title: Impact of multimorbidity: acute morbidity, area of residency and use of health services across the life span in a region of south Europe.
abstract: BACKGROUND
  Concurrent diseases, multiple pathologies and multimorbidity patterns are topics of increased interest as the world's population ages. To explore the impact of multimorbidity on affected patients and the consequences for health services, we designed a study to describe multimorbidity by sex and life-stage in a large population sample and to assess the association with acute morbidity, area of residency and use of health services.
  
  
  METHODS
  A cross-sectional study was conducted in Catalonia (Spain). Participants were 1,749,710 patients aged 19+ years (251 primary care teams).
  
  
  METHODS
  Multimorbidity (≥2 chronic diseases). Secondary outcome: Number of new events of each acute disease. Other variables: number of acute diseases per patient, sex, age group (19-24, 25-44, 45-64, 65-79, and 80+ years), urban/rural residence, and number of visits during 2010.
  
  
  RESULTS
  Multimorbidity was present in 46.8% (95% CI, 46.7%-46.8%) of the sample, and increased as age increased, being higher in women and in rural areas. The most prevalent pair of chronic diseases was hypertension and lipid disorders in patients older than 45 years. Infections (mainly upper respiratory infection) were the most common acute diagnoses. In women, the highest significant RR of multimorbidity vs. non-multimorbidity was found for teeth/gum disease (aged 19-24) and acute upper respiratory infection. In men, this RR was only positive and significant for teeth/gum disease (aged 65-79). The adjusted analysis showed a strongly positive association with multimorbidity for the oldest women (80+ years) with acute diseases and women aged 65-79 with 3 or more acute diseases, compared to patients with no acute diseases (OR ranged from 1.16 to 1.99, p < 0.001). Living in a rural area was significantly associated with lower probability of having multimorbidity. The odds of multimorbidity increased sharply as the number of visits increased, reaching the highest probability in those aged 65-79 years.
  
  
  CONCLUSIONS
  Multimorbidity is related to greater use of health care services and higher incidence of acute diseases, increasing the burden on primary care services. The differences related to sex and life-stage observed for multimorbidity and acute diseases suggest that further research on multimorbidity should be stratified according to these factors.
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes, 587 àtic, 08007 Barcelona, Spain. qfoguet@idiapjgol.org.
authors.forename: Quintí
authors.initials: Q
authors.lastname: Foguet-Boreu
authors.forename: Concepció
authors.initials: C
authors.lastname: Violan
authors.forename: Albert
authors.initials: A
authors.lastname: Roso-Llorach
authors.forename: Teresa
authors.initials: T
authors.lastname: Rodriguez-Blanco
authors.forename: Mariona
authors.initials: M
authors.lastname: Pons-Vigués
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Muñoz-Pérez
authors.forename: Enriqueta
authors.initials: E
authors.lastname: Pujol-Ribera
authors.forename: Jose M
authors.initials: JM
authors.lastname: Valderas
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D017678:Sex Distribution; D013030:Spain / Q000453:epidemiology; D055815:Young Adult