Early dynamics of multimorbidity in 17.4 million people in Spain: onset patterns and prognostic value

Multimorbidity, the coexistence of two or more chronic diseases, has become a defining challenge for ageing societies. Yet evidence on when and how chronic diseases begin to cluster, and on the prognostic importance of this timing, remains limited. We used nationwide primary care electronic health records covering 17.4 million people in Spain to reconstruct the onset and progression of chronic disease over the life course. The first recorded diagnosis was used to trace temporal trajectories of multimorbidity by age and sex. We examined how the first condition, age at diagnosis, and time since that diagnosis were associated with advanced (≥3 diseases), multisystem (≥2 organ systems), and complex multimorbidity (≥3 organ systems), as well as premature mortality (<50 and <65 years) and outcomes related to polypharmacy and high-risk prescribing, using multivariable regression and gradient boosting models. By 2021, more than one in three Spaniards lived with a chronic condition, and over half of adults aged 45 years or older had multimorbidity. Among them, nearly 60% had complex multimorbidity. The time elapsed since the first diagnosis showed the closest link to further accumulation, followed by age at first diagnosis and current age. Later onset, particularly after the mid-50s, was associated with faster decline once disease emerged. The timing of the first chronic condition is a powerful but often overlooked prognostic marker. Public health strategies delaying onset and integrating early management could substantially reduce the long-term burden of multimorbidity in European populations.

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Publication Details

Journal
European Journal of Public Health
Published
2026-04-11
DOI
https://doi.org/10.1093/eurpub/ckag067
Primary Topic
Chronic Disease Management Strategies
Type
article
Field-Weighted Citation Impact
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article

Early dynamics of multimorbidity in 17.4 million people in Spain: onset patterns and prognostic value

Ramón Orueta‐Sánchez, Miguel Ángel Hernández Rodríguez, Antonio Gimeno‐Miguel, Mercedes Aza‐Pascual‐Salcedo et al.
European Journal of Public Health
Chronic Disease Management Strategies
article

Early dynamics of multimorbidity in 17.4 million people in Spain: onset patterns and prognostic value

Ramón Orueta‐Sánchez, Miguel Ángel Hernández Rodríguez, Antonio Gimeno‐Miguel, Mercedes Aza‐Pascual‐Salcedo, Sallie‐Anne Pearson, Vicente Palop‐Larrea, Jorge Vicente Romero, María Pilar Arroyo‐Aniés, Francisca González‐Rubio, Óscar Esteban‐Jiménez, Carmen Gómez‐Vaquero, Caterina Vicens, Ermengol Sempere‐Verdú, Ignatios Ioakeim‐Skoufa, Pilar Marín-Murillo, Isabel Barrio-Díez, Clara Laguna-Berna
article en

Abstract

Multimorbidity, the coexistence of two or more chronic diseases, has become a defining challenge for ageing societies. Yet evidence on when and how chronic diseases begin to cluster, and on the prognostic importance of this timing, remains limited. We used nationwide primary care electronic health records covering 17.4 million people in Spain to reconstruct the onset and progression of chronic disease over the life course. The first recorded diagnosis was used to trace temporal trajectories of multimorbidity by age and sex. We examined how the first condition, age at diagnosis, and time since that diagnosis were associated with advanced (≥3 diseases), multisystem (≥2 organ systems), and complex multimorbidity (≥3 organ systems), as well as premature mortality (<50 and <65 years) and outcomes related to polypharmacy and high-risk prescribing, using multivariable regression and gradient boosting models. By 2021, more than one in three Spaniards lived with a chronic condition, and over half of adults aged 45 years or older had multimorbidity. Among them, nearly 60% had complex multimorbidity. The time elapsed since the first diagnosis showed the closest link to further accumulation, followed by age at first diagnosis and current age. Later onset, particularly after the mid-50s, was associated with faster decline once disease emerged. The timing of the first chronic condition is a powerful but often overlooked prognostic marker. Public health strategies delaying onset and integrating early management could substantially reduce the long-term burden of multimorbidity in European populations.

European Journal of Public HealthVol. 36(3)
The University of Sydney (AU), Norwegian Institute of Public Health (NO), Universidad de Zaragoza (ES), Bellvitge University Hospital (ES), Servei de Salut de les Illes Balears (ES), Conselleria de Sanitat Universal i Salut Pública (ES), Servicio Aragonés de Salud (ES), Red de Investigación en Actividades Preventivas y Promoción de la Salud (ES), Sociedad Española de Medicina de Familia y Comunitaria (ES), Observatorio de la Inmigración de Tenerife (ES), Health Research Institute of the Balearic Islands (ES), Primary Health Care (QA), Instituto de Investigación Sanitaria Aragón (ES), Instituto de Salud Musculoesquelética (ES), Universitat de Barcelona (ES)
European Commission, Ministerio de Ciencia e Innovación, Gobierno de Aragón
Good health and well-being
Openalex Percentile: Top 8%
Chronic Disease Management Strategies
DOIOpen Access PDFOpenAlex
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