hdl:11250/2487933. PMID 18949641. S2CID 34601052.
  56. ↑ Tinetti ME, Fried TR, Boyd CM (June 2012). "Designing health care for the most common chronic condition--multimorbidity". JAMA. 307 (23): 2493–2494. doi:10.1001/jama.2012.5265. PMC 4083627. PMID 22797447.
  57. ↑ Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B (July 2012). "Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study". Lancet. 380 (9836): 37–43. doi:10.1016/S0140-6736(12)60240-2. PMID 22579043. S2CID 8212325.
  58. ↑ Pathirana TI, Jackson CA (April 2018). "Socioeconomic status and multimorbidity: a systematic review and meta-analysis". Australian and New Zealand Journal of Public Health. 42 (2): 186–194. doi:10.1111/1753-6405.12762. hdl:10072/384397. PMID 29442409. S2CID 4754463.
  59. ↑ Afshar S, Roderick PJ, Kowal P, Dimitrov BD, Hill AG (August 2015). "Multimorbidity and the inequalities of global ageing: a cross-sectional study of 28 countries using the World Health Surveys". BMC Public Health. 15: 776. doi:10.1186/s12889-015-2008-7. PMC 4534141. PMID 26268536.
  60. ↑ Hariri P, Clarke R, Bragg F, Chen Y, Guo Y, Yang L, et al. (January 2022). "Frequency and types of clusters of major chronic diseases in 0.5 million adults in urban and rural China". Journal of Multimorbidity and Comorbidity. 12: 26335565221098327. doi:10.1177/26335565221098327. PMC 9125108. PMID 35615751.
  61. ↑ The Lancet (April 2018). "Making more of multimorbidity: an emerging priority". Lancet. 391 (10131): 1637. doi:10.1016/S0140-6736(18)30941-3. PMID 29726322.
  62. ↑ Pearson-Stuttard J, Ezzati M, Gregg EW (December 2019). "Multimorbidity-a defining challenge for health systems". The Lancet. Public Health. 4 (12): e599–e600. doi:10.1016/S2468-2667(19)30222-1. hdl:10044/1/75127. PMID 31812234. S2CID 208955266.
  63. ↑ Kuan V, Denaxas S, Patalay P, Nitsch D, Mathur R, Gonzalez-Izquierdo A, et al. (January 2023). "Identifying and visualising multimorbidity and comorbidity patterns in patients in the English National Health Service: a population-based study". The Lancet. Digital Health. 5 (1): e16–e27. doi:10.1016/S2589-7500(22)00187-X. PMID 36460578. S2CID 254129048.
  64. ↑ Garmany A, Yamada S, Terzic A (September 2021). "Longevity leap: mind the healthspan gap". npj Regenerative Medicine. 6 (1): 57. doi:10.1038/s41536-021-00169-5. PMC 8460831. PMID 34556664.
  65. ↑ Farrelly C (November 2022). "Aging, Equality and the Human Healthspan". HEC Forum: 1–19. doi:10.1007/s10730-022-09499-3. PMC 9644010. PMID 36348214.
  66. 1 2 3 4 Multiple long-term conditions (multimorbidity) and inequality- addressing the challenge: insights from research (Report). National Institute for Health Research. 20 September 2023. doi:10.3310/nihrevidence_59977.
  67. ↑ Kantilafti, Maria; Giannakou, Konstantinos; Chrysostomou, Stavri (6 July 2023). Alahdab, Fares (ed.). "Multimorbidity and food insecurity in adults: A systematic review and meta-analysis". PLOS ONE. 18 (7): e0288063. Bibcode:2023PLoSO..1888063K. doi:10.1371/journal.pone.0288063. ISSN 1932-6203. PMC 10325088. PMID 37410753.
  68. ↑ Álvarez-Gálvez, Javier; Ortega-Martín, Esther; Carretero-Bravo, Jesús; Pérez-Muñoz, Celia; Suárez-Lledó, Víctor; Ramos-Fiol, Begoña (27 March 2023). "Social determinants of multimorbidity patterns: A systematic review". Frontiers in Public Health. 11. doi:10.3389/fpubh.2023.1081518. ISSN 2296-2565. PMC 10084932. PMID 37050950.
  69. ↑ Fleitas Alfonzo, Ludmila; King, Tania; You, Emily; Contreras-Suarez, Diana; Zulkelfi, Syafiqah; Singh, Ankur (23 February 2022). "Theoretical explanations for socioeconomic inequalities in multimorbidity: a scoping review". BMJ Open. 12 (2): e055264. doi:10.1136/bmjopen-2021-055264. ISSN 2044-6055. PMC 8882654. PMID 35197348.
  70. ↑ Pathirana, Thanya I.; Jackson, Caroline A. (14 February 2018). "Socioeconomic status and multimorbidity: a systematic review and meta-analysis". Australian and New Zealand Journal of Public Health. 42 (2): 186–194. doi:10.1111/1753-6405.12762. hdl:10072/384397. PMID 29442409. S2CID 4754463.
  71. ↑ Ingram, Elizabeth; Ledden, Sarah; Beardon, Sarah; Gomes, Manuel; Hogarth, Sue; McDonald, Helen; Osborn, David P.; Sheringham, Jessica (1 March 2021). "Household and area-level social determinants of multimorbidity: a systematic review". J Epidemiol Community Health. 75 (3): 232–241. doi:10.1136/jech-2020-214691. ISSN 0143-005X. PMC 7892392. PMID 33158940.
  72. ↑ Woodward, Abi; Davies, Nathan; Walters, Kate; Nimmons, Danielle; Stevenson, Fiona; Protheroe, Joanne; Chew-Graham, Carolyn A.; Armstrong, Megan (21 February 2023). Sagtani, Reshu Agrawal (ed.). "Self-management of multiple long-term conditions: A systematic review of the barriers and facilitators amongst people experiencing socioeconomic deprivation". PLOS ONE. 18 (2): e0282036. Bibcode:2023PLoSO..1882036W. doi:10.1371/journal.pone.0282036. ISSN 1932-6203. PMC 9942951. PMID 36809286.
  73. ↑ Barnett, Karen; Mercer, Stewart W; Norbury, Michael; Watt, Graham; Wyke, Sally; Guthrie, Bruce (10 May 2012). "Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study". The Lancet. 380 (9836): 37–43. doi:10.1016/S0140-6736(12)60240-2. PMID 22579043.
  74. ↑ Head, Anna; Fleming, Kate; Kypridemos, Chris; Schofield, Pieta; Pearson-Stuttard, Jonathan; O'Flaherty, Martin (21 July 2021). "Inequalities in incident and prevalent multimorbidity in England, 2004–19: a population-based, descriptive study". The Lancet Healthy Longevity. 2 (8): e489–e497. doi:10.1016/S2666-7568(21)00146-X. PMID 36097998. S2CID 237719820.
  75. ↑ Charlton, Judith; Rudisill, Caroline; Bhattarai, Nawaraj; Gulliford, Martin (October 2013). "Impact of deprivation on occurrence, outcomes and health care costs of people with multiple morbidity". Journal of Health Services Research & Policy. 18 (4): 215–223. doi:10.1177/1355819613493772. ISSN 1355-8196. PMC 3808175. PMID 23945679.
  76. ↑ Hayanga, Brenda; Stafford, Mai; Bécares, Laia (27 January 2023). "Ethnic inequalities in multiple long-term health conditions in the United Kingdom: a systematic review and narrative synthesis". BMC Public Health. 23 (1): 178. doi:10.1186/s12889-022-14940-w. ISSN 1471-2458. PMC 9879746. PMID 36703163.
  77. ↑ Verest, Wim J G M; Galenkamp, Henrike; Spek, Bea; Snijder, Marieke B; Stronks, Karien; van Valkengoed, Irene G M (1 August 2019). "Do ethnic inequalities in multimorbidity reflect ethnic differences in socioeconomic status? The HELIUS study". European Journal of Public Health. 29 (4): 687–693. doi:10.1093/eurpub/ckz012. ISSN 1101-1262. PMC 6660190. PMID 30768174.
  78. ↑ Mathur, Rohini; Hull, Sally A; Badrick, Ellena; Robson, John (26 April 2011). "Cardiovascular multimorbidity: the effect of ethnicity on prevalence and risk factor management". British Journal of General Practice. 61 (586): e262–e270. doi:10.3399/bjgp11X572454. ISSN 0960-1643. PMC 3080231. PMID 21619750.
  79. ↑ "Quantifying health inequalities in England". www.health.org.uk. Retrieved 28 September 2023.
  80. ↑ Stafford, Mai; Knight, Hannah; Hughes, Jay; Alarilla, Anne; Mondor, Luke; Pefoyo Kone, Anna; Wodchis, Walter P.; Deeny, Sarah R. (1 April 2022). Torén, Kjell (ed.). "Associations between multiple long-term conditions and mortality in diverse ethnic groups". PLOS ONE. 17 (4): e0266418. Bibcode:2022PLoSO..1766418S. doi:10.1371/journal.pone.0266418. ISSN 1932-6203. PMC 8974956. PMID 35363804.
  81. ↑ Saunders, Catherine L; MacCarthy, Sarah; Meads, Catherine; Massou, Efthalia; Mant, Jonathan; Saunders, Alison M; Elliott, Marc N (October 2021). "Long-term conditions among sexual minority adults in England: evidence from a cross-sectional analysis of responses to the English GP Patient Survey". BJGP Open. 5 (5): BJGPO.2021.0067. doi:10.3399/BJGPO.2021.0067. ISSN 2398-3795. PMC 8596314. PMID 34465579.
  82. ↑ Caceres, Billy A.; Travers, Jasmine; Sharma, Yashika (June 2021). "Differences in Multimorbidity among Cisgender Sexual Minority and Heterosexual Adults: Investigating Differences across Age-Groups". Journal of Aging and Health. 33 (5–6): 362–376. doi:10.1177/0898264320983663. ISSN 0898-2643. PMC 8122030. PMID 33382014.
  83. ↑ Han, Benjamin H.; Duncan, Dustin T.; Arcila-Mesa, Mauricio; Palamar, Joseph J. (4 August 2020). "Co-occurring mental illness, drug use, and medical multimorbidity among lesbian, gay, and bisexual middle-aged and older adults in the United States: a nationally representative study". BMC Public Health. 20 (1): 1123. doi:10.1186/s12889-020-09210-6. ISSN 1471-2458. PMC 7401198. PMID 32746891.
  84. ↑ "Research funders publish framework to tackle multiple long-term conditions". The Academy of Medical Sciences. Retrieved 28 June 2022.
  85. ↑ Cross-funder multimorbidity research framework (Report). The Academy of Medical Sciences. June 2020.
  86. ↑ Taylor RS, Singh S (May 2020). "Personalised rehabilitation for cardiac and pulmonary patients with multimorbidity: Time for implementation?". European Journal of Preventive Cardiology. 28 (16): e19–e23. doi:10.1177/2047487320926058. PMID 33611479.
  87. ↑ Carlesso LC, Skou ST, Tang LH, Simonÿ C, Brooks D (February 2020). "Multimorbidity: Making the Case for an End to Disease-Specific Rehabilitation". Physiotherapy Canada. Physiotherapie Canada. 72 (1): 1–3. doi:10.3138/ptc-72-1-gee. PMC 8330980. PMID 34385742. S2CID 214155787.
  88. ↑ "The PERFORM trial". University of Leicester. Retrieved 5 February 2023.
  89. ↑ Bricca A, Jäger M, Dideriksen M, Rasmussen H, Nyberg M, Pedersen JR, et al. (December 2022). "Personalised exercise therapy and self-management support for people with multimorbidity: Development of the MOBILIZE intervention". Pilot and Feasibility Studies. 8 (1): 244. doi:10.1186/s40814-022-01204-y. PMC 9717541. PMID 36461048.
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