The number of cases of people with multimorbidity or multiple health conditions is increasing, creating significant challenges in healthcare. Higher levels of multimorbidity was found in women, in the first comprehensive systematic review in this field. Equally as importantly, it has revealed the poor quality of evidence on this increasingly critical area of healthcare.
The review's main author, Professor Jose M Valderas, NIHR Clinician Scientist of the University of Exeter Medical School, is calling for better quality research to be supported as a priority, so that key decisions on healthcare policy can be evidence-based.
In this study, published on July 21 in open access journal PLOS ONE
, an international group of experts analysed published data from studies in 12 countries. The work, supported by the National Institute for Health Research and Spain's Ministry of Science and Innovation, showed that the prevalence of multiple health conditions varied widely between the studies - from less than 15 per cent to more than 95 per cent. The definition of multimorbidity itself also varied, meaning that overall the evidence is poor quality.
Professor Valderas said: "It is now recognized that suffering from multiple health conditions is the norm in patients over the age of 65 who visit their family doctor, but it is also a very frequent problem in younger patients as well. To tackle this, policy makers are working to implement programmes and apply approaches to maintain a high standard of healthcare that deals with the individual holistically rather than through vertical disease oriented programmes. Yet our study reveals that the starting point of what we know about multimorbidity is very low indeed - this must be addressed if we are to be sure that the action we are taking is likely to be effective and efficient."
Multimorbidity increases the risk of premature death, hospitalizations, loss of physical functioning, depression, and worsening quality of life, translating into a substantial economic burden for health systems.
Professor Valderas said: "Despite the variations in the studies, one over-arching finding is that older women are more likely to have multiple health conditions than men. It has long been known that multiple conditions are likely to develop with age, and we had also observed that they were more frequent among women in a previous study with English patients. But this is the first verification using data from different countries all over the world. In our study we found that women may suffer from multiple conditions up to 62% more than men. We know that women live longer than men, but we mitigated for that factor and still found a stronger association among women. We must urgently investigate further why this effect could be, so that we can look towards prevention and targeted treatment."