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Prevalent Multimorbidity Combinations Among Middle-Aged and Older Adults Seen in Community Health Centers



Multimorbidity (≥ 2 chronic diseases) is associated with greater disability and higher treatment burden, as well as difficulty coordinating self-management tasks for adults with complex multimorbidity patterns. Comparatively little work has focused on assessing multimorbidity patterns among patients seeking care in community health centers (CHCs).


To identify and characterize prevalent multimorbidity patterns in a multi-state network of CHCs over a 5-year period.


A cohort study of the 2014–2019 ADVANCE multi-state CHC clinical data network. We identified the most prevalent multimorbidity combination patterns and assessed the frequency of patterns throughout a 5-year period as well as the demographic characteristics of patient panels by prevalent patterns.


The study included data from 838,642 patients aged ≥ 45 years who were seen in 337 CHCs across 22 states between 2014 and 2019.

Main measures

Prevalent multimorbidity patterns of somatic, mental health, and mental-somatic combinations of 22 chronic diseases based on the U.S. Department of Health and Human Services Multiple Chronic Conditions framework: anxiety, arthritis, asthma, autism, cancer, cardiac arrhythmia, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), congestive heart failure, coronary artery disease, dementia, depression, diabetes, hepatitis, human immunodeficiency virus (HIV), hyperlipidemia, hypertension, osteoporosis, post-traumatic stress disorder (PTSD), schizophrenia, substance use disorder, and stroke.

Key results

Multimorbidity is common among middle-aged and older patients seen in CHCs: 40% have somatic, 6% have mental health, and 24% have mental-somatic multimorbidity patterns. The most frequently occurring pattern across all years is hyperlipidemia-hypertension. The three most frequent patterns are various iterations of hyperlipidemia, hypertension, and diabetes and are consistent in rank of occurrence across all years. CKD-hyperlipidemia-hypertension and anxiety-depression are both more frequent in later study years.


CHCs are increasingly seeing more complex multimorbidity patterns over time; these most often involve mental health morbidity and advanced cardiometabolic-renal morbidity.

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This work was conducted with the Accelerating Data Value Across a National Community Health Center Network (ADVANCE) Clinical Research Network (CRN). OCHIN leads the ADVANCE network in partnership with Health Choice Network, Fenway Health, and Oregon Health & Science University. ADVANCE is funded through the Patient-Centered Outcomes Research Institute (PCORI), contract number RI-CRN-2020–001. This study was supported by the National Institute on Aging of the National Institutes of Health award (R01AG061386 to ARQ). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations



ARQ contributed to the literature search, study design, data interpretation, and drafting of the manuscript. SHV contributed to the data management, data analysis, data interpretation, and writing and editing of the manuscript. NH and JH contributed to the data interpretation and writing and editing of the manuscript. MU, MM, JL, JO, TS, RV, KP, and NW contributed to the data interpretation and editing of the manuscript. All of the authors approved the final version of the manuscript. ARQ and SHV had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding author

Correspondence to Ana R. Quiñones PhD.

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All authors declare they have no conflicts of interest to report.

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Prior presentations

A preliminary version of these analyses was presented at the North American Primary Care Research Group Annual Meeting held virtually in November 2020.

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Quiñones, A.R., Valenzuela, S.H., Huguet, N. et al. Prevalent Multimorbidity Combinations Among Middle-Aged and Older Adults Seen in Community Health Centers. J GEN INTERN MED (2022).

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  • multimorbidity
  • multiple chronic conditions
  • community health centers
  • safety-net clinics
  • vulnerable populations