title: Burden of multimorbidity in relation to age, gender and immigrant status: a cross-sectional study based on administrative data.
abstract: Many studies have investigated multimorbidity, whose prevalence varies according to settings and data sources. However, few studies on this topic have been conducted in Italy, a country with universal healthcare and one of the most aged populations in the world. The aim of this study was to estimate the prevalence of multimorbidity in a Northern Italian region, to investigate its distribution by age, gender and citizenship and to analyse the correlations of diseases.
  
  
  
  Cross-sectional study based on administrative data.
  
  
  
  Emilia-Romagna, an Italian region with ∼4.4 million inhabitants, of which almost one-fourth are aged ≥65 years.
  
  
  
  All adults residing in Emilia-Romagna on 31 December 2012. Hospitalisations, drug prescriptions and contacts with community mental health services from 2003 to 2012 were traced to identify the presence of 17 physical and 9 mental health disorders.
  
  
  
  Descriptive analysis of differences in the prevalence of multimorbidity in relation to age, gender and citizenship. The correlations of diseases were analysed using exploratory factor analysis.
  
  
  
  The study population included 622 026 men and 751 011women, with a mean age of 66.4 years. Patients with multimorbidity were 33.5% in 75 years and >60% among patients aged ≥90 years; among patients aged ≥65 years, the proportion of multimorbidity was 39.9%. After standardisation by age and gender, multimorbidity was significantly more frequent among Italian citizens than among immigrants. Factor analysis identified 5 multimorbidity patterns: (1) psychiatric disorders, (2) cardiovascular, renal, pulmonary and cerebrovascular diseases, (3) neurological diseases, (4) liver diseases, AIDS/HIV and substance abuse and (5) tumours.
  
  
  
  Multimorbidity was highly prevalent in Emilia-Romagna and strongly associated with age. This finding highlights the need for healthcare providers to adopt individualised care plans and ensure continuity of care.
authors.affiliation: Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Jacopo
authors.identifier: 0000-0003-2882-4223
authors.initials: J
authors.lastname: Lenzi
authors.affiliation: Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Vera Maria
authors.initials: VM
authors.lastname: Avaldi
authors.affiliation: Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Paola
authors.identifier: 0000-0002-7704-0831
authors.initials: P
authors.lastname: Rucci
authors.affiliation: Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Pieri
authors.affiliation: Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Fantini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants; D005006:Ethnicity; D005260:Female; D015658:HIV Infections; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007674:Kidney Diseases; D008107:Liver Diseases; D008297:Male; D001523:Mental Disorders; D008875:Middle Aged; D000076322:Multimorbidity; D009369:Neoplasms; D009422:Nervous System Diseases; D055815:Young Adult
keywords: EPIDEMIOLOGY; PRIMARY CARE; PUBLIC HEALTH