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Open Access Research article

Overcoming cut-off restrictions in multimorbidity prevalence estimates

Barbara M Holzer14*, Klarissa Siebenhuener14, Matthias Bopp24 and Christoph E Minder3

Author Affiliations

1 Division of Internal Medicine, University Hospital Zurich, Zurich, Switzerland

2 Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland

3 Horten Center, University Hospital Zurich, Zurich, Switzerland

4 Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland

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BMC Public Health 2014, 14:780  doi:10.1186/1471-2458-14-780

Published: 1 August 2014



Presently, there is no consensus on how to define multimorbidity. In this paper we investigate the connection between prevalence estimates for two or more and three or more chronic conditions to improve comparability of multimorbidity studies with different cut-offs.


In a systematic review of the literature published between January, 1990 and December, 2011, we found 52 suitable studies, many providing prevalence estimates for several age groups. A total of 31 studies reported both the prevalence for multimorbidity based on two or more chronic conditions and three or more chronic conditions, which were analysed in this study. Our research question was whether there is a systematic interrelation between these two prevalence estimates, and how this could be used to improve the comparability of studies on the burden of multimorbidity.


Actually, we found a tight relationship between the prevalence of two or more and three or more chronic conditions. Moreover, each of these estimates can be predicted from the other. I.e. the cut-offs of two or three for the number of chronic conditions produce essentially the same information on prevalence.


Our study shows a way to enhance and improve the comparability of prevalence estimates from different multimorbidity studies.

Comorbidity; Multimorbidity; Definition; Operationalization; Multiple chronic conditions; Systematic review