Background
Methods
Population study sample
Condition | Definition | Prevalence (%) |
---|---|---|
Atopy | Positive (wheal > 3 mm) on skin prick tests for common allergens (dust-mites, grasses, moulds, cat hair, dog dander) | 54.4 |
Arthritis | Self-reported doctor-diagnosed | 25.1 |
Bowel disease | Self-reported doctor-diagnosed colonic polyps, Crohn’s disease, ulcerative colitis, irritable bowel syndrome or diverticular disease | 23.3 |
Liver disease | Self-reported doctor-diagnosed cirrhosis of the liver or ALT > 40 U/L in men or > 35 U/L in women | 23.1 |
Depression/anxiety | Current treatment or PHQ9 or GAD7 scores indicative of current depression or anxiety, respectively | 20.5 |
Bronchitis | Self-reported chronic cough or phlegm on most days for > 3 months each year | 17.6 |
Eye condition | Self-reported macular degeneration, glaucoma, cataract, non-diabetes related serious eye condition resulting in loss of vision | 14.6 |
Asthma | Self-reported doctor-diagnosed asthma | 14.2 |
Heart disease | Self-reported doctor-diagnosed angina, cardiac pacemaker, myocardial infarction, coronary angioplasty or stent, or bypass surgery or Abnormal ECG | 9.7 |
Thyroid disease | Self-reported doctor-diagnosed | 8.6 |
Low back pain | Current self-reported chronic low back pain lasting > 3 months and Oswestry Disability Index > 12 | 8.5 |
Skin cancer | Self-reported doctor-diagnosed | 8.2 |
Obstructive Sleep Apnoea | Apnoea hypopnea index > 19^ or, if not available, self-reported doctor-diagnosed | 8.1 |
Hearing impairment | Audiometry best ear 4-frequency average > 25 dB* or, if not available, hearing impairment affecting daily life frequently/constantly | 7.1 |
Diabetes | Self-reported doctor-diagnosed diabetes (not only during pregnancy) or fasting blood glucose > 7.0 mmol/L or glycosylated haemaglobin (HbA1c) > 6.5% | 7 |
Cancer (non-skin cancer) | Self-reported doctor-diagnosed | 6.7 |
COPD | Post-bronchodilator FEV1/FVC < 0.7 and FEV1% predicted < 80% or, if spirometry not available, self-reported doctor-diagnosed COPD | 5.7 |
Kidney disease | Self-reported doctor-diagnosed kidney disease or estimated glomerular filtration rate < 60 ml/min | 5.2 |
Osteoporosis | DXA measured femur or AP spine T-score ≤ − 2.5^^ or, if not available, self-reported doctor-diagnosed | 3.4 |
Stroke | Self-reported doctor-diagnosed stroke, TIA or carotid surgery (endarterectomy or stent) | 2.1 |
Peripheral artery disease | Ankle brachial index < 0.9 for right or left side^^^ | 1.9 |
Prevalence estimates and patterns of multimorbidity
Results
Prevalence of individual conditions and number of conditions per person
Relationship between number of conditions and participant characteristics
Common pairs of conditions
Co-occurring pairs of conditions | Prevalence (%) | O/E | ||
---|---|---|---|---|
Asthma | + | COPD | 2.41 | 2.95 |
Depression–anxiety | + | Low back pain | 3.86 | 2.21 |
Arthritis | + | Low back pain | 4.71 | 2.2 |
Bronchitis | + | COPD | 1.89 | 1.86 |
Low back pain | + | Bronchitis | 2.66 | 1.78 |
Diabetes | + | Eye condition | 1.73 | 1.7 |
Diabetes | + | Liver disease | 2.66 | 1.66 |
Depression–anxiety | + | OSA | 2.64 | 1.6 |
Thyroid disease | + | Arthritis | 3.46 | 1.59 |
Kidney disease | + | Depression anxiety | 1.67 | 1.57 |
Liver disease | + | OSA | 2.86 | 1.54 |
Bowel disease | + | Low back pain | 3.02 | 1.53 |
Bowel disease | + | Arthritis | 8.81 | 1.51 |
Common triplets of conditions
Patterns of multimorbidity – latent class analysis (LCA)
ALL | CLASS 1 | CLASS 2 | CLASS 3 | CLASS 4 | |
---|---|---|---|---|---|
(N = 5029) | Relatively healthy | Predominant respiratory & atopy | Multi-morbid non-cardio-metabolic | Multi-morbid cardio-metabolic and other | |
Number assigned to class | 5029 (100%) | 3541 (70.4%) | 529 (10.5%) | 691 (13.7%) | 268 (5.3%) |
Mean number of conditions | 2.75 | 1.95 | 3.65 | 4.77 | 6.32 |
Condition | Prevalence (%) | Probability (%) | Probability (%) | Probability (%) | Probability (%) |
Atopy | 54.4 | 52.3 | 82.0 | 40.8 | 62.7 |
Arthritis | 25.1 | 13.3 | 24.6 | 77.1 | 48.1 |
Bowel disease | 23.3 | 16.5 | 21.9 | 54.1 | 35.4 |
Liver disease | 23.1 | 21.9 | 23.3 | 15.8 | 57.5 |
Depression/anxiety | 20.5 | 13.3 | 14.7 | 54.6 | 38.4 |
Bronchitis | 17.6 | 11.8 | 20.6 | 37.8 | 36.9 |
Eye condition | 14.6 | 10.8 | 11.9 | 30.4 | 29.1 |
Asthma | 14.2 | 0.1 | 99.1 | 14.5 | 32.5 |
Heart disease | 9.7 | 7.7 | 9.1 | 7.4 | 44.0 |
Thyroid disease | 8.6 | 5.2 | 7.6 | 25.8 | 12.3 |
Low back pain | 8.5 | 1.6 | 4.7 | 37.5 | 32.5 |
Skin cancer | 8.2 | 8.7 | 4.7 | 8.7 | 6.3 |
OSA | 8.1 | 5.8 | 2.5 | 12.4 | 37.3 |
Hearing impairment | 7.1 | 6.0 | 3.6 | 11.6 | 16.4 |
Diabetes | 7.0 | 4.2 | 0.0 | 4.3 | 64.6 |
Non skin cancer | 6.7 | 5.0 | 6.2 | 14.2 | 10.8 |
COPD | 5.7 | 2.7 | 19.3 | 8.4 | 13.1 |
Kidney disease | 5.2 | 3.4 | 2.6 | 10.0 | 20.9 |
Osteoporosis | 3.4 | 2.7 | 4.2 | 7.7 | 0.4 |
Stroke | 2.1 | 0.9 | 0.8 | 2.5 | 20.1 |
Peripheral artery disease | 1.9 | 1.2 | 1.5 | 1.6 | 12.3 |
Characteristics of multimorbidity
Morbidity patterns versus number of conditions
Characteristics across assigned multimorbidity classes
ALL | Class 1 | Class 2 | Class 3 | Class 4 | ||
---|---|---|---|---|---|---|
Relatively healthy | Predominantly respiratory & atopy | Multi-morbid non-cardiometabolic | Multi-morbid cardiometabolic and other | |||
Characteristic | (n = 5029) | (n = 3541) | (n = 529) | (n = 691) | (n = 268) | P - value* |
Age (mean years) | 58.0 | 57.5 | 57.1 | 60.2 | 61.0 | < 0.001 |
Sex (Female, %) | 54.8 | 52 | 61 | 73 | 36 | < 0.001 |
Waist circumference (mean cm) | 92.2 | 91.0 | 90.8 | 93.3 | 108.6 | < 0.001 |
Tobacco smoking: | ||||||
Never (%) | 47 | 48 | 49 | 43 | 35 | |
Former (%) | 43 | 43 | 43 | 41 | 51 | |
Current < 15 cigarettes per day (%) | 4 | 4 | 3 | 7 | 4 | < 0.001 |
Current 15 cigarettes per day (%) | 6 | 5 | 5 | 9 | 9 | |
Moderate/vigorous physical activity (mean total hours per week) | 9.5 | 10.1 | 9.0 | 7.8 | 7.4 | < 0.001 |
Alcohol consumption (mean total glasses per week) | 11.5 | 11.9 | 10.9 | 9.7 | 12.1 | 0.001 |
First degree relatives# with: | ||||||
Asthma | 0.34 | 0.29 | 0.59 | 0.37 | 0.39 | < 0.001 |
Diabetes | 0.37 | 0.34 | 0.36 | 0.42 | 0.61 | < 0.001 |
Myocardial infarct | 0.5 | 0.47 | 0.44 | 0.62 | 0.69 | < 0.001 |
Cancer (any type) | 0.86 | 0.82 | 0.84 | 1.03 | 0.91 | < 0.001 |
Relationship between membership of particular multimorbidity class and participant characteristics
Comparison | Class 2 vs Class 1 | Class 3 vs Class 1 | Class 4 vs Class 1 | |||
---|---|---|---|---|---|---|
Characteristic | Estimated odds ratio | P Value | Estimated odds ratio | P Value | Estimated odds ratio | P Value |
Sex (female vs male) | 1.409 | 0.0023 | 3.227 | < 0.0001 | 1.076 | 0.6511 |
Age (per year) | 0.996 | 0.6518 | 1.089 | < 0.0001 | 1.113 | < 0.0001 |
Waist circumference (per cm) | 1.006 | 0.1275 | 1.026 | < 0.0001 | 1.097 | < 0.0001 |
Tobacco smoking | ||||||
Current 15 cigs/day vs never | 0.982 | 0.9370 | 3.382 | < 0.0001 | 3.216 | < 0.0001 |
Current < 15 cigs/day vs never | 0.816 | 0.4383 | 2.527 | < 0.0001 | 1.915 | 0.0737 |
Former smoker vs Never smoked | 0.959 | 0.6769 | 1.084 | 0.3951 | 1.228 | 0.1869 |
Weekly moderate/vigorous physical activity (per hr) | 0.995 | 0.2739 | 0.993 | 0.0703 | 0.986 | 0.0251 |
First degree relative with: | ||||||
Asthma | 1.834 | <.0001 | 1.189 | 0.0139 | 1.335 | 0.0080 |
Diabetes | 0.981 | 0.8029 | 1.076 | 0.2792 | 1.437 | 0.0001 |
Myocardial infarct | 0.882 | 0955 | 1.141 | 0.0293 | 1.291 | 0.0065 |
Cancer (any) | 0.999 | 0.9790 | 1.237 | < 0.0001 | 1.061 | 0.4747 |