title: Burden of multimorbidity, socioeconomic status and use of health services across stages of life in urban areas: a cross-sectional study.
abstract: BACKGROUND
  The burden of chronic conditions and multimorbidity is a growing health problem in developed countries. The study aimed to determine the estimated prevalence and patterns of multimorbidity in urban areas of Catalonia, stratified by sex and adult age groups, and to assess whether socioeconomic status and use of primary health care services were associated with multimorbidity.
  
  
  METHODS
  A cross-sectional study was conducted in Catalonia. Participants were adults (19+ years) living in urban areas, assigned to 251 primary care teams.
  
  
  RESULTS
  multimorbidity (≥2 chronic conditions). Other variables: sex (male/female), age (19-24; 25-44; 45-64; 65-79; 80+ years), socioeconomic status (quintiles), number of health care visits during the study.
  
  
  RESULTS
  We included 1,356,761 patients; mean age, 47.4 years (SD: 17.8), 51.0% women. Multimorbidity was present in 47.6% (95% CI 47.5-47.7) of the sample, increasing with age in both sexes but significantly higher in women (53.3%) than in men (41.7%). Prevalence of multimorbidity in each quintile of the deprivation index was higher in women than in men (except oldest group). In women, multimorbidity prevalence increased with quintile of the deprivation index. Overall, the median (interquartile range) number of primary care visits was 8 (4-14) in multimorbidity vs 1 (0-4) in non-multimorbidity patients. The most prevalent multimorbidity pattern beyond 45 years of age was uncomplicated hypertension and lipid disorder. Compared with the least deprived group, women in other quintiles of the deprivation index were more likely to have multimorbidity than men until 65 years of age. The odds of multimorbidity increased with number of visits in all strata.
  
  
  CONCLUSIONS
  When all chronic conditions were included in the analysis, almost 50% of the adult urban population had multimorbidity. The prevalence of multimorbidity differed by sex, age group and socioeconomic status. Multimorbidity patterns varied by life-stage and sex; however, circulatory-endocrine-metabolic patterns were the most prevalent multimorbidity pattern after 45 years of age. Women younger than 80 years had greater prevalence of multimorbidity than men, and women's multimorbidity prevalence increased as socioeconomic status declined in all age groups. Identifying multimorbidity patterns associated with specific age-related life-stages allows health systems to prioritize and to adapt clinical management efforts by age group.
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain. cviolan@idiapjgol.org.
authors.forename: Concepción
authors.initials: C
authors.lastname: Violán
authors.forename: Quintí
authors.initials: Q
authors.lastname: Foguet-Boreu
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: Enriqueta
authors.initials: E
authors.lastname: Pujol-Ribera
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Muñoz-Pérez
authors.forename: Jose M
authors.initials: JM
authors.lastname: Valderas
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs; D006801:Humans; D006973:Hypertension / Q000191:economics / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000191:economics / Q000453:epidemiology; D012737:Sex Factors; D012923:Social Class; D013030:Spain / Q000453:epidemiology; D014505:Urban Population