Assessing and Measuring Chronic Multimorbidity in the Older Population: A Proposal for Its Operationalization

J Gerontol A Biol Sci Med Sci. 2017 Oct 1;72(10):1417-1423. doi: 10.1093/gerona/glw233.


Background: Although the definition of multimorbidity as "the simultaneous presence of two or more chronic diseases" is well established, its operationalization is not yet agreed. This study aims to provide a clinically driven comprehensive list of chronic conditions to be included when measuring multimorbidity.

Methods: Based on a consensus definition of chronic disease, all four-digit level codes from the International Classification of Diseases, 10th revision (ICD-10) were classified as chronic or not by an international and multidisciplinary team. Chronic ICD-10 codes were subsequently grouped into broader categories according to clinical criteria. Last, we showed proof of concept by applying the classification to older adults from the Swedish National study of Aging and Care in Kungsholmen (SNAC-K) using also inpatient data from the Swedish National Patient Register.

Results: A disease or condition was considered to be chronic if it had a prolonged duration and either (a) left residual disability or worsening quality of life or (b) required a long period of care, treatment, or rehabilitation. After applying this definition in relation to populations of older adults, 918 chronic ICD-10 codes were identified and grouped into 60 chronic disease categories. In SNAC-K, 88.6% had ≥2 of these 60 disease categories, 73.2% had ≥3, and 55.8% had ≥4.

Conclusions: This operational measure of multimorbidity, which can be implemented using either or both clinical and administrative data, may facilitate its monitoring and international comparison. Once validated, it may enable the advancement and evolution of conceptual and theoretical aspects of multimorbidity that will eventually lead to better care.

Keywords: Chronic disease; Epidemiology; International Classification of Diseases.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Chronic Disease / classification*
  • Chronic Disease / epidemiology*
  • Comorbidity / trends*
  • Female
  • Humans
  • International Classification of Diseases
  • Male
  • Middle Aged
  • Sweden