Research ArticleOriginal Research

The Prevalence of Chronic Diseases and Multimorbidity in Primary Care Practice: A PPRNet Report

Steven M. Ornstein, Paul J. Nietert, Ruth G. Jenkins and Cara B. Litvin
The Journal of the American Board of Family Medicine September 2013, 26 (5) 518-524; DOI: https://doi.org/10.3122/jabfm.2013.05.130012

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    Multimorbidity prevalence by age, stratified by sex. Prevalence rates were estimated using hierarchical logistic regression models (see Methods for details).

Tables

  • Table 1. Prevalence of Chronic Conditions Among 667,379 Active Patients and 148 Practices as of October 1, 2011
    Chronic ConditionICD-9-CM Codes*Prevalence Among All Patients, % (n)Prevalence Among Practices, median % (10th, 90th percentile)
    Hypertension362.11, 401, 402, 403, 404, 405, 437.2, 997.9133.51 (223,653)35.77 (22.62, 53.63)
    Hyperlipidemia272.0–272.1, 272.3, 272.4, 277.732.97 (220,053)34.74 (20.40, 55.70)
    Depression290.13, 290.21, 296.2, 296.3, 298.0, 300.4, 31118.67 (124,596)20.15 (9.47, 30.37)
    Gastroesophageal reflux530.11, 530.81, 530.8514.93 (99,658)15.63 (6.49, 27.39)
    Diabetes mellitus250, 357.2, 362.0, 366.4111.93 (79,641)12.80 (6.72, 20.31)
    Obesity278.09, 278.01, 278.03, 278.8, V85.3, V85.411.90 (79,407)9.66(3.31, 25.92)
    Osteoarthritis715, 721 (excluding 721.7, 721.8)9.93 (66,255)8.95 (2.47,21.20)
    Asthma493 (excluding 493.81)8.73 (58,900)7.99 (4.84, 14.27)
    Osteoporosis and osteopenia733.0, 733.90 (with text indicating osteopenia)6.55 (43,700)5.51 (1.96, 12.74)
    Migraine3465.66 (37,756)5.42 (2.70, 9.75)
    Coronary disease410, 411, 412, 413, 414, 429.7, P36.0, P36.1, P36.3, V45.81, V45.824.92 (32,867)4.76 (1.50, 10.89)
    Atherosclerosis290.4, 433, 434, 435, 436 437.0, 437.8, 437.9, 438, 440, 441, 442, 443, 444, 445, P38.12, P38.44, P39.22, P39.24, P39.25, P39.28, P39.29, V12.544.74 (31,638)4.11 (1.44, 11.16)
    Chronic obstructive pulmonary disease491, 492, 4964.35 (29,005)4.02 (1.37, 9.29)
    Chronic kidney disease250.4, 285.21, 403, 404, 581, 582, 583, 585, 586, 587, 588, 996.73, V42.0, V45.13.37 (22,496)2.55 (0.87, 8.73)
    Cerebrovascular disease290.4, 430, 431, 432, 433, 434, 435, 436, 437, 438, 439, P38.12, P38.44, V12.542.88 (19,227)2.44 (0.88, 6.78)
    Atrial fibrillation427.312.17 (14,487)2.07 (0.69, 4.49)
    Heart failure402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93, 4281.68 (11,241)1.67 (0.50, 3.76)
    Alcohol use disorders291, 303, 305.0, 357.5, 425.5, 535.3, 571.0–571.3, 790.3, 980.0, 980.9, P94.621.29 (8594)1.30 (0.43, 3.01)
    Dementia046.1, 290, 291.2, 292.82, 294.1, 330.1, 331.0, 331.1, 331.2, 331.821.10 (7361)0.93 (0.27, 2.47)
    Peptic ulcer531, 532, 533, 534, V12.711.09 (7242)0.94 (0.19, 2.26)
    Chronic liver disease070.22, 070.23, 070.32, 070.33, 070.44, 070.54, 155, 197.7, 571.2, 571.4, 571.5, 571.6, 571.8, 571.9, 572.2, 572.4, 572.8, 996.82, P50.4, P50.59, V10.07, V42.71.04 (6951)0.82 (0.27, 2.55)
    Epilepsy3451.03 (6893)1.01 (0.36, 1.74)
    Rheumatoid arthritis7140.95 (6357)0.91 (0.37, 1.76)
    Parkinson's disease or syndrome332.00.28 (1886)0.23 (0.00, 0.67)

    • ↵* The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes were either included in the database diagnoses lists or derived by the PPRNet algorithms (see text). P set before a number indicates a procedure code. Codes used but not listed include G-codes used for quality reporting and procedure codes used for procedures unique to a diagnosis (eg, diabetic eye examination, gastric bypass for obesity).

  • Table 2. Number of Chronic Conditions Among 667,379 Active Patients and 148 Practices as of October 1, 2011
    Chronic Conditions (n)Patients in All Practices, % (n)Prevalence Among Practices, Median (10th, 90th Percentile)
    034.65 (231,235)30.11 (14.02, 47.66)
    120.10 (134,136)19.76 (12.88, 24.92)
    214.89 (99,367)15.47 (12.01, 18.59)
    311.18 (74,586)11.86 (7.61, 15.48)
    47.67 (51,163)8.44 (4.00, 12.76)
    54.89 (32,652)5.36 (1.93, 9.90)
    62.97 (19,821)3.07 (0.94, 6.54)
    7 to 233.66 (24,419)0.31 (0.04, 1.05)
  • Table 3. Prevalence of Multimorbidity by Age and Definition Among All 667,379 Active Patients and 148 Practices as of October 1, 2011
    Age (Years)≥2 Chronic Conditions≥3 Chronic ConditionsChronic Conditions, Median (IQR)
    Patients in All Practices*Prevalence Among Practices†Patients in All Practices*Prevalence Among Practices†
    18–3413.85 (22,025)14.21 (6.58, 28.98)4.97 (7911)4.93 (1.86, 13.60)0 (0–1)
    35–4429.83 (31,683)32.50 (16.47, 55.43)15.10 (16,032)15.73 (6.58, 34.54)1 (0–2)
    45–5444.82 (58,022)47.48 (26.69, 69.97)26.88 (34,794)27.90 (11.76, 50.78)1 (0–3)
    55–6461.00 (76,684)66.01 (41.19, 81.93)71.92 (52,594)44.62 (24.20, 65.33)2 (1–4)
    65–7474.30 (59,902)78.74 (54.12, 91.57)57.35 (46,231)60.63 (35.55, 79.34)3 (1–4)
    75–8480.99 (37,668)87.26 (60.32, 96.50)67.51 (31,402)73.79 (42.80, 88.39)4 (2–5)
    ≥8580.82 (16,024)87.30 (61.55, 98.34)68.99 (13,677)75.66 (44.09, 92.69)4 (2–6)

    • ↵* Data are % (n).

    • ↵† Data are median (10th, 90th percentile).

    • IQR, interquartile range.

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