title: Prevalence and Patterns of Multi-Morbidity in Serbian Adults: A Cross-Sectional Study.
abstract: BACKGROUND
  Like many developing countries, Serbia is facing a growing burden of chronic diseases. Within such public health issue, multi-morbidity requires a special attention.
  
  
  OBJECTIVE
  This study investigated the prevalence of multi-morbidity in the Serbia population and assessed the co-occurrence of chronic diseases by age and gender.
  
  
  METHODS
  We analyzed data from the 2013 National Health Survey, which included 13,103 individuals ≥ 20 years old. Multi-morbidity patterns were identified by exploratory factor analysis of data on self-reported chronic diseases, as well as data on measured body weight and height. The analysis was stratified by age and gender.
  
  
  RESULTS
  Multi-morbidity was present in nearly one-third of respondents (26.9%) and existed in all age groups, with the highest prevalence among individuals aged 65 years and older (47.2% of men and 65.0% of women). Six patterns of multi-morbidity were identified: non-communicable, cardio-metabolic, respiratory, cardiovascular, aggregate, and mechanical/mental/metabolic. The non-communicable pattern was observed in both genders but only in the 20-44 years age group, while the aggregate pattern occurred only in middle-aged men. Cardio-metabolic and respiratory patterns were present in all age groups. Cardiovascular and mechanical/mental/metabolic patterns showed similar presentation in both men and women.
  
  
  CONCLUSIONS
  Multi-morbidity is a common occurrence among adults in Serbia, especially in the elderly. While several patterns may be explained by underlying pathophysiologies, some require further investigation and follow-up. Recognizing the complexity of multi-morbidity in Serbia is of great importance from both clinical and preventive perspectives given that it affects one-third of the population and may require adjustment of the healthcare system to address the needs of affected individuals.
authors.affiliation: Center for Hygiene and Human Ecology, Institute of Public Health of Serbia, Belgrade, Serbia.
authors.forename: Dragana
authors.initials: D
authors.lastname: Jovic
authors.affiliation: Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Dejana
authors.initials: D
authors.lastname: Vukovic
authors.affiliation: Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Jelena
authors.initials: J
authors.lastname: Marinkovic
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D008171:Lung Diseases / Q000453:epidemiology*; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008659:Metabolic Diseases / Q000453:epidemiology*; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000453:epidemiology*; D015995:Prevalence; D055771:Serbia / Q000453:epidemiology; D012737:Sex Factors