Table 1 Included Cross-Sectional Studies
From: Multimorbidity and functional decline in community-dwelling adults: a systematic review
Author Publication Year Country | Population and setting | Definition and prevalence of multimorbidity (MM) | Functional decline outcome measure | Results |
|---|---|---|---|---|
Agborsangaya 2012 Canada | Population based survey 4946 adults ≥ 18 years | Self-report chronic conditions from list of 16 19 % with ≥ 2 conditions | EQ–5D | MM associated with a significant reduction in EQ5D index score -0.12 |
Baker 2000 USA | Primary care clinic 194 adults, 48 % > 60 years | Self-report of > 1 diagnosis according to ICPC categories 51 % > 1 condition | SF– 36 | SF36 PCS scores decline with increasing numbers conditions (p < 0.05 on one way MANOVA analysis) |
Baker 2006 USA | Community dwelling 247 African American adults, mean age 69 | Self-report of doctor-diagnosed conditions used to create condition count Mean 2.9 conditions | AIMS2 (Arthritis Impact Measurement Scale) | No significant association between number of conditions and physical functioning on multivariate analysis |
Bayliss M 2012 USA | Population based survey 3877 adults 63 % ≥ 45 years 36 % ≥ 60 years | Self-report of conditions from 26 condition checklist Mean 2.4 conditions Grouped into physical condition MM, mental health MM or both | SF–36 | Reduction in PCS score v healthy group: Physical MM : - 6.4 Mental health MM: - 11 Combined physical and mental health MM: -15 |
Bayliss EA 2012 USA | Primary care, members of HMO 961 aged ≥ 65 years | Self-report of 3 or more conditions from a list of 10 conditions Mean 7.9 conditions | SF–36 | Higher condition counts associated with significantly lower PCS scores on multivariate analysis |
Brettschneider 2013 Germany | Primary Care – GP databases 3189 patients 65–85 years | Co-existence of 3 or more chronic conditions from a list of 29 Measured by a weighted counts score Mean 7 conditions | EQ–5D | Increased condition count and severity associated with significant reductions in EQ5D-VAS on multivariate analysis |
Cesari 2006 Italy | Population – cohort study in mountain community 364 adults ≥ 80 years | Physician report of ≥ 3 conditions based on self-report and chart review 136 patients with ≥ 3 conditions (37.4 %) | Short Physical Performance Battery (SPPB) Four minute walking speed score MDS-HC: ADLs and IADLs | MM significantly associated with lower SPPB score, lower walking speed scores and lower IADLs, but no difference in ADLs |
Chen 2011 USA | Population based survey (Behavioural Risk Factor Surveillance System) 430,912 adults ≥18 years | Self-report from list of 8 conditions >90 % participants had ≥ 2 conditions | CDC HRQOL - 4 domains: general health, mental distress, physical distress and activity limitations | Participants with ≥ 3 conditions had highest risk of reporting fair or poor health (AOR 8.7, 95 % CI 8.0 to 9.4) |
Cheng 2003 USA | Primary care clinics 316 consecutive clinic attenders 55 –64 years | 80 % of patients in the study had ≥ 2 conditions confirmed on chart review | SF–36 | Number of conditions significantly associated with decreases in PCS scores in multivariate analysis |
Formiga 2005 Spain | Community based 186 adults aged ≥ 90 years | Charlson Comorbidity index, mean score 1.43 | Barthel Index (ADLs) Lawton and Brody Scale (IADLS) | Higher comorbidity score significantly associated with worse functional and cognitive capacity on multivariate analysis |
Fortin 2007 Canada | Primary care 238 adults attending primary care clinic (randomly collected from a larger study cohort) Mean age 59.0 years | Chart confirmed ≥ two conditions Severity assessed using CIRS score Mean 5.3 (+/-2.8) diagnoses | SF–36 | MM measured by simple count was associated with significantly reduced PCS scores on multivariate analysis Increases in MM severity (CIRS scores) associated with greater decreases in PCS scores than simple counts alone |
Goins 2010 USA | Community based sample 505 adults ≥ 55 years | Comorbidity scale – self-report from list of 32 conditions Combined with severity assessment using score 0–3 Mean score 5.8 | Short Physical Performance Battery (SPPB) Hand grip test | Higher comorbidity scores significantly associated with poor SPPB and hand grip scores in multivariate analysis |
Griffith 2010 Canada | Population based sample 8858 adults ≥ 65 years | Self-report of ≥ 2 from list of 12 conditions 72.0 % with ≥ 2 conditions | Multi-dimensional functional assessment questionnaire (OARS) | Combination of foot problems, arthritis and heart problems had most impact on functional disabilities on multivariate analysis A significant association between 11 conditions and functional disability. |
Heyworth 2009 UK | Primary care registered patients 4836 adults Mean age 47.9 | Self-report from a list of 6 conditions, confirmed by chart review 24 % had ≥ 2 conditions | EQ-5D | Increasing numbers conditions significantly associated with lower EQ5D scores on multivariate analysis |
Hunger 2011 Germany | Population based 4412 adults ≥ 65 years | Self-report of ≥ 2 conditions from a list of 6 conditions Prevalence of MM within sample not reported | EQ-5D | Combinations of conditions significantly associated with reduced EQ5D index scores on multivariate analysis (examined in pairs and compared to single condition alone) |
Jayasinghe 2009 Australia | Primary care 96 General practices 7606 adults ≥ 18 years Mean age 59.1 | Software selected patients with at least one of three chronic conditions. MM: two or more chronic conditions. n = 1497 (19.7 %) | SF-12 | Number of chronic conditions negatively associated with PCS-12 scores (physical component summary). |
Joshi 2003 India | Population based survey 200 adults ≥ 60 years | Self-report of conditions (ICD-10 codes) confirmed by chart review 83 % had ≥ 4 conditions | Standardised Rapid Disability Rating Scale-2 | Number of conditions significantly associated with increased mean disability scores |
Kadam 2007 UK | Primary care registered patients 9439 aged ≥ 50 years | 1. Simple condition counts using chart review for ≥ 2 coded conditions 81 % had ≥ 2 conditions 2. Combinations of 185 selected conditions classified by severity on 4 point scale by GPs | SF-12 dichotomised into poor and good function | Increasing number of conditions significantly associated with poor physical function. AOR 1.6 for 2 or 3 conditions AOR 5 for ≥6 conditions Increasing strength of association between MM severity and poor function |
Kadam 2009 UK | Primary care 8791 English aged ≥ 50 years 7753 from Netherlands aged ≥ 18 years | Classified based on 78 conditions which were classified on a 4 point severity index by GPs | SF-12 | Higher morbidity severity was significantly associated with poorer physical health on multivariate analysis |
Keles 2007 Turkey | Community based survey 4605 parents /grandparents Mean age 53.2 (male) 51.6 (female) | Self-report of conditions from a list of 11 conditions 46 % of participants >1 chronic condition (n ~ 2118) | SF-12 | As number of chronic conditions increased physical functioning declined Number of comorbidities an independent predictor of physical functioning |
Kim 2012 Korea | Population based survey 1419 adults ≥65 years | Self-report of ≥ 2 conditions from list of 20 conditions Mean 3.88 conditions | EQ-5D | MM significantly associated with lower EQ-5D index score in multivariate analysis |
Lawson 2013 UK | Population based survey 7054 aged ≥ 20 years | Self-report of ≥ 2 conditions from list of 40 conditions 18 % ≥ 2 conditions | SF-12 (no breakdown into physical component scores) | Number of conditions all significantly associated with reductions in SF12 scores in multivariate analysis |
Michelson 2001 Sweden | Population based survey 3069 adults, Mean age 51 | Self-report from list of 13 conditions Categorised into groups - no problems (0 conditions); few problems (1-2 conditions); some problems (3-4 conditions) and a lot (5-13 conditions) 28Â % had some or a lot of problems | EORTC QLQ-C30 (HRQOL, specific to Cancer) | Multiple chronic health problems significantly associated with reduced HRQOL adjusted for age |
Mujica-Mota 2014 UK | Population based survey 831,537 aged ≥ 18 years | Self-report of ≥ 2 conditions from list of 12 conditions 23 % ≥ 2 conditions | EQ-5D | Number of conditions significantly associated with decrease in EQ-5D scores in multivariate analysis |
Noel 2007 USA | Primary care enrolled patients 422 adults Mean age 57 years | ≥2 ICD-9 coded conditions from a list of 45 conditions 54 % ≥ 2 conditions | SF-12 | Multimorbidity group had significantly lower PCS score (34.8) compared to single morbidity group (39.5) |
Parker 2014 UK | Population based survey 5849 adults ≥ 65 years | Self-report of ≥ 2 conditions from list of 15 conditions, verified by chart review HADS score for depression 26 % ≥ 2 conditions | EQ-5D | Total number of conditions not associated with decreased EQ-5D scores on multivariate analysis |
Rijken 2005 Netherlands | Primary care sample 1673 chronic disease patients | Coded conditions identified by chart review from list of six conditions 13 % ≥ 2 conditions | SF-36 | Multimorbidity associated with significantly lower PCS scores |
Wensing 2001 Netherlands | Primary care attenders 4040 adults (28 % ≥ 60 years) | Self-report of ≥ 2 conditions from a list of 25 conditions 16 % ≥ 2 conditions | SF-36 | Increasing number conditions associated with lower PCS scores but effect disappeared when controlled for age |