Impact of multimorbidity on disability and quality of life in the Spanish older population

PLoS One. 2014 Nov 6;9(11):e111498. doi: 10.1371/journal.pone.0111498. eCollection 2014.


Background: Population aging is closely related to high prevalence of chronic conditions in developed countries. In this context, health care policies aim to increase life span cost-effectively while maintaining quality of life and functional ability. There is still, however, a need for further understanding of how chronic conditions affect these health aspects. The aim of this paper is to assess the individual and combined impact of chronic physical and mental conditions on quality of life and disability in Spain, and secondly to show gender trends.

Methods: Cross-sectional data were collected from the COURAGE study. A total of 3,625 participants over 50 years old from Spain were included. Crude and adjusted multiple linear regressions were conducted to detect associations between individual chronic conditions and disability, and between chronic conditions and quality of life. Separate models were used to assess the influence of the number of diseases on the same variables. Additional analogous regressions were performed for males and females.

Results: All chronic conditions except hypertension were statistically associated with poor results in quality of life and disability. Depression, anxiety and stroke were found to have the greatest impact on outcomes. The number of chronic conditions was associated with substantially lower quality of life [β for 4+ diseases: -18.10 (-20.95,-15.25)] and greater disability [β for 4+ diseases: 27.64 (24.99,30.29]. In general, women suffered from higher rates of multimorbidity and poorer results in quality of life and disability.

Conclusions: Chronic conditions impact greatly on quality of life and disability in the older Spanish population, especially when co-occurring diseases are added. Multimorbidity considerations should be a priority in the development of future health policies focused on quality of life and disability. Further studies would benefit from an expanded selection of diseases. Policies should also deal with gender idiosyncrasy in certain cases.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Chronic Disease / epidemiology*
  • Comorbidity
  • Cross-Sectional Studies
  • Disability Evaluation
  • Disabled Persons*
  • Female
  • Humans
  • Male
  • Mental Disorders / epidemiology*
  • Middle Aged
  • Quality of Life*
  • Spain
  • Stroke / epidemiology*

Grants and funding

The research leading to these results has received funding from the European Community's Seventh Framework Program (FP7/2007–2013) under grant agreement number 223071 (COURAGE in Europe) and the Spanish Ministry of Education, Culture and Sport (FPU12/05661). Additional support was provided by funds from the Instituto de Salud Carlos III-FIS research grant numbers PS09/00295 and PS09/01845, from the Spanish Ministry of Science and Innovation's ACIPromociona (ACI2009-1010). The study was supported by the Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III. This article is part of a PhD program developed in the Public Health Department of the Universitat de Barcelona, Spain. B.O. is grateful to the Sara Borrell postdoctoral program (reference CD12/00429) supported by the Instituto de Salud Carlos III, Spain. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.