Quality of Life Research

, Volume 15, Issue 1, pp 83–91 | Cite as

Relationship Between Multimorbidity and Health-Related Quality of Life of Patients in Primary Care

  • Martin FortinEmail author
  • Gina Bravo
  • Catherine Hudon
  • Lise Lapointe
  • José Almirall
  • Marie-France Dubois
  • Alain Vanasse


Previous studies about the association of multimorbidity and the health-related quality of life (HRQOL) in primary-care patients are limited because of their reliance on simple counts of diseases from a limited list of diseases and their failure to assess the severity of disease. We evaluated the association while taking into account the severity of the medical conditions based on the Cumulative Illness Rating Scale (CIRS) score, and controlling for potential confounders (age, sex, household income, education, self-perception of economic status, number of people living in the same dwelling, and perceived social support). We randomly selected 238 patients to construct quintiles of increasing multimorbidity (CIRS). Patients completed the 36-item Medical Outcomes study questionnaire (SF-36) to evaluate their HRQOL. Applying bivariate and multivariate linear regression analyses, we used the CIRS as either a continuous or a categorical (quintiles) variable. Use of the CIRS revealed a stronger association of HRQOL with multimorbidity than using a simple count of chronic conditions. Physical more than mental health deteriorated with increasing multimorbidity. Perceived social support and self-perception of economic status were significantly related to all scales of the SF-36 (p < 0.05). Increased multimorbidity adversely affected HRQOL in primary-care adult patients, even when confounding variables were controlled for.


Chronic disease Family medicine Health-related quality of life Multimorbidity or comorbidity 



Bodily pain


Cumulative Illness Rating Scale


General health


Quality of life


Health transition


Mental component summary


Mental health


Physical component summary


Physical functioning


Role emotional


Role physical


Social functioning


36-item Medical Outcomes Study questionnaire


Vitality scale


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Hoffman, C, Rice, D, Sung, HY 1996Persons with chronic conditions. Their prevalence and costsJAMA27614731479CrossRefPubMedGoogle Scholar
  2. 2.
    Metsemakers, JF, Hoppener, P, Knottnerus, JA, Kocken, RJ, Limonard, CB 1992Computerized health information in The Netherlands: a registration network of family practicesBr J Gen Pract42102106PubMedGoogle Scholar
  3. 3.
    Akker, M, Buntinx, F, Metsemakers, JF, Roos, S, Knottnerus, JA 1998Multimorbidity in general practice: prevalence, incidence, and determinants of co-occurring chronic and recurrent diseasesJ Clin Epidemiol51367375PubMedGoogle Scholar
  4. 4.
    Fortin, M, Bravo, G, Hudon, C, Vanasse, A, Lapointe, L 2005Prevalence of multimorbidity among adults seen in family practiceAnn Fam Med3223228CrossRefPubMedGoogle Scholar
  5. 5.
    McDowell, I, Newell, C 1996Measuring Health. A Guide to Rating Scales and QuestionnairesOxford University PressNew York380492Google Scholar
  6. 6.
    Fan, VS, Curtis, JR, Tu, S, McDonell, MB, Fihn, SD 2002Using quality of life to predict hospitalization and mortality in patients with obstructive lung diseasesChest122429436CrossRefPubMedGoogle Scholar
  7. 7.
    Howes, CJ, Reid, MC, Brandt, C, Ruo, B, Yerkey, MW, Prasad, B, Lin, C, Peduzzi, P, Ezekowitz, MD 2001Exercise tolerance and quality of life in elderly patients with chronic atrial fibrillationJ Cardiovasc Pharmacol Ther62329PubMedGoogle Scholar
  8. 8.
    Schaeffer, AJ, Landis, JR, Knauss, JS, Propert, KJ, Alexander, RB, Litwin, MS, Nickel, JC, O’Leary, MP, Nadler, RB, Pontari, MA, Shoskes, DA, Zeitlin, SI, Fowler, JE,Jr, Mazurick, CA, Kishel, L, Kusek, JW, Nyberg, LM 2002Chronic Prostatitis Collaborative Research Network G. Demographic and clinical characteristics of men with chronic prostatitis: the national institutes of health chronic prostatitis cohort studyJ Urol168593598PubMedGoogle Scholar
  9. 9.
    Xuan, J, Kirchdoerfer, LJ, Boyer, JG, Norwood, GJ 1999Effects of comorbidity on health-related quality-of-life scores: an analysis of clinical trial dataClin Ther21383403CrossRefPubMedGoogle Scholar
  10. 10.
    Fortin, M, Lapointe, L, Hudon, C, Ntetu, AL, Maltais, D, Vanasse, A 2004Multimorbidity and quality of life in primary care: a systematic reviewHealth and Quality of life Outcomes251CrossRefPubMedGoogle Scholar
  11. 11.
    Cheng, L, Cumber, S, Dumas, C, Winter, R, Nguyen, KM, Nieman, LZ 2003Health related quality of life in pregeriatric patients with chronic diseases at urban, public supported clinicsHealth and Quality of Life Outcomes163CrossRefPubMedGoogle Scholar
  12. 12.
    Wensing, M, Vingerhoets, E, Grol, R 2001Functional status, health problems, age and comorbidity in primary care patientsQual Life Res10141148CrossRefPubMedGoogle Scholar
  13. 13.
    Michelson, H, Bolund, C, Brandberg, Y 2000Multiple chronic health problems are negatively associated with health related quality of life (HRQoL) irrespective of ageQual Life Res910931104CrossRefPubMedGoogle Scholar
  14. 14.
    Cuijpers, P, Lammeren, P, Duzijn, B 1999Relation between quality of life and chronic illnesses in elderly living in residential homes: a prospective studyInt Psychogeriatr11445454CrossRefPubMedGoogle Scholar
  15. 15.
    Grimby, A, Svanborg, A 1997Morbidity and health-related quality of life among ambulant elderly citizensAging Clin Exp Res9356364Google Scholar
  16. 16.
    Fryback, DG, Dasbach, EJ, Klein, R, Klein, BE, Dorn, N, Peterson, K, Martin, PA 1993The beaver dam health outcomes study: initial catalog of health-state quality factorsMed Decis Making1389102PubMedGoogle Scholar
  17. 17.
    Kempen, GI, Jelicic, M, Ormel, J 1997Personality, chronic medical morbidity, and health-related quality of life among older personsHealth Psychol16539546CrossRefPubMedGoogle Scholar
  18. 18.
    Groot, V, Beckerman, H, Lankhorst, GJ, Bouter, LM 2003How to measure comorbidity. a critical review of available methodsJ Clin Epidemiol56221229PubMedGoogle Scholar
  19. 19.
    Ormel, J, VonKorff, M, Ustun, B, Pini, S, Korten, A, Oldehinkel, T 1994Common mental disorders and disability across cultures: results from the WHO collaborative study on psychological problems in general health careJAMA27217411748CrossRefPubMedGoogle Scholar
  20. 20.
    World Health Organization. Innovative Care for Chronic Conditions. Building blocks for action. Geneva, Switzerland: World Health Organization; 2002 [cited 2004 Dec 28] Available from:
  21. 21.
    Linn, BS, Linn, MW, Gurel, L 1968Cumulative illness rating scaleJ Am Geriatr Soc16622626PubMedGoogle Scholar
  22. 22.
    Miller EA, Towers A. A manual of guidelines for scoring the cumulative illness rating scale for geriatrics (CIRS-G).: University of Pittsburgh, 1991.Google Scholar
  23. 23.
    Harboun, M, Ankri, J 2001[Comorbidity indexes: review of the literature and application to studies of elderly population][French]Rev Epidemiol Sante Publique49287298PubMedGoogle Scholar
  24. 24.
    Hudon, C, Fortin, M, Vanasse, A 2005 Cumulative Illness Rating Scale was a reliable and valid index in a family practice contextJ Clin Epidemiol58603608CrossRefPubMedGoogle Scholar
  25. 25.
    Ware, JE, Sherbourne, CD 1992The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selectionMed Care30473483PubMedGoogle Scholar
  26. 26.
    Ware JE, Jr. SF-36® Health Survey Update [cited 2004 Dec 28]. Available from:
  27. 27.
    Dauphinee, SW, Gauthier, L, Gandek, B, Magnan, L, Pierre, U 1997Readying a US measure of health status, the SF-36, for use in CanadaClin Invest Med20224238PubMedGoogle Scholar
  28. 28.
    Cutrona, CA, Russel, DW 1987The provisions of social support and adaptation to stressAdv Pers Relationships13767Google Scholar
  29. 29.
    Caron, J 1996[The scale of social provisions: their validation in Quebec][French]Santé Mentale au Québec21158180PubMedGoogle Scholar
  30. 30.
    Hopman, WM, Towheed, T, Anastassiades, T, Tenenhouse, A, Poliquin, S, Berger, C, Joseph, L, Brown, JP, Murray, TM, Adachi, JD, Hanley, DA, Papadimitropoulos, E 2000Canadian normative data for the SF-36 health surveyCan Mult Osteoporosis Study Res Group. CMAJ163265271Google Scholar
  31. 31.
    Walker, JG, Jackson, HJ, Littlejohn, GO 2004Models of adjustment to chronic illness: using the example of rheumatoid arthritisClin Psychol Rev24461488PubMedGoogle Scholar
  32. 32.
    Katz, JN, Larson, MG, Phillips, CB, Fossel, AH, Liang, MH 1992Comparative measurement sensitivity of short and longer health status instrumentsMed Care30917925PubMedGoogle Scholar
  33. 33.
    Allaire, D 1988Questionnaires: mesure verbale du comportamentRobert, M eds. Fondements et étapes de la recherche scientifique en psychologie3St-HyacintheQuébec, Edisem229275Google Scholar

Copyright information

© Springer 2006

Authors and Affiliations

  • Martin Fortin
    • 1
    Email author
  • Gina Bravo
    • 2
    • 3
  • Catherine Hudon
    • 1
  • Lise Lapointe
    • 1
  • José Almirall
    • 1
  • Marie-France Dubois
    • 2
    • 3
  • Alain Vanasse
    • 1
  1. 1.Department of Family MedicineSherbrooke University, SherbrookeQueCanada
  2. 2.Department of Community Health SciencesSherbrooke University, SherbrookeQueCanada
  3. 3.Research Center on AgingSherbrooke University Geriatric Institute, SherbrookeQueCanada

Personalised recommendations