Multimorbidity

Valderas, J. M., Starfield, B., Sibbald, B., Salisbury, C. & Roland, M. Defining comorbidity: implications for understanding health and health services. Ann. Fam. Med. 7, 357–363 (2009).

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Salisbury, C. Multimorbidity: redesigning health care for people who use it. Lancet 380, 7–9 (2012).

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Nicholson, K., Almirall, J. & Fortin, M. The measurement of multimorbidity. Health Psychol. 38, 783–790 (2019).

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Harrison, C. et al. Comorbidity versus multimorbidity: why it matters. J. Comorb. 11, 2633556521993993 (2021).

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Boyd, C. M. & Fortin, M. Future of multimorbidity research: how should understanding of multimorbidity inform health system design? Public. Health Rev. 32, 451–474 (2010).

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Tugwell, P. & Knottnerus, J. A. Multimorbidity and comorbidity are now separate MESH headings. J. Clin. Epidemiol. 105, vi–viii (2019).

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Menotti, A. et al. Prevalence of morbidity and multimorbidity in elderly male populations and their impact on 10-year all-cause mortality: the FINE study (Finland, Italy, Netherlands, Elderly). J. Clin. Epidemiol. 54, 680–686 (2001).

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Vogeli, C. et al. Multiple chronic conditions: prevalence, health consequences, and implications for quality, care management, and costs. J. Gen. Intern. Med. 22 (Suppl. 3), 391–395 (2007).

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Fortin, M. et al. Psychological distress and multimorbidity in primary care. Ann. Fam. Med. 4, 417–422 (2006).

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Fortin, M. et al. Multimorbidity and quality of life in primary care: a systematic review. Health Qual. Life Outcomes 2, 51 (2004).

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Bayliss, E. A., Bayliss, M. S., Ware, J. E. Jr. & Steiner, J. F. Predicting declines in physical function in persons with multiple chronic medical conditions: what we can learn from the medical problem list. Health Qual. Life Out. 2, 47 (2004).

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Marengoni, A. et al. Aging with multimorbidity: a systematic review of the literature. Ageing Res. Rev. 10, 430–439 (2011).

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Townsend, A., Hunt, K. & Wyke, S. Managing multiple morbidity in mid-life: a qualitative study of attitudes to drug use. BMJ 327, 837 (2003).

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Ryan, A., Wallace, E., O’Hara, P. & Smith, S. M. Multimorbidity and functional decline in community-dwelling adults: a systematic review. Health Qual. Life Outcomes 13, 168 (2015).

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Lehnert, T. et al. Review: health care utilization and costs of elderly persons with multiple chronic conditions. Med. Care Res. Rev. 68, 387–420 (2011).

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Read, J. R., Sharpe, L., Modini, M. & Dear, B. F. Multimorbidity and depression: a systematic review and meta-analysis. J. Affect. Disord. 221, 36–46 (2017).

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Barnett, K. et al. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 380, 37–43 (2012). This study extracted data on 40 conditions from a database of 1.7 million people across Scotland, and highlighted the differences in prevalence of multimorbidity across age groups, sex and socioeconomic status.

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Boyd, C. M. et al. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA 294, 716–724 (2005). This early review suggests that adhering to clinical practice guidelines developed for individual conditions may have undesirable effects if applied in older people with several comorbidities; this was later confirmed by Hughes et al. (2013).

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Mair, F. S. & May, C. R. Thinking about the burden of treatment. BMJ 349, g6680 (2014). This editorial introduces the concept of treatment burden and highlights the enormous demands that patients and their carers are put under by the health-care system.

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Noel, P. H., Frueh, B. C., Larme, A. C. & Pugh, J. A. Collaborative care needs and preferences of primary care patients with multimorbidity. Health Expect. 8, 54–63 (2005). This early qualitative study highlights the concerns of patients with multimorbidity who report functional difficulties, negative effects on well-being and relationships and challenges managing multiple medicines.

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Bower, P. et al. Multimorbidity, service organization and clinical decision making in primary care: a qualitative study. Fam. Pract. 28, 579–587 (2011).

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Smith, S. M., O’Kelly, S. & O’Dowd, T. GPs’ and pharmacists’ experiences of managing multimorbidity: a ‘Pandora’s box’. Br. J. Gen. Pract. 60, 285–294 (2010).

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Vos, T. et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 396, 1204–1222 (2020).

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Ryan, B. L. et al. Beyond the grey tsunami: a population-based study of multimorbidity in Ontario. Can. J. Public Health 109, 845–854 (2018).

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Fortin, M., Stewart, M., Poitras, M.-E., Almirall, J. & Maddocks, H. A systematic review of prevalence studies on multimorbidity: toward a more uniform methodology. Ann. Fam. Med. 10, 142–151 (2012).

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Miranda, J. J. et al. Multimorbidity at sea level and high-altitude urban and rural settings: the CRONICAS cohort study. J. Comorb. 9, 2235042X19875297 (2019).

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Miranda, J. J. et al. Understanding the rise of cardiometabolic diseases in low- and middle-income countries. Nat. Med. 25, 1667–1679 (2019). This review explores the long-term impacts of adverse exposures in early life, many of them more common in LMICs than in high-income settings, including the exposure to repeated infections and chronic undernutrition in childhood, among others, and how these environmental, social, and biological penalties in early life impair reaching full development of individuals, and thus provides a more nuanced understanding of the rising incidence of non-communicable diseases, including multimorbidity, in LMICs.

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Pesantes, M. A. et al. Family support and diabetes: patient’s experiences from a public hospital in Peru. Qual. Health Res. 28, 1871–1882 (2018).

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Pesantes, M. A., Tetens, A., Valle, A. D. & Miranda, J. J. “It is not easy living with this illness”: a syndemic approach to medication adherence and lifestyle change among low-income diabetes patients in Lima. Peru. Hum. Org. 78, 85–96 (2019).

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Jan, S. et al. Action to address the household economic burden of non-communicable diseases. Lancet 391, 2047–2058 (2018).

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Macinko, J., Andrade, F. C. D., Nunes, B. P. & Guanais, F. C. Primary care and multimorbidity in six Latin American and Caribbean countries. Rev. Panam. Salud Publica 43, e8 (2019).

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Aebischer Perone, S. et al. Report of the WHO independent high-level commission on NCDs: where is the focus on addressing inequalities? BMJ Glob. Health https://doi.org/10.1136/bmjgh-2020-002820 (2020).

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Chikumbu, E. et al. Experiences of multimorbidity in urban and rural Malawi: an interview study of burdens of treatment and lack of treatment. PLoS Glob. Public Health 2, e0000139 (2022).

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Iaccarino, G. et al. Age and multimorbidity predict death among COVID-19 patients: results of the SARS-RAS study of the Italian Society of Hypertension. Hypertension 76, 366–372 (2020).

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McQueenie, R. et al. Multimorbidity, polypharmacy, and COVID-19 infection within the UK Biobank cohort. PLoS ONE 15, e0238091 (2020).

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Mair, F. S., Foster, H. M. & Nicholl, B. I. Multimorbidity and the COVID-19 pandemic – an urgent call to action. J. Comorb. 10, 2235042X20961676 (2020).

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Emami, A., Javanmardi, F., Pirbonyeh, N. & Akbari, A. Prevalence of underlying diseases in hospitalized patients with COVID-19: a systematic review and meta-analysis. Arch. Acad. Emerg. Med. 8, e35 (2020).

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Pati, S., Mahapatra, P., Kanungo, S., Uddin, A. & Sahoo, K. C. Managing multimorbidity (multiple chronic diseases) amid COVID-19 pandemic: a community based study from Odisha, India. Front. Public Health https://doi.org/10.3389/fpubh.2020.584408 (2021).

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Burgess, R. COVID-19 mental-health responses neglect social realities. Nature https://doi.org/10.1038/d41586-020-01313-9 (2020).

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Pesantes, A. et al. Los retos del cuidado de las personas con diabetes durante el estado de emergencia nacional por la COVID-19 en Lima, Perú: recomendaciones para la atención primaria. Rev. Peru. Med. Exp. Salud Publica 37, 541–546 (2020).

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The Academy of Medical Sciences. Multimorbidity: a priority for global health research (The Academy of Medical Sciences, 2018). This report focuses on important research areas within multimorbidity, including pending agendas in LMICs.

The Lancet. Making more of multimorbidity: an emerging priority. Lancet 391, 1637 (2018).

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Kruk, M. E. et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet Glob. Health 6, e1196–e1252 (2018).

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Fortin, M. “It-that-must-not-be-named”: addressing patient discomfort with the term multimorbidity. Can. Fam. Physician 64, 881–882 (2018).

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World Health Organization. Multimorbidity: Technical Series on Safer Primary Care (WHO, 2016).

Griffith, L. E. et al. Multimorbidity frameworks impact prevalence and relationships with patient-important outcomes. J. Am. Geriatr. Soc. 67, 1632–1640 (2019).

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Stirland, L. E. et al. Measuring multimorbidity beyond counting diseases: systematic review of community and population studies and guide to index choice. BMJ 368, m160 (2020). This review demonstrates that 35 different multimorbidity indices are available with different components and outcomes and provides a guide to choosing a relevant multimorbidity index.

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