title: Multimorbidity and comorbidity in the Dutch population - data from general practices.
abstract: BACKGROUND
  Multimorbidity is increasingly recognized as a major public health challenge of modern societies. However, knowledge about the size of the population suffering from multimorbidity and the type of multimorbidity is scarce. The objective of this study was to present an overview of the prevalence of multimorbidity and comorbidity of chronic diseases in the Dutch population and to explore disease clustering and common comorbidities.
  
  
  METHODS
  We used 7 years data (2002-2008) of a large Dutch representative network of general practices (212,902 patients). Multimorbidity was defined as having two or more out of 29 chronic diseases. The prevalence of multimorbidity was calculated for the total population and by sex and age group. For 10 prevalent diseases among patients of 55 years and older (N = 52,014) logistic regressions analyses were used to study disease clustering and descriptive analyses to explore common comorbid diseases.
  
  
  RESULTS
  Multimorbidity of chronic diseases was found among 13% of the Dutch population and in 37% of those older than 55 years. Among patients over 55 years with a specific chronic disease more than two-thirds also had one or more other chronic diseases. Most disease pairs occurred more frequently than would be expected if diseases had been independent. Comorbidity was not limited to specific combinations of diseases; about 70% of those with a disease had one or more extra chronic diseases recorded which were not included in the top five of most common diseases.
  
  
  CONCLUSIONS
  Multimorbidity is common at all ages though increasing with age, with over two-thirds of those with chronic diseases and aged 55 years and older being recorded with multimorbidity. Comorbidity encompassed many different combinations of chronic diseases. Given the ageing population, multimorbidity and its consequences should be taken into account in the organization of care in order to avoid fragmented care, in medical research and healthcare policy.
authors.affiliation: Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven 3720 BA, the Netherlands. Sandra.van.oostrom@rivm.nl
authors.forename: Sandra H
authors.initials: SH
authors.lastname: van Oostrom
authors.forename: H Susan J
authors.initials: HS
authors.lastname: Picavet
authors.forename: Boukje M
authors.initials: BM
authors.lastname: van Gelder
authors.forename: Lidwien C
authors.initials: LC
authors.lastname: Lemmens
authors.forename: Nancy
authors.initials: N
authors.lastname: Hoeymans
authors.forename: Christel E
authors.initials: CE
authors.lastname: van Dijk
authors.forename: Robert A
authors.initials: RA
authors.lastname: Verheij
authors.forename: François G
authors.initials: FG
authors.lastname: Schellevis
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Baan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000453:epidemiology*; D015897:Comorbidity / Q000639:trends; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D015995:Prevalence; D055815:Young Adult