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The influence of age, gender and socio-economic status on multimorbidity patterns in primary care. first results from the multicare cohort study

Ingmar Schäfer1*, Heike Hansen1, Gerhard Schön2, Susanne Höfels3, Attila Altiner4, Anne Dahlhaus5, Jochen Gensichen6, Steffi Riedel-Heller7, Siegfried Weyerer8, Wolfgang A Blank9, Hans-Helmut König10, Olaf von dem Knesebeck10, Karl Wegscheider2, Martin Scherer1, Hendrik van den Bussche1 and Birgitt Wiese11

Author Affiliations

1 Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany

2 Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany

3 Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn, Germany

4 Department of General Practice, Medical Faculty, University of Rostock, 18055 Rostock, Germany

5 Institute for General Practice, University of Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany

6 Institute for General Practice, University of Jena, Bachstraße 18, 07743 Jena, Germany

7 Institute for Social Medicine, Occupational Health and Public Health, University of Leipzig, Semmelweisstr. 10, 04103 Leipzig, Germany

8 Central Institute of Mental Health, J 5, 68159 Mannheim, Germany

9 Institute of General Practice, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany

10 Department of Medical Sociology and Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany

11 Institute for Biometry, Hannover Medical School, 30623 Hannover, Germany

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BMC Health Services Research 2012, 12:89  doi:10.1186/1472-6963-12-89

Published: 3 April 2012



Multimorbidity is a phenomenon with high burden and high prevalence in the elderly. Our previous research has shown that multimorbidity can be divided into the multimorbidity patterns of 1) anxiety, depression, somatoform disorders (ADS) and pain, and 2) cardiovascular and metabolic disorders. However, it is not yet known, how these patterns are influenced by patient characteristics. The objective of this paper is to analyze the association of socio-demographic variables, and especially socio-economic status with multimorbidity in general and with each multimorbidity pattern.


The MultiCare Cohort Study is a multicentre, prospective, observational cohort study of 3.189 multimorbid patients aged 65+ randomly selected from 158 GP practices. Data were collected in GP interviews and comprehensive patient interviews. Missing values have been imputed by hot deck imputation based on Gower distance in morbidity and other variables. The association of patient characteristics with the number of chronic conditions is analysed by multilevel mixed-effects linear regression analyses.


Multimorbidity in general is associated with age (+0.07 chronic conditions per year), gender (-0.27 conditions for female), education (-0.26 conditions for medium and -0.29 conditions for high level vs. low level) and income (-0.27 conditions per logarithmic unit). The pattern of cardiovascular and metabolic disorders shows comparable associations with a higher coefficient for gender (-1.29 conditions for female), while multimorbidity within the pattern of ADS and pain correlates with gender (+0.79 conditions for female), but not with age or socioeconomic status.


Our study confirms that the morbidity load of multimorbid patients is associated with age, gender and the socioeconomic status of the patients, but there were no effects of living arrangements and marital status. We could also show that the influence of patient characteristics is dependent on the multimorbidity pattern concerned, i.e. there seem to be at least two types of elderly multimorbid patients. First, there are patients with mainly cardiovascular and metabolic disorders, who are more often male, have an older age and a lower socio-economic status. Second, there are patients mainly with ADS and pain-related morbidity, who are more often female and equally distributed across age and socio-economic groups.

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