title: Global Multimorbidity Patterns: A Cross-Sectional, Population-Based, Multi-Country Study.
abstract: BACKGROUND
  Population ageing challenges health care systems due to the high prevalence and impact of multimorbidity in older adults. However, little is known about how chronic conditions present in certain multimorbidity patterns, which could have great impact on public health at several levels. The aim of our study was to identify and describe multimorbidity patterns in low-, middle-, and high-income countries.
  
  
  METHODS
  We analyzed data from the Collaborative Research on Ageing in Europe project (Finland, Poland, and Spain) and the World Health Organization's Study on Global Ageing and Adult Health (China, Ghana, India, Mexico, Russia, and South Africa). These cross-sectional studies obtained data from 41,909 noninstitutionalized adults older than 50 years. Exploratory factor analysis was performed to detect multimorbidity patterns. Additional adjusted binary logistic regressions were performed to identify associations between sociodemographic factors and multimorbidity.
  
  
  RESULTS
  Overall multimorbidity prevalence was high across countries. Hypertension, cataract, and arthritis were the most prevalent comorbid conditions. Two or three multimorbidity patterns were found per country. Several patterns were identified across several countries: "cardio-respiratory" (angina, asthma, and chronic obstructive pulmonary disease), "metabolic" (diabetes, obesity, and hypertension), and "mental-articular" (arthritis and depression).
  
  
  CONCLUSIONS
  A high prevalence of multimorbidity occurs in older adults across countries, with low- and middle-income countries gradually approaching the figures of richer countries. Certain multimorbidity patterns are present in several countries, which suggest that common underlying etiopathogenic factors may play a role. Deeper understanding of these patterns may lead to the development of preventive actions to diminish their prevalence and also give rise to new, comprehensive approaches for the management of these co-occurring conditions.
authors.affiliation: Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Institut d'Investigacions Biomèdiques Sant Pau (IIB Sant Pau), Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain. Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Spain. Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
authors.forename: Noe
authors.initials: N
authors.lastname: Garin
authors.affiliation: Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Spain. Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
authors.forename: Ai
authors.initials: A
authors.lastname: Koyanagi
authors.affiliation: Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland.
authors.forename: Somnath
authors.initials: S
authors.lastname: Chatterji
authors.affiliation: Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Spain. Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
authors.forename: Stefanos
authors.initials: S
authors.lastname: Tyrovolas
authors.affiliation: Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Spain. Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Olaya
authors.affiliation: Neurology, Public Health and Disability Unit, Neurological Institute Carlo Besta IRCCS Foundation, Milan, Italy.
authors.forename: Matilde
authors.initials: M
authors.lastname: Leonardi
authors.affiliation: Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Spain. Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
authors.forename: Elvira
authors.initials: E
authors.lastname: Lara
authors.affiliation: National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Seppo
authors.initials: S
authors.lastname: Koskinen
authors.affiliation: Department of Epidemiology, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Beata
authors.initials: B
authors.lastname: Tobiasz-Adamczyk
authors.affiliation: Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain. Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain. Department of Psychiatry, Universidad Autónoma de Madrid, Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Ayuso-Mateos
authors.affiliation: Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Spain. Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain. jmharo@pssjd.org.
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Haro
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D015897:Comorbidity / Q000639:trends*; D003430:Cross-Sectional Studies; D005260:Female; D014943:Global Health; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012959:Socioeconomic Factors
keywords: Epidemiology; Health disparities; Morbidity; Multimorbidities; Public health; Socioeconomic issues