International Journal of Public Health

, Volume 62, Issue 6, pp 679–686 | Cite as

Expansion or compression of multimorbidity? 10-year development of life years spent in multimorbidity based on health insurance claims data of Lower Saxony, Germany

  • Juliane Tetzlaff
  • Denise Muschik
  • Jelena Epping
  • Sveja Eberhard
  • Siegfried Geyer
Original Article



Our study examined how life years spent in multimorbidity changed over a period of 10 years (2005–2014) and whether morbidity expansion or compression has taken place. There is a little evidence on whether life years gained due to increasing life expectancy are spent in good health, or if they are accompanied by morbidity expansion.


The analyses are based on German administrative claims data. Multimorbidity was defined as a combination of at least six chronic conditions and polypharmacy. After having estimated age-standardized prevalence, time trends for life years with and without multimorbidity, and the proportion of life years spent in multimorbidity (morbidity ratio) were estimated.


Prevalence proportions of multimorbidity rose continuously. Increasing life expectancies were accompanied by increasing life years with multimorbidity, decreasing multimorbidity-free life years, and by an increasing morbidity ratio.


The lifespan spent in multimorbidity was increasing over time. Our findings indicate a growing burden of multimorbidity and an increasing proportion of life years with multiple chronic conditions. It can be concluded that an expansion of morbidity in absolute and in relative terms has occurred. The findings stress the importance of prevention, healthy lifestyles, and improved medical care strategies meeting the specific requirements of patients with multimorbidity.


Multimorbidity Time trend Prevalence Compression Expansion 



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

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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.


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.

Supplementary material

38_2017_962_MOESM1_ESM.pdf (640 kb)
Supplementary material 1 (PDF 640 KB)


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Copyright information

© Swiss School of Public Health (SSPH+) 2017

Authors and Affiliations

  • Juliane Tetzlaff
    • 1
  • Denise Muschik
    • 1
  • Jelena Epping
    • 1
  • Sveja Eberhard
    • 2
  • Siegfried Geyer
    • 1
  1. 1.Medical Sociology UnitHannover Medical SchoolHanoverGermany
  2. 2.AOK Niedersachsen-Statutory Health Insurance of Lower SaxonyHanoverGermany

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