Original ResearchAssociation between body mass index and prevalence of multimorbidity: a cross-sectional study
Introduction
Patients with chronic diseases, especially the elderly, often face multimorbidity, defined as the simultaneous presence of two or more chronic diseases.1, 2, 3 It is well documented that multiple chronic diseases are associated with impaired quality of life, risk of functional limitations,4 difficulties in treatment delivery,4 and increased need for healthcare services.5 A recent review from Scotland revealed that there were more people with multimorbidity than with a single chronic disease,6 indicating that multimorbidity is becoming the norm rather than the exception.6, 7 This is supported by findings which indicate that the prevalence of multimorbidity worldwide has risen substantially in recent decades.5 International estimates suggest that this trend will continue to rise in the coming years.8 The proportion of adults with a body mass index (BMI) ≥25 kg/m2 has also been increasing globally over the last three decades, affecting 36.9% of men and 38.0% of women in a study conducted in 2013.9 It has been determined that increased BMI is a major risk factor for a range of chronic diseases, including cardiovascular diseases, diabetes, musculoskeletal disorders and some cancers.10, 11 The determinants of multimorbidity continue to be studied. Factors that have been found to be associated with increased risk of multimorbidity include age, female sex, lower socio-economic status, lower education, unemployment and smoking.1, 4 The role of obesity as a risk factor for multimorbidity has been evaluated recently by various studies.12, 13, 14, 15
Serbia, like many other countries, is suffering from increasing prevalence of certain chronic diseases, in addition to increasing rates of obesity.16, 17 Several studies have contributed significantly to a better understanding of the overall disease burden and the subsection of this disease burden that is attributable to avoidable risk factors in Serbia.18, 19 However, information on the association between BMI and multimorbidity is still lacking.
Therefore, this study aimed to explore the prevalence of multimorbidity in Serbia according to sex and BMI categories, and to examine the association between BMI and multimorbidity. In addition, this study examined the relationships between the main demographic and socio-economic characteristics of the population (age, settlement, education) and multimorbidity.
Section snippets
Study design and participants
This study is a secondary data analysis of the 2013 National Health Survey (NHS 2013) undertaken by the Ministry of Health of Serbia and the Institute of Public Health of Serbia. People living in collective households and/or institutions, and residents of Kosovo and Metohija (under the United Nations Mission) were not included in the survey.
In order to provide statistically reliable estimates for this survey at national level, a two-staged representative sample of the Serbian population was
Results
The baseline characteristics of the study population are listed in Table 1. There were slightly more women (52.5%) than men (47.5%) in the study. Compared with men, women were significantly older, less educated, urban dwellers and were more frequently of normal weight, with lower mean BMI. However, women had a higher mean number of chronic diseases and more frequently suffered from two or more diseases compared with men. The overall prevalence of multimorbidity was higher than the overall
Discussion
Multimorbidity was present in almost three out of 10 respondents, and was more common than a single chronic disease in both sexes. The prevalence of multimorbidity increased substantially with BMI. Age was independently associated with multimorbidity in both sexes, and low and middle educational level was independently associated with multimorbidity in females.
Numerous studies regarding the prevalence of multimorbidity have been conducted in Europe, the Middle East, Australia, the USA and
Acknowledgements
The authors acknowledge the Ministry of Health of the Republic of Serbia, because the study is part of NHS 2013 for the population of Serbia conducted by the Ministry of Health of the Republic of Serbia and Institute of Public Health of Serbia ‘Dr Milan Jovanovic Batut.’ Data were obtained from NHS 2013 with agreement of the Institute of Public Health of Serbia and Ministry of Health of the Republic of Serbia.
Ethical approval
Ethical approval was received from the Review Board of the Ministry of Health of
References (44)
- et al.
Problems in determining occurrence rates of multimorbidity
J Clin Epidemiol
(2001) - et al.
Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study
Lancet
(2012) - et al.
Epidemiology of multimorbidity in China and implications for the healthcare system: cross-sectional survey among 162,464 community household residents in southern China
BMC Med
(2014) - et al.
Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013
Lancet
(2014) - et al.
Multimorbidity patterns: a systematic review
J Clin Epidemiol
(2014) - et al.
Aging with multimorbidity: a systematic review of the literature
Ageing Res Rev
(2011) - et al.
Providing better care at lower cost for multimorbid patients
Health Int
(2011) - et al.
Comorbidity or multimorbidity: what's in a name? A review of literature
Eur J Gen Pract
(1996) - et al.
Trajectories of multimorbidity: exploring patterns of multimorbidity in patients with more than ten chronic health problems in life course
BMC Fam Pract
(2015) In this issue: challenges of managing multimorbidity
Ann Fam Med
(2012)
Long-term conditions compendium of information
The impact of obesity
Multimorbidity prevalence in the general population: the role of obesity in chronic disease clustering
BMC Public Health
Impact of body mass index on prevalence of multimorbidity in primary care: cohort study
Fam Pract
Chronic disease burden associated with overweight and obesity in Ireland: the effects of a small BMI reduction at population level
BMC Public Health
Aging, obesity, and multimorbidity in women 50 years or older: a population-based study
Menopause
National Health Survey Serbia 2006 – key findings
Rezultati istraživanja zdravlja stanovnika Srbije 2013
The burden of disease and injury in Serbia
Eur J Public Health
The burden of disease preventable by risk factor reduction in Serbia
Vojnosanit Pregl
Cited by (33)
Leading determinants for multimorbidity in middle-aged Australian men and women: A nine-year follow-up cohort study
2020, Preventive MedicineCitation Excerpt :A significant finding of our study is that the leading predictor for multimorbidity in women was a modifiable factor BMI whereas BMI was the second leading predictor in men. Previous studies in high-income countries have reported that multimorbidity prevalence increases with increased BMI (Fortin et al., 2014; Jovic et al., 2016; Booth et al., 2014). A longitudinal study has demonstrated that obesity and overweight were both associated with higher risks of heart disease, stroke, and diabetes multimorbidity (Xu et al., 2018).
Association of Lifestyle Factors with Multimorbidity Risk in China: A National Representative Study
2024, Applied Research in Quality of LifeThe prevalence and social determinants of multimorbidity in South Africa
2023, World Medical and Health Policy