Multimorbidity Trends in United States Adults, 1988–2014

Dana E. King; Jun Xiang; Courtney S. Pilkerton

doi:10.3122/jabfm.2018.04.180008

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Figure 1.
Age-standardized trends in multi-morbidity prevalence for participants 20 years or older from NHANES 1988–2014 by number of comorbidities.
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Figure 2.
Age-standardized prevalence of various chronic conditions in participants 20 years or older from NHANES 1988–2014.

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Table 1.

Age-Standardized Prevalence of Multimorbidity in Participants 20 Years or Older, Stratified by Age, Sex, Race, Poverty, Education, and Insurance Status for National Health and Nutrition Examination Survey (NHANES) 2013–2014

	Total No. of Subjects (N)^*	2 or More Multimorbidities			3 or More Multimorbidities			4 or More Multimorbidities
	Total No. of Subjects (N)^*	N^*	Prevalence, % (95% CI)	P^‡	N^*	Prevalence, % (95% CI)^{^†}	P^{^‡}	N^*	Prevalence, % (95% CI)^{^†}	P value^{^‡}
Overall prevalence	5541	3342	59.6 (58.1–61.1)		2202	38.5 (36.3–40.6)		1321	22.7 (21.1–24.3)
Age group, y
20–44	2367	868	37.5 (35.4–39.5)	<.0001	364	15.3 (13.4–17.2)	<.0001	140	6.0 (4.7–7.2)	<.0001
45–64	1909	1333	70.6 (67.5–73.6)		902	47.7 (44.9–50.9)		512	26.4 (23.8–29.0)
65+	1265	1153	91.8 (88.6–95.1)		936	76.5 (72.2–80.8)		669	55.6 (52.4–58.8)
Sex
Male	2669	1551	55.9 (54.6–57.2)	.01	964	33.8 (31.6–36.1)	.0002	538	18.4 (16.9–19.8)	<.0001
Female	2872	1803	58.4 (56.7–60.2)		1238	38.4 (36.3–40.5)		783	23.6 (21.7–25.6)
Race
Hispanic	1234	712	54.9 (52.8–57.1)	<.0001	409	30.1 (28.1–32.1)	<.0001	220	15.5 (14.2–16.9)	<.0001
White	2377	1570	59.2 (57.5–60.9)		1119	37.9 (35.9–39.9)		702	22.1 (20.9–23.3)
Black	1135	734	60.1 (56.7–63.4)		495	39.3 (36.4–42.3)		310	23.9 (21.4–26.4)
Others	795	338	45.0 (42.0–48.0)		179	27.8 (24.5–31.2)		89	15.8 (12.0–19.5)
Ratio of family income to poverty
Above Poverty (≥1.0)	3967	2426	57.5 (56.1–58.9)	.36	1600	36.2 (34.6–37.7)	.18	953	20.7 (19.4–22.0)	.02
Under poverty (<1.0)	1149	672	58.0 (54.5–61.6)		455	39.1 (35.5–42.6)		280	25.1 (22.3–27.9)
Health insurance
Yes	4363	2834	58.7 (57.1–60.4)	.01	1935	37.3 (35.5–39.2)	.04	1201	21.7 (20.5–22.9)	.22
No	1172	516	51.3 (47.7–54.9		264	29.1 (23.4–34.8)		118	17.1 (12.2–22.1)
Education
≥High school	4344	2584	57.4 (56.1–58.8)	.89	1677	36.2 (34.5–38.0)	.93	985	20.8 (19.4–22.1)	.20
<High school	1192	766	57.1 (53.1–61.0)		522	36.3 (31.9–40.7)		333	22.8 (19.3–26.2)

Note: Numbers of subjects in each category may be different due to the missing values in some variables.
↵* Unweighted total number of subjects with multimorbidity.
↵† The overall and age group prevalence were weighted. The sex, race, poverty ratio, health insurance, and education group prevalence were age standardized.
↵‡ P value from F test.
CI, confidential interval.
Chronic conditions included in determining multimorbidity: cardiovascular disease, chronic obstructive pulmonary disease, chronic kidney disease, asthma, arthritis, cancer, stroke, hypertension, hyperlipidemia, diabetes, and obesity.

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Table 2.

Age-Standardized Prevalence of 2 or More Multimorbidities for Participants Aged 20 Years or Older, Stratified by Age, Sex, Race, Poverty, Education, and Insurance Status for National Health and Nutrition Examination Survey (NHANES) 1988–2014

	1988–1994 (n = 16573)	1999–2000 (n = 4222)	2001–2002 (n = 4792)	2003–2004 (n = 4742)	2005–2006 (n = 4481)	2007–2008 (n = 5660)	2009–2010 (n = 6011)	2011–2012 (n = 5281)	2013–2014 (n = 5541)	P for trend^{^‡}
No. with 2 or more multimorbidities^*	8535	2528	2735	2900	2664	3519	3618	3135	3354
Overall prevalence, %^{^†}	45.7 (43.5–47.8)	51.9 (48.0–55.8)	51.2 (48.3–54.0)	55.8 (52.7–58.9	57.0 (54.0–60.0)	56.8 (53.5–60.1)	55.2 (52.9–57.4)	57.4 (54.0–60.8)	59.6 (58.1–61.1)	<.0001
Age group, y
20–44	26.6 (24.2–28.9)	30.9 (26.9–34.9)	31.9 (29.3–34.6)	34.5 (31.5–37.5)	35.4 (30.9–39.9)	35.1 (31.3–39.0)	32.4 (30.2–34.6)	34.9 (31.4–38.4)	37.5 (35.4–39.5)	<.0001
45–64	63.1 (61.0–65.3)	68.0 (61.5–74.5)	63.6 (59.4–67.7)	70.1 (66.2–73.9)	69.0 (66.3–71.7)	68.8 (65.2–72.3)	67.3 (64.4–70.2)	69.2 (66.5–72.0)	70.6 (67.5–73.6)	<.0001
65+	83.5 (81.5–85.6)	91.7 (89.8–93.6)	88.9 (86.6–91.1)	90.6 (88.6–92.6)	91.5 (89.2–93.8)	90.5 (88.4–92.5)	90.8 (89.3–92.4)	89.8 (87.5–92.0)	91.8 (88.6–95.1)	<.0001
Sex
Male	45.6 (43.6–47.5)	51.3 (46.0–56.8)	51.3 (48.6–54.0)	54.6 (51.4–57.9)	54.8 (51.8–57.8)	54.4 (51.2–57.5)	54.8 (52.7–56.9)	54.5 (52.0–57.0)	56.1 (54.8–57.3)	<.0001
Female	50.2 (48.5–51.9)	54.9 (51.2–58.5)	52.3 (49.8–54.7)	56.2 (53.4–59.0)	56.7 (53.7–59.6)	56.4 (53.1–59.7)	52.4 (50.7–54.1)	56.1 (53.4–58.7	58.7 (56.9–60.5)	<.0001
Race
Hispanic	46.9 (45.2–48.7)	49.6 (45.3–53.9)	48.0 (43.6–52.3)	50.5 (46.3–54.6)	49.8 (46.5–53.1)	51.5 (48.5–54.4)	51.1 (47.5–54.7)	56.2 (52.4–60.0)	54.9 (52.8–57.1)	<.0001
White	44.0 (38.7–49.4)	53.5 (49.0–57.9)	52.2 (49.6–54.7)	56.6 (53.9–59.3)	56.5 (53.4–59.6)	56.3 (51.8–60.8)	53.9 (51.9–55.9)	55.1 (51.7–58.5)	59.2 (57.5–60.9)	<.0001
Black	47.9 (45.9–49.9)	57.5 (55.4–59.5)	56.0 (54.2–57.9)	58.8 (56.5–61.1)	58.9 (55.5–62.3)	58.6 (55.5–61.7)	61.5 (58.7–64.5)	61.6 (59.0–64.2)	60.1 (56.7–63.4)	<.0001
Others	52.9 (51.3–54.5)	52.7 (37.7–67.7)	47.9 (40.7–55.0)	45.3 (34.5–56.1)	53.5 (44.8–62.3)	49.8 (40.3–59.2)	42.6 (37.6–47.6)	45.0 (41.2–48.9)	45.0 (42.0–48.0)	.11
Ratio of family income to poverty
Above poverty (≥1.0)	47.4 (45.7–49.2)	52.7 (48.9–56.5)	51.4 (49.0–53.9)	55.3 (52.5–58.0)	55.6 (52.5–58.7)	55.3 (52.8–57.9)	53.4 (51.9–55.0)	54.8 (52.5–57.2)	57.5 (56.1–58.9)	<.0001
Under poverty, <1.0	53.1 (50.5–55.8)	58.9 (52.4–65.4)	54.0 (48.7–59.3)	58.4 (52.9–64.0)	57.1 (52.2–61.9)	59.1 (53.4–64.8)	58.4 (55.2–61.7)	57.0 (53.0–61.0)	58.0 (54.5–61.6)	.001
Health insurance
Yes	48.1 (46.3–50.0)	54.2 (49.7–58.7)	52.9 (51.1–54.7)	57.0 (54.2–59.8)	57.5 (54.4–60.6)	56.6 (53.2–60.0)	54.6 (52.9–56.2)	55.5 (53.2–57.9)	58.7 (57.1–60.4)	<.0001
No	43.1 (38.3–47.8)	47.9 (40.7–55.1)	46.4 (38.5–54.3)	46.7 (40.0–53.3)	48.9 (44.9–53.0)	50.5 (46.4–54.7)	48.8 (44.1–53.4)	53.9 (50.0–57.7)	51.3 (47.7–54.9	<.0001
Education
≥High school	46.4 (44.7–48.2)	52.9 (48.6–57.2)	51.4 (49.3–53.6)	54.9 (52.4–57.4)	55.8 (52.8–58.9)	54.8 (51.8–57.9)	53.2 (51.7–54.7)	54.4 (52.0–56.7)	57.4 (56.1–58.8)	<.0001
<High school	52.5 (50.0–55.0)	54.4 (49.9–58.9)	53.8 (49.8–57.9)	58.2 (53.4–63.1)	56.1 (53.0–59.3)	57.6 (52.7–62.5)	55.5 (51.4–59.5)	60.3 (56.1–64.4)	57.1 (53.1–61.0)	.05

↵* Unweighted total number of subjects with 2 or more multimorbidities.
↵† Weighted overall prevalence of (95% confidence interval) 2 or more multimorbidities.
↵‡ P value from logistic regression analysis.
Chronic conditions included in determining multi-morbidity: cardiovascular disease, chronic obstructive pulmonary disease, chronic kidney disease, asthma, arthritis, cancer, stroke, hypertension, hyperlipidemia, diabetes, and obesity.

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Table 3.

Weighted Prevalence of 3 or More Multimorbidities for Participants Aged 20 Years or Older for National Health and Nutrition Examination Survey (NHANES) 1988–2014

NHANES	1988–1994 (n = 16573)	1999–2000 (n = 4222)	2001–2002 (n = 4792)	2003–2004 (n = 4742)	2005–2006 (n = 4481)	2007–2008 (n = 5660)	2009–2010 (n = 6011)	2011–2012 (n = 5281	2013–2014 (n = 5541)	P for trend^{^‡}
No. with 3 or more comorbidities^*	4975	1591	1678	1893	1705	2349	2366	1996	2202
Overall prevalence, %^{^†}	24.6 (23.2–25.9)	30.5 (27.5–33.5)	29.2 (26.8–31.6)	34.2 (31.5–36.9)	34.2 (31.5–36.9)	34.7 (32.1–37.4)	33.8 (31.9–35.8)	34.7 (31.3–38.1)	38.5 (36.3–40.6)	<.0001

↵* Unweighted total number of subjects with 3 or more multimorbidities.
↵† Weighted overall prevalence (95% confidence interval) of 3 or more multimorbidities.
↵‡ P value from logistic regression analysis.
Chronic conditions included in determining multimorbidity: cardiovascular disease, chronic obstructive pulmonary disease, chronic kidney disease, asthma, arthritis, cancer, stroke, hypertension, hyperlipidemia, diabetes, and obesity.

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Table 4.

Weighted Prevalence of 4 or More Multimorbidities for Participants Aged 20 Years or Older for National Health and Nutrition Examination Survey (NHANES) 1988–2014

NHANES	1988–1994 (n = 16573)	1999–2000 (n = 4222)	2001–2002 (n = 4792)	2003–2004 (n = 4742)	2005–2006 (n = 4481)	2007–2008 (n = 5660)	2009–2010 (n = 6011)	2011–2012 (n = 5281)	2013–2014 (n = 5541)	P for trend^{^‡}
No. with 4 or more comorbidities^*	2521	875	924	1092	964	1413	1398	1152	1321
Overall prevalence^{^†}	12.0 (11.1–12.9)	15.8 (13.7–17.8)	15.3 (13.2–17.3)	18.5 (16.2–20.9)	18.4 (16.4–20.4)	19.3 (17.0–21.6)	18.8 (17.2–20.4)	19.4 (17.0–21.8)	22.7 (21.1–24.3)	<.0001

↵* Unweighted total number of subjects with 4 or more multimorbidities.
↵† Weighted overall prevalence of (95% confidence interval) 4 or more multimorbidities.
↵‡ P value from logistic regression analysis.
Chronic conditions included in determining multi-morbidity: cardiovascular disease, chronic obstructive pulmonary disease, chronic kidney disease, asthma, arthritis, cancer, stroke, hypertension, hyperlipidemia, diabetes, and obesity.