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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)
28 % 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