Multimorbidity is a common problem in aged populations with a wide range of individual and societal consequences. The objective of the study was to explore patterns of comorbidity and multimorbidity in an elderly population using different analytical approaches. Data were gathered from the population-based KORA-Age project, which included 4,127 persons aged 65–94 years living in the city of Augsburg and its two surrounding counties in Southern Germany. Information on the presence of 13 chronic conditions was collected in a standardized telephone interview and a self-administered questionnaire. Patterns of comorbidity and multimorbidity were analyzed using prevalence figures, logistic regression models and exploratory tetrachoric factor analysis. The prevalence of multimorbidity (≥2 diseases) was 58.6% in the total sample. Hypertension and diabetes (Odds Ratio [OR] 2.95, 99.58% confidence interval [CI] [2.19–3.96]), as well as hypertension and stroke (OR 2.00, 99.58% CI [1.26–3.16]) most often occurred in combination. This association was independent of age, sex and the presence of other conditions. Using factor analysis, we identified four patterns of multimorbidity: the first pattern includes cardiovascular and metabolic diseases, the second includes joint, liver, lung and eye diseases, the third covers mental and neurologic diseases and the fourth pattern includes gastrointestinal diseases and cancer. 44% of the persons were assigned to at least one of the four multimorbidity patterns; 14% could be assigned to both the cardiovascular/metabolic and the joint/liver/lung/eye pattern. Further common pairs were the mental/neurologic pattern combined with the cardiovascular/metabolic pattern (7.2%) or the joint/liver/lung/eye pattern (5.3%), respectively. Our results confirmed the existence of co-occurrence of certain diseases in elderly persons, which is not caused by chance. Some of the identified patterns of multimorbidity and their overlap may indicate common underlying pathological mechanisms.
Loza E, Jover JA, Rodriguez L, Carmona L, EPISER Study Group (2009) Multimorbidity: prevalence, effect on quality of life and daily functioning, and variation of this effect when one condition is a rheumatic disease. Semin Arthritis Rheum 38: 312–319.
Laux G, Kuehlein T, Rosemann T, Szecsenyi J (2008) Co- and multimorbidity patterns in primary care based on episodes of care: results from the German CONTENT project. BMC Health Serv Res 8: 14.
Fung CH, Setodji CM, Kung FY, Keesey J, Asch SM, et al. (2008) The relationship between multimorbidity and patients' ratings of communication. J Gen Intern Med 23: 788–793.
Schoenberg NE, Kim H, Edwards W, Fleming ST (2007) Burden of common multiple-morbidity constellations on out-of-pocket medical expenditures among older adults. Gerontologist 47: 423–437.
Taylor AW, Price K, Gill TK, Adams R, Pilkington R, et al. (2010) Multimorbidity - not just an older person's issue. Results from an Australian biomedical study. BMC Public Health 10: 718.
Van den Akker M, Buntinx F, Metsemakers JF, Roos S, Knottnerus JA (1998) Multimorbidity in general practice: prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases. J Clin Epidemiol 51: 367–75.
Fortin M, Hudon C, Haggerty J, Akker M, Almirall J (2010) Prevalence estimates of multimorbidity: a comparative study of two sources. BMC Health Serv Res 10: 111.
Nagel G, Peter R, Braig S, Hermann S, Rohrmann S, et al. (2008) The impact of education on risk factors and the occurrence of multimorbidity in the EPIC-Heidelberg cohort. BMC Public Health 8: 384.
Van den Bussche H, Koller D, Kolonko T, Hansen H, Wegscheider K, et al. (2011) Which chronic diseases and disease combinations are specific to multimorbidity in the elderly? Results of a claims data based cross-sectional study in Germany. BMC Public Health 11: 101.
Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, et al. (2011) Aging with multimorbidity: A systematic review of the literature. Ageing Res Rev 2011 10: 430–9.
Fried LP, Bandeen-Roche K, Kasper JD, Guralnik JM (1999) Association of comorbidity with disability in older women: the Women's Health and Aging Study. J Clin Epidemiol 52: 27–37.
Marengoni A, Rizzuto D, Wang HX, Winblad B, Fratiglioni L (2009) Patterns of chronic multimorbidity in the elderly population. J Am Geriatr Soc 57: 225–230.
John R, Kerby DS, Hennessy CH (2003) Patterns and impact of comorbidity and multimorbidity among community-resident American Indian elders. Gerontologist 43: 649–660.
Cornell JE, Pugh JA, Williams JW, Kazis L, Parchman ML, et al. (2007) Multimorbidity clusters: Clustering binary data from a large administrative medical database. Applied Multivariate Research 12: 163–182.
Sch？fer I, von Leitner EC, Sch？n G, Koller D, Hansen H, et al. (2010) Multimorbidity patterns in the elderly: a new approach of disease clustering identifies complex interrelations between chronic conditions. PLoS One 5: e15941.
Holle R, Happich M, L？wel H, Wichmann HE, MONICA/KORA Study Group (2005) KORA–a research platform for population based health research. Gesundheitswesen 67: Suppl 1S19–25.
L？wel H, D？ring A, Schneider A, Heier M, Thorand B, et al. (2005) The MONICA Augsburg surveys–basis for prospective cohort studies. Gesundheitswesen 67: Suppl 1S13–18.
Spitzer RL, Kroenke K, Williams JB, L？we B (2006) A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 166: 1092–1097.
Wolff JL, Starfield B, Anderson G (2002) Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med 162: 2269–2276.
Marengoni A, Winblad B, Karp A, Fratiglioni L (2008) Prevalence of chronic diseases and multimorbidity among the elderly population in Sweden. Am J Public Health 98: 1198–1200.
Meisinger C, D？ring A, Heier M (2008) Blood pressure and risk of type 2 diabetes mellitus in men and women from the general population: the Monitoring Trends and Determinants on Cardiovascular Diseases/Cooperative Health Research in the Region of Augsburg Cohort Study. J Hypertens 26: 1809–1815.
Cates MJ, Paton JF, Smeeton NC, Wolfe CD (2011) Hypertension Before and After Posterior Circulation Infarction: Analysis of Data from the South London Stroke Register. J Stroke Cerebrovasc. [Epub ahead of print].
Long AN, Dagogo-Jack S (2011) Comorbidities of diabetes and hypertension: mechanisms and approach to target organ protection. J Clin Hypertens (Greenwich) 13: 244–251.
Prasad S, Kamath GG, Jones K, Clearkin LG, Phillips RP (2001) Prevalence of blindness and visual impairment in a population of people with diabetes. Eye 15: 640–643.
Moorthy S, Cheung N, Klein R, Shahar E, Wong TY (2011) Are lung disease and function related to age-related macular degeneration? Am J Ophthalmol 151: 375–379.
Weatherall M, Clay J, James K, Perrin K, Shirtcliffe P, et al. (2009) Dose-response relationship of inhaled corticosteroids and cataracts: a systematic review and meta-analysis. Respirology 14: 983–990.
Lamers F, van Oppen P, Comijs HC, Smit JH, Spinhoven P, et al. (2011) Comorbidity patterns of anxiety and depressive disorders in a large cohort study: the Netherlands Study of Depression and Anxiety (NESDA). J Clin Psychiatry. [Epub ahead of print].
Schoevers RA, Beekman AT, Deeg DJ, Jonker C, van Tilburg W (2003) Comorbidity and risk-patterns of depression, generalised anxiety disorder and mixed anxiety-depression in later life: results from the AMSTEL study. Int J Geriatr Psychiatry 18: 994–1001.
Ottman R, Lipton RB, Ettinger AB, Cramer JA, Reed ML, et al. (2011) Comorbidities of epilepsy: results from the Epilepsy Comorbidities and Health (EPIC) survey. Epilepsia 52: 308–315.
Maes M, Ruckoanich P, Chang YS, Mahanonda N, Berk M (2010) Multiple aberrations in shared inflammatory and oxidative & nitrosative stress (IO&NS) pathways explain the co-association of depression and cardiovascular disorder (CVD), and the increased risk for CVD and due mortality in depressed patients. Prog Neuropsychopharmacol Biol Psychiatry. [Epub ahead of print].
Maes M, Kubera M, Obuchowiczwa E, Goehler L, Brzeszcz J (2011) Depression's multiple comorbidities explained by (neuro)inflammatory and oxidative & nitrosative stress pathways. Neuro Endocrinol Lett 32: 7–24.
