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Age Ageing. 2016 May;45(3):431-5. doi: 10.1093/ageing/afw044. Epub 2016 Mar 24.

Associations between multimorbidity, healthcare utilisation and health status: evidence from 16 European countries.

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Primary Care and Public Health, Imperial College of London, London W6 8RP, UK.
Primary Care and Public Health, Imperial College of London, London W6 8RP, UK Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
Primary Care and Public Health Sciences, King's College, London, UK.
Department of Public Health, 'Federico II' University of Naples, Naples, Italy.



with ageing populations and increasing exposure to risk factors for chronic diseases, the prevalence of chronic disease multimorbidity is rising globally. There is little evidence on the determinants of multimorbidity and its impact on healthcare utilisation and health status in Europe.


we used cross-sectional data from the Survey of Health, Ageing and Retirement in Europe (SHARE) in 2011-12, which included nationally representative samples of persons aged 50 and older from 16 European nations. Negative binomial and logistic regression models were used to assess the association between number of chronic diseases and healthcare utilisation, self-perceived health, depression and reduction of functional capacity.


overall, 37.3% of participants reported multimorbidity; the lowest prevalence was in Switzerland (24.7%), the highest in Hungary (51.0%). The likelihood of having multimorbidity increased substantially with age. Number of chronic conditions was associated with greater healthcare utilisation in both primary (regression coefficient for medical doctor visits = 0.29, 95% CI = 0.27-0.30) and secondary setting (adjusted odds ratio (AOR) for having any hospitalisation in the last year = 1.49, 95% CI = 1.42-1.55) in all countries analysed. Number of chronic diseases was associated with fair/poor health status (AOR 2.13, 95% CI = 2.03-2.24), being depressed (AOR 1.48, 95% CI = 1.42-1.54) and reduced functional capacity (AOR 2.12, 95% CI = 2.02-2.22).


multimorbidity is associated with greater healthcare utilisation, worse self-reported health status, depression and reduced functional capacity in European countries. European health systems should prioritise improving the management of patients with multimorbidity to improve their health status and increase healthcare efficiency.


chronic disease; health status; healthcare utilisation; multimorbidity; older people

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