Open Access Research article

Multimorbidity and comorbidity in the Dutch population – data from general practices

Sandra H van Oostrom1*, H Susan J Picavet1, Boukje M van Gelder1, Lidwien C Lemmens1, Nancy Hoeymans2, Christel E van Dijk3, Robert A Verheij3, François G Schellevis34 and Caroline A Baan1

Author Affiliations

1 Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven 3720 BA, the Netherlands

2 Centre for Public Health Forecasting, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, the Netherlands

3 Department of General Practice, Netherlands Institute for Health Services Research, P.O. Box 1568, Utrecht, 3500 BN, the Netherlands

4 Department of General Practice/EMGO Institute, VU University Medical Centre, Amsterdam, the Netherlands

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BMC Public Health 2012, 12:715  doi:10.1186/1471-2458-12-715

Published: 30 August 2012



Multimorbidity is increasingly recognized as a major public health challenge of modern societies. However, knowledge about the size of the population suffering from multimorbidity and the type of multimorbidity is scarce. The objective of this study was to present an overview of the prevalence of multimorbidity and comorbidity of chronic diseases in the Dutch population and to explore disease clustering and common comorbidities.


We used 7 years data (2002–2008) of a large Dutch representative network of general practices (212,902 patients). Multimorbidity was defined as having two or more out of 29 chronic diseases. The prevalence of multimorbidity was calculated for the total population and by sex and age group. For 10 prevalent diseases among patients of 55 years and older (N = 52,014) logistic regressions analyses were used to study disease clustering and descriptive analyses to explore common comorbid diseases.


Multimorbidity of chronic diseases was found among 13% of the Dutch population and in 37% of those older than 55 years. Among patients over 55 years with a specific chronic disease more than two-thirds also had one or more other chronic diseases. Most disease pairs occurred more frequently than would be expected if diseases had been independent. Comorbidity was not limited to specific combinations of diseases; about 70% of those with a disease had one or more extra chronic diseases recorded which were not included in the top five of most common diseases.


Multimorbidity is common at all ages though increasing with age, with over two-thirds of those with chronic diseases and aged 55 years and older being recorded with multimorbidity. Comorbidity encompassed many different combinations of chronic diseases. Given the ageing population, multimorbidity and its consequences should be taken into account in the organization of care in order to avoid fragmented care, in medical research and healthcare policy.

Multimorbidity; Comorbidity; Chronic disease; Epidemiology; Prevalence