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Identifying time trends in multimorbidity—defining multimorbidity in times of changing diagnostic practices

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Abstract

Aim

Time trends in multimorbidity have rarely been examined and no criteria have been developed to measure the development of multimorbidity over time. Against the backdrop of increasing numbers of diagnoses a robust measure is needed that is sensitive to changes over time and allows to differentiate between multimorbid and non-multimorbid individuals. We examine how prevalence estimates change as criteria for defining multimorbidity are varied systematically and how this influences the observed time trend.

Subject and methods

Our analyses are based on the data of a German statutory health insurance from 2005 to 2013. Measures are compared using different minimal numbers of chronic conditions required to define multimorbidity: three and six. As a stricter criterion both variants are then combined with polypharmacy.

Results

All definitions of multimorbidity are leading to increasing prevalence rates over time. Defining multimorbidity as the presence of three or more chronic conditions leads to very high prevalence rates and is lacking discriminative power in the oldest old. Lower prevalence rates with a sharp increase over time can be observed in the proportion of insured with at least six chronic conditions. Adding polypharmacy reduces the growth over time remarkably.

Conclusion

The analyses suggest that the increase of multimorbidity is mainly driven by chronic conditions that are not in need of complex medication. Simple disease counts are inappropriate for defining multimorbidity.

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Acknowledgments

The permission of the Allgemeine Ortskrankenkasse Niedersachsen (AOK Niedersachsen-Statutory Health Insurance of Lower Saxony) to work with the health insurance data is greatly appreciated. In particular, the support of Jürgen Peter (AOK Niedersachsen) made it possible to carry out the project from which the data were derived.

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Authors and Affiliations

  1. Medical Sociology Unit, Hannover Medical School, Carl-Neuberg-Straße 1, D-30625, Hannover, Germany

    Juliane Tetzlaff, Denise Muschik, Jelena Epping & Siegfried Geyer

  2. Institute of General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany

    Ulrike Junius-Walker

  3. AOK Niedersachsen, Hildesheimer Straße 273, 30519, Hannover, Germany

    Sveja Eberhard

Authors
  1. Juliane Tetzlaff
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  2. Ulrike Junius-Walker
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  3. Denise Muschik
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  4. Jelena Epping
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  5. Sveja Eberhard
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  6. Siegfried Geyer
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Corresponding author

Correspondence to Juliane Tetzlaff.

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Funding

The work done by JT was funded by the AOK Niedersachsen-Statutory Health Insurance of Lower Saxony as part of a project on morbidity compression.

The work done by DM was funded by the Ministry of Science and Culture of Lower Saxony as part of the doctoral program GESA: Health related care for a self-determined life in old age—Theoretical concepts, users’ needs and responsiveness of the health care system.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors. The AOK Niedersachsen gave permission to use the data.

Conflict of interest

The authors declare that they have no conflict of interest.

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Tetzlaff, J., Junius-Walker, U., Muschik, D. et al. Identifying time trends in multimorbidity—defining multimorbidity in times of changing diagnostic practices. J Public Health 25, 215–222 (2017). https://doi.org/10.1007/s10389-016-0771-2

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  • DOI: https://doi.org/10.1007/s10389-016-0771-2

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