Multimorbidity of four cardiometabolic and chronic pulmonary disease groups: prevalence and attributable fraction in US adults, 2007–2012

Lisa R. Staimez*, Melissa Y. Wei*, Min Kim, K.M. Venkat Narayan, Sharon S. Saydah


Background: Cardiometabolic and chronic pulmonary diseases may be associated with modifiable risk factors that can be targeted to prevent multimorbidity. Objectives: (i) Estimate the prevalence of multimorbidity across four cardiometabolic and chronic pulmonary disease groups; (ii) compare the prevalence of multimorbidity to monomorbidity and no disease; and (iii) quantify population attributable fractions (PAFs) for modifiable risk factors of multimorbidity. Design: Data from adults aged 18–79 years who participated in the US National Health and Nutrition Examination Survey 2007–2012 were examined. Multimorbidity was defined as ≥2 co-occurring diseases across four common cardiometabolic and chronic pulmonary disease groups. Multivariate-adjusted PAFs for poverty, obesity, smoking, hypertension, and low high-density lipoprotein (HDL) cholesterol were estimated. Results: Among 16,676 adults, the age-standardized prevalence of multimorbidity was 9.3% (95% confidence interval [CI] 8.8–9.9). Multimorbidity occurred in 34.8% (95% CI 32.4–37.2) of adults aged 65–79 years and in 1.5% (95% CI 1.2–1.9) of adults aged 18–40 years. Multimorbidity was greatest among the poorest versus non-poorest adults and among blacks versus other races/ethnicities. Multimorbidity was also greater in adults with obesity, hypertension, and low HDL cholesterol. Risk factors with greatest PAFs were hypertension (38.8%; 95% confidence interval [CI] 29.4–47.4) and obesity (19.3; 95% CI 10.2–28.1). Conclusions: In the USA, 9.3% of adults have multimorbidity across four chronic disease groups, with a disproportionate burden among older, black, and poor adults. Our results suggest that reducing hypertension and obesity might yield over 50% reduction in the prevalence of multimorbidity of these diseases.

*Equal contribution

Journal of Comorbidity 2017;7(1):22–32


multimorbidity, comorbidity, chronic disease prevalence, population attributable fraction, cardiovascular disease, diabetes mellitus, chronic kidney disease, chronic obstructive pulmonary disease, hypertension, obesity

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