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      Prevalence of multimorbidity in the Cypriot population; A cross-sectional study (2018–2019)

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          Abstract

          Background

          Multimorbidity is defined as the co-existence of two or more chronic conditions. As life expectancy is increasing so does the prevalence of multimorbidity. Our aim was to estimate the prevalence of multimorbidity in Cyprus and identify the most prevalent diseases.

          Methods

          A representative sample of n = 1140 individuals over 18 years old was surveyed during 2018–2019. Demographic characteristics as well as the presence of chronic conditions, including mental disorders, were collected through a standardized questionnaire. Diseases were classified according to the International Classification of Diseases, 10 th Revision (ICD-10).

          Results

          The age and gender standardized prevalence of multimorbidity was 28.6%. Multimorbidity was associated with age (p<0.001), with the highest rate observed among people aged 65+ years old (68.9%). Multimorbidity was higher in women than men (28.2% vs. 22.5%, p < .001) but similar in urban and rural regions (26.4% vs. 23.8%, p = 0.395). The most prevalent chronic diseases among people with multimorbidity were hyperlipidemia (44.7%), followed by hypertension (37.5%), gastric reflux (23.9%), and thyroid diseases (22.2%), while the most common combinations of diseases were in the circulatory and endocrine systems. The profile of the multimorbid individual indicated this to be a person at an older age with a higher BMI, a current smoker with a higher salary.

          Conclusions

          More than one quarter of the general population of Cyprus has multimorbidity, and this rate is almost 70% among the elderly. Multimorbidity is relatively common even in younger ages too. This underlines the need for prevention strategies and health awareness programs for the entire population.

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          Most cited references36

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          Global aetiology and epidemiology of type 2 diabetes mellitus and its complications

          Sylvia Ley, Yan Zheng, Frank Hu (2017)
          Globally, the number of people with diabetes mellitus has quadrupled in the past three decades, and diabetes mellitus is the ninth major cause of death. About 1 in 11 adults worldwide now have diabetes mellitus, 90% of whom have type 2 diabetes mellitus (T2DM). Asia is a major area of the rapidly emerging T2DM global epidemic, with China and India the top two epicentres. Although genetic predisposition partly determines individual susceptibility to T2DM, an unhealthy diet and a sedentary lifestyle are important drivers of the current global epidemic; early developmental factors (such as intrauterine exposures) also have a role in susceptibility to T2DM later in life. Many cases of T2DM could be prevented with lifestyle changes, including maintaining a healthy body weight, consuming a healthy diet, staying physically active, not smoking and drinking alcohol in moderation. Most patients with T2DM have at least one complication, and cardiovascular complications are the leading cause of morbidity and mortality in these patients. This Review provides an updated view of the global epidemiology of T2DM, as well as dietary, lifestyle and other risk factors for T2DM and its complications.
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            Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study.

            Karen Barnett, Stewart W Mercer, Michael Norbury … (2012)
            Long-term disorders are the main challenge facing health-care systems worldwide, but health systems are largely configured for individual diseases rather than multimorbidity. We examined the distribution of multimorbidity, and of comorbidity of physical and mental health disorders, in relation to age and socioeconomic deprivation. In a cross-sectional study we extracted data on 40 morbidities from a database of 1,751,841 people registered with 314 medical practices in Scotland as of March, 2007. We analysed the data according to the number of morbidities, disorder type (physical or mental), sex, age, and socioeconomic status. We defined multimorbidity as the presence of two or more disorders. 42·2% (95% CI 42·1-42·3) of all patients had one or more morbidities, and 23·2% (23·08-23·21) were multimorbid. Although the prevalence of multimorbidity increased substantially with age and was present in most people aged 65 years and older, the absolute number of people with multimorbidity was higher in those younger than 65 years (210,500 vs 194,996). Onset of multimorbidity occurred 10-15 years earlier in people living in the most deprived areas compared with the most affluent, with socioeconomic deprivation particularly associated with multimorbidity that included mental health disorders (prevalence of both physical and mental health disorder 11·0%, 95% CI 10·9-11·2% in most deprived area vs 5·9%, 5·8%-6·0% in least deprived). The presence of a mental health disorder increased as the number of physical morbidities increased (adjusted odds ratio 6·74, 95% CI 6·59-6·90 for five or more disorders vs 1·95, 1·93-1·98 for one disorder), and was much greater in more deprived than in less deprived people (2·28, 2·21-2·32 vs 1·08, 1·05-1·11). Our findings challenge the single-disease framework by which most health care, medical research, and medical education is configured. A complementary strategy is needed, supporting generalist clinicians to provide personalised, comprehensive continuity of care, especially in socioeconomically deprived areas. Scottish Government Chief Scientist Office. Copyright © 2012 Elsevier Ltd. All rights reserved.
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              Aging with multimorbidity: a systematic review of the literature.

              Alessandra Marengoni, Sara Angleman, René F Melis … (2011)
              A literature search was carried out to summarize the existing scientific evidence concerning occurrence, causes, and consequences of multimorbidity (the coexistence of multiple chronic diseases) in the elderly as well as models and quality of care of persons with multimorbidity. According to pre-established inclusion criteria, and using different search strategies, 41 articles were included (four of these were methodological papers only). Prevalence of multimorbidity in older persons ranges from 55 to 98%. In cross-sectional studies, older age, female gender, and low socioeconomic status are factors associated with multimorbidity, confirmed by longitudinal studies as well. Major consequences of multimorbidity are disability and functional decline, poor quality of life, and high health care costs. Controversial results were found on multimorbidity and mortality risk. Methodological issues in evaluating multimorbidity are discussed as well as future research needs, especially concerning etiological factors, combinations and clustering of chronic diseases, and care models for persons affected by multiple disorders. New insights in this field can lead to the identification of preventive strategies and better treatment of multimorbid patients. Copyright © 2011 Elsevier B.V. All rights reserved.
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                Author and article information

                Contributors
                Maria Kyprianidou:
                ORCID: https://orcid.org/0000-0002-4917-0508
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: Writing – original draft
                Demosthenes Panagiotakos: Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: ResourcesRole: SupervisionRole: Writing – review & editing
                Antigoni Faka: Role: ConceptualizationRole: MethodologyRole: VisualizationRole: Writing – review & editing
                Maria Kambanaros: Role: ConceptualizationRole: Formal analysisRole: Writing – review & editing
                Konstantinos C. Makris: Role: ConceptualizationRole: Formal analysisRole: Writing – review & editing
                Costas A. Christophi:
                ORCID: https://orcid.org/0000-0003-0503-1538
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: Writing – review & editing
                Brecht Devleesschauwer: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS One
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 26 October 2020
                Publication date Collection: 2020
                Volume: 15
                Issue: 10
                Electronic Location Identifier: e0239835
                Affiliations
                [1 ] Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
                [2 ] Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
                [3 ] Department of Geography, School of Environment, Geography and Applied Economics, Harokopio University, Athens, Greece
                [4 ] Department of Rehabilitation Sciences, Cyprus University of Technology, Limassol, Cyprus
                Sciensano, BELGIUM
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0002-4917-0508
                https://orcid.org/0000-0003-0503-1538
                Article
                Publisher ID: PONE-D-20-11934
                DOI: 10.1371/journal.pone.0239835
                PMC ID: 7588119
                PubMed ID: 33104700
                SO-VID: c04deb73-f4a0-41a0-8b1b-0e5990f47057
                Copyright © © 2020 Kyprianidou et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 24 April 2020
                Date accepted : 14 September 2020
                Page count
                Figures: 3, Tables: 3, Pages: 14
                Funding
                The author(s) received no specific funding for this work.
                Categories
                Subject: Research Article
                Subject: People and places
                Subject: Geographical locations
                Subject: Europe
                Subject: European Union
                Subject: Cyprus
                Subject: People and Places
                Subject: Geographical Locations
                Subject: Asia
                Subject: Cyprus
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Health Statistics
                Subject: Morbidity
                Subject: Social Sciences
                Subject: Economics
                Subject: Labor Economics
                Subject: Salaries
                Subject: Biology and Life Sciences
                Subject: Physiology
                Subject: Physiological Parameters
                Subject: Body Weight
                Subject: Body Mass Index
                Subject: Medicine and Health Sciences
                Subject: Public and Occupational Health
                Subject: Physical Activity
                Subject: Medicine and Health Sciences
                Subject: Clinical Medicine
                Subject: Signs and Symptoms
                Subject: Hyperlipidemia
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Health Care Providers
                Subject: Physicians
                Subject: People and Places
                Subject: Population Groupings
                Subject: Professions
                Subject: Medical Personnel
                Subject: Physicians
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Endocrine System
                Subject: Thyroid
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Endocrine System
                Subject: Thyroid
                Custom metadata
                Data Availability All relevant data are within the manuscript and its Supporting Information files.

                ScienceOpen disciplines: Uncategorized
                Data availability:
                ScienceOpen disciplines: Uncategorized

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