{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T19:14:52Z","timestamp":1791054892973,"version":"4.1.0"},"reference-count":39,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2021,10,4]],"date-time":"2021-10-04T00:00:00Z","timestamp":1633305600000},"content-version":"unspecified","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003510","name":"Estonian Ministry of Education and Research","doi-asserted-by":"crossref","award":["IUT34-17"],"award-info":[{"award-number":["IUT34-17"]}],"id":[{"id":"10.13039\/501100003510","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,9,20]]},"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Prevalence estimates for specific chronic conditions and multimorbidity (MM) in eastern Europe are scarce. This national study estimates the prevalence of MM by age group and sex in Estonia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>A population-based cross-sectional study, using administrative data.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Data were collected on 55 chronic conditions from the Estonian Health Insurance Fund from 2015 to 2017. MM was defined as the coexistence of two or more conditions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>The Estonian Health Insurance Fund includes data for approximately 95% of the Estonian population receiving public health insurance.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Primary and secondary outcome measures<\/jats:title>\n                  <jats:p>Prevalence and 95% CIs for MM stratified by age group and sex.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Nearly half (49.1%) of the individuals (95%\u2009CI 49.0 to 49.3) had at least 1 chronic condition, and 30.1% (95% CI 30.0 to 30.2) had MM (2 or more chronic conditions). The number of conditions and the prevalence of MM increased with age, ranging from an MM prevalence of 3.5% (3.5%\u20133.6%) in the youngest (0\u201324 years) to as high as 80.4% (79.4%\u201381.3%) in the oldest (\u226585 years) age group. Half of all individuals had MM by 60 years of age, and 75% of the population had MM by 75 years of age. Women had a higher prevalence of MM (34.9%, 95%\u2009CI 34.7 to 35.0) than men (24.4%, 95%\u2009CI 24.3 to 24.5). Hypertension was the most frequent chronic condition (24.5%), followed by chronic pain (12.4%) and arthritis (7.7%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Hypertension is an important chronic condition amenable to treatment with lifestyle and therapeutic interventions. Given the established correlation between uncontrolled hypertension and exacerbation of other cardiovascular conditions as well as acute illnesses, this most common condition within the context of MM may be suitable for targeted public health interventions.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-049045","type":"journal-article","created":{"date-parts":[[2021,10,5]],"date-time":"2021-10-05T18:49:50Z","timestamp":1633459790000},"page":"e049045","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["Prevalence of chronic conditions and multimorbidity in Estonia: a population-based cross-sectional study"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4487-7045","authenticated-orcid":false,"given":"Mikk","family":"J\u00fcrisson","sequence":"first","affiliation":[{"name":"Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heti","family":"Pisarev","sequence":"additional","affiliation":[{"name":"Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4036-3856","authenticated-orcid":false,"given":"Anneli","family":"Uusk\u00fcla","sequence":"additional","affiliation":[{"name":"Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrin","family":"Lang","sequence":"additional","affiliation":[{"name":"Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Oona","sequence":"additional","affiliation":[{"name":"Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Kalda","sequence":"additional","affiliation":[{"name":"Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,10,5]]},"reference":[{"key":"2025101811565272000_11.10.e049045.1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(12)60240-2"},{"key":"2025101811565272000_11.10.e049045.2","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1093\/ageing\/afx201","article-title":"Projections of multi-morbidity in the older population in England to 2035: estimates from the population ageing and care simulation (PACSim) model","volume":"47","author":"Kingston","year":"2018","journal-title":"Age Ageing"},{"key":"2025101811565272000_11.10.e049045.3","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0160264","article-title":"Time trends in prevalence of chronic diseases and multimorbidity not only due to aging: data from general practices and health surveys","volume":"11","author":"van Oostrom","year":"2016","journal-title":"PLoS One"},{"key":"2025101811565272000_11.10.e049045.4","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-015-0698-2","article-title":"Multimorbidity, health care utilization and costs in an elderly community-dwelling population: a claims data based observational study","volume":"15","author":"B\u00e4hler","year":"2015","journal-title":"BMC Health Serv Res"},{"key":"2025101811565272000_11.10.e049045.5","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2296-15-1"},{"key":"2025101811565272000_11.10.e049045.6","first-page":"16","article-title":"Healthcare use in patients with multimorbidity","volume":"30","author":"Quinaz Romana","year":"2020","journal-title":"Eur J Public Health"},{"key":"2025101811565272000_11.10.e049045.7","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.eurger.2016.11.010","article-title":"Disparities in multimorbidity across Europe\u00a0\u2013\u00a0Findings from the SHARE Survey","volume":"8","author":"Nielsen","year":"2017","journal-title":"Eur Geriatr Med"},{"key":"2025101811565272000_11.10.e049045.8","doi-asserted-by":"crossref","DOI":"10.4178\/epih.e2020001","article-title":"Socio-Demographic and lifestyle factors associated with multimorbidity in New Zealand","volume":"42","author":"Aminisani","year":"2020","journal-title":"Epidemiol Health"},{"key":"2025101811565272000_11.10.e049045.9","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-031649","article-title":"Journey to multimorbidity: longitudinal analysis exploring cardiovascular risk factors and sociodemographic determinants in an urban setting","volume":"9","author":"Ashworth","year":"2019","journal-title":"BMJ Open"},{"key":"2025101811565272000_11.10.e049045.10","first-page":"10s","article-title":"Multimorbidity: the Brazilian longitudinal study of aging (ELSI-Brazil)","volume":"52 Suppl 2","author":"Nunes","year":"2018","journal-title":"Rev Saude Publica"},{"key":"2025101811565272000_11.10.e049045.11","doi-asserted-by":"crossref","unstructured":"Flores T , Rodrigues AP , Neves R . The risk of multimorbidity associated with overweight and obesity: data from the Brazilian National health survey 2013. J Obes Metab Syndr 2021;30.","DOI":"10.7570\/jomes20110"},{"key":"2025101811565272000_11.10.e049045.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2015.02.012"},{"key":"2025101811565272000_11.10.e049045.13","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39201.463819.2C"},{"key":"2025101811565272000_11.10.e049045.14","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-037079","article-title":"Critical review of multimorbidity outcome measures suitable for low-income and middle-income country settings: perspectives from the global alliance for chronic diseases (GACD) researchers","volume":"10","author":"Hurst","year":"2020","journal-title":"BMJ Open"},{"key":"2025101811565272000_11.10.e049045.15","doi-asserted-by":"crossref","unstructured":"Atun R , Gurol\u2013Urganci I , Hone T , et al . Shifting chronic disease management from hospitals to primary care in Estonian health system: analysis of national panel data. J Glob Health 2016;6.doi:10.7189\/jogh.06.020701","DOI":"10.7189\/jogh.06.020701"},{"key":"2025101811565272000_11.10.e049045.16","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1016\/j.dsx.2020.06.003","article-title":"Multimorbidity and SARS-CoV-2 infection in UK Biobank","volume":"14","author":"Chudasama","year":"2020","journal-title":"Diabetes Metab Syndr"},{"key":"2025101811565272000_11.10.e049045.17","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1159\/000513288","article-title":"The association between presence of comorbidities and COVID-19 severity: a systematic review and meta-analysis","volume":"50","author":"Honardoost","year":"2021","journal-title":"Cerebrovasc Dis"},{"key":"2025101811565272000_11.10.e049045.18","first-page":"1","article-title":"A systematic review and meta-analysis of geographic differences in comorbidities and associated severity and mortality among individuals with COVID-19","volume":"111","author":"Thakur","year":"2021","journal-title":"Sci Reports"},{"key":"2025101811565272000_11.10.e049045.19","doi-asserted-by":"crossref","first-page":"e1003","DOI":"10.1016\/S2214-109X(20)30264-3","article-title":"Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study","volume":"8","author":"Clark","year":"2020","journal-title":"Lancet Glob Health"},{"key":"2025101811565272000_11.10.e049045.20","doi-asserted-by":"publisher","DOI":"10.26633\/RPSP.2020.166"},{"key":"2025101811565272000_11.10.e049045.21","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-033445","article-title":"Priorities of patients with multimorbidity and of clinicians regarding treatment and health outcomes: a systematic mixed studies review","volume":"10","author":"Sathanapally","year":"2020","journal-title":"BMJ Open"},{"key":"2025101811565272000_11.10.e049045.22","doi-asserted-by":"crossref","first-page":"2235042X1987093","DOI":"10.1177\/2235042X19870934","article-title":"Prevalence of multimorbidity in community settings: a systematic review and meta-analysis of observational studies","volume":"9","author":"Nguyen","year":"2019","journal-title":"J Comorb"},{"key":"2025101811565272000_11.10.e049045.23","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31891-9"},{"key":"2025101811565272000_11.10.e049045.24","unstructured":"TE75: Disability Free Life Expectancy by Sex and Age Group . Health Statistics and Health Research Database, National Institute of Health Development, Tallinn, Estonia, 2020. Available: https:\/\/statistika.tai.ee\/index_en.html"},{"key":"2025101811565272000_11.10.e049045.25","unstructured":"Estonian Health Insurance Fund . Estonian health care system, 2021. Available: https:\/\/www.haigekassa.ee\/en\/people\/health-care-services\/estonian-health-care-system"},{"key":"2025101811565272000_11.10.e049045.26","unstructured":"Lai T , Knai C . Assessing chronic disease management in European health systems: Country reports: Estonia. In: Nolte E , Knai C , eds. Assessing chronic disease management in European health systems: Country reports. Copenhagen: World Health Organization, 2015: 37\u201342."},{"key":"2025101811565272000_11.10.e049045.27","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1080\/13814788.2018.1429594","article-title":"Challenges for clinical practice and research in family medicine in reducing the risk of chronic diseases. notes on the EGPRN spring conference 2017 in Riga","volume":"24","author":"Silina","year":"2018","journal-title":"Eur J Gen Pract"},{"key":"2025101811565272000_11.10.e049045.28","unstructured":"Eesti Haigekassa . Estonian health insurance fund. Annu. Rep, 2017. Available: https:\/\/www.haigekassa.ee\/"},{"key":"2025101811565272000_11.10.e049045.29","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-11-101"},{"key":"2025101811565272000_11.10.e049045.30","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0015941","article-title":"Multimorbidity patterns in the elderly: a new approach of disease clustering identifies complex interrelations between chronic conditions","volume":"5","author":"Sch\u00e4fer","year":"2010","journal-title":"PLoS One"},{"key":"2025101811565272000_11.10.e049045.31","unstructured":"Statistics Estonia . PO021: population, 1 January by sex, year and age group, 2017. Available: https:\/\/www.stat.ee\/database"},{"key":"2025101811565272000_11.10.e049045.32","doi-asserted-by":"crossref","first-page":"845","DOI":"10.17269\/s41997-018-0103-0","article-title":"Beyond the grey tsunami: a cross-sectional population-based study of multimorbidity in Ontario","volume":"109","author":"Ryan","year":"2018","journal-title":"Can J Public Health"},{"key":"2025101811565272000_11.10.e049045.33","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2016-012812","article-title":"Burden of multimorbidity in relation to age, gender and immigrant status: a cross-sectional study based on administrative data","volume":"6","author":"Lenzi","year":"2016","journal-title":"BMJ Open"},{"key":"2025101811565272000_11.10.e049045.34","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-019-6576-9"},{"key":"2025101811565272000_11.10.e049045.35","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/j.healthpol.2018.03.003","article-title":"Does multimorbidity still remain a matter of the elderly: Lithuanian national data analysis","volume":"122","author":"Jurevicien\u0117","year":"2018","journal-title":"Health Policy"},{"key":"2025101811565272000_11.10.e049045.36","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.ejim.2015.02.015","article-title":"Prevalence and structure of multiple chronic conditions in Lithuanian population and the distribution of the associated healthcare resources","volume":"26","author":"Navickas","year":"2015","journal-title":"Eur J Intern Med"},{"key":"2025101811565272000_11.10.e049045.37","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glq208"},{"key":"2025101811565272000_11.10.e049045.38","doi-asserted-by":"publisher","DOI":"10.1370\/afm.1337"},{"key":"2025101811565272000_11.10.e049045.39","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s41927-019-0074-7","article-title":"Administrative database as a source for assessment of systemic lupus erythematosus prevalence: Estonian experience","volume":"3","author":"Otsa","year":"2019","journal-title":"BMC Rheumatol"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2021-049045","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T18:57:00Z","timestamp":1760813820000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2021-049045"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10]]},"references-count":39,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,10,5]]},"published-print":{"date-parts":[[2021,10]]}},"alternative-id":["10.1136\/bmjopen-2021-049045"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2021-049045","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10]]}}}