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Managing multiple comorbidities

Heather E Whitson, MD, MHS
Cynthia M Boyd, MD, MPH
Section Editor
Kenneth E Schmader, MD
Deputy Editor
H Nancy Sokol, MD


Multimorbidity, or multiple comorbidity, or multiple chronic conditions, is common and greatly increases the complexity of managing disease in patients. In developed nations, about one in four adults have at least two chronic conditions [1-3], and more than half of older adults have three or more chronic conditions [4]. As worldwide mortality declines, people are living longer with disability and multiple comorbidities, with important implications for global healthcare needs [5].

This topic will discuss the particular challenges posed by managing patients with multiple comorbidities and present strategies to maximize effective care for such patients.


Multimorbidity refers to the co-occurrence of two or more medical or psychiatric conditions, which may or may not directly interact with each other within the same individual [2,6,7]. The term "multimorbidity" is sometimes used interchangeably with comorbidity [8], but comorbidity technically indicates a condition or conditions that coexist in the context of an index disease [9]. As an example, an oncologist may be concerned with the effect of comorbidity on the management of lung cancer, whereas multimorbidity captures the general complexity of patients without focusing on any single disease [10,11].

"Multiple chronic conditions" (MCC) is a term closely related to multimorbidity. Several initiatives in the United States use this term in targeting a population for improving outcomes and care quality. The National Quality Forum defines MCC as "two or more chronic conditions that collectively have an adverse effect on health status, function, or quality of life and that require complex healthcare management, decision-making, or coordination" [12]. This concept recognizes the marked heterogeneity within the large population of individuals with two or more chronic conditions. Hypertension and hypothyroidism, for example, do not generally encompass the same complexity or health needs as heart failure and dementia. Therefore, it can be beneficial to identify a subset of people with multiple chronic conditions that is in particular need of a different paradigm for care. Hereafter, we refer to the more basic definition of multimorbidity as two or more conditions, but recognize that more nuanced definitions may better target interventions towards specific populations that need them.


Although exact prevalence estimates depend on the type and number of conditions considered in the definition of multimorbidity [13,14], most experts agree that more than one in four Americans have at least two chronic conditions [1,2]. Similarly, a study in Scotland found multimorbidity in 23 percent of the 1.75 million people included in a database from over 300 medical practices [3].


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