{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:51:24Z","timestamp":1760151084101,"version":"build-2065373602"},"reference-count":36,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,2,20]],"date-time":"2022-02-20T00:00:00Z","timestamp":1645315200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BioMed"],"abstract":"<jats:p>Multimorbid patients represent a special population of vulnerable individuals who suffer from two or more long-term conditions. They are a very prevalent group with an increased risk of death from COVID-19. The present study aimed to identify the sociodemographic and clinical determinants of multimorbidity of underlying conditions that increase the risk of severe COVID-19 in chronic adult individuals by analyzing data from the Portuguese National Health Survey 2019. The inclusion sample consisted of 7859 adult residents in Portugal who had at least one chronic condition. The health conditions considered for multimorbidity were CKD, COPD, heart conditions, diabetes mellitus, obesity, and smoking. In Portugal, approximately 6 out of every 10 individuals with chronic diseases suffer from one or more conditions that are on the list of those at increased risk of severe COVID-19 disease, and approximately 2 out of every 10 individuals have multimorbidity. Obesity and diabetes are the most frequent risk factors. Timely interventions (e.g., regular medical follow-up for preventive health services and health information) targeting multimorbidity in males and individuals with low educational levels, a poor health status, and low functionality may help to reduce the risk of severe COVID-19 and post-COVID-19 sequelae, and to improve health in a large proportion of the population.<\/jats:p>","DOI":"10.3390\/biomed2010010","type":"journal-article","created":{"date-parts":[[2022,2,21]],"date-time":"2022-02-21T08:14:46Z","timestamp":1645431286000},"page":"94-103","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Sociodemographic and Clinical Determinants of Multimorbidity of Underlying Conditions That Increase the Risk of Severe Illness from COVID-19 in Chronic Adult Individuals"],"prefix":"10.3390","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2849-5194","authenticated-orcid":false,"given":"Filipe","family":"Prazeres","sequence":"first","affiliation":[{"name":"Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilh\u00e3, Portugal"},{"name":"Family Health Unit Beira Ria, 3830-596 Gafanha da Nazar\u00e9, Portugal"},{"name":"Centre for Health Technology and Services Research (CINTESIS), University of Porto, 4200-450 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1312-0154","authenticated-orcid":false,"given":"Lu\u00edsa","family":"Castro","sequence":"additional","affiliation":[{"name":"Centre for Health Technology and Services Research (CINTESIS), University of Porto, 4200-450 Porto, Portugal"},{"name":"School of Health of Polytechnic of Porto, 4200-072 Porto, Portugal"},{"name":"MEDCIDS-Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1199-2220","authenticated-orcid":false,"given":"Andreia","family":"Teixeira","sequence":"additional","affiliation":[{"name":"Centre for Health Technology and Services Research (CINTESIS), University of Porto, 4200-450 Porto, Portugal"},{"name":"MEDCIDS-Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal"},{"name":"AdiT-LAB, Instituto Polit\u00e9cnico de Viana do Castelo, Rua Escola Industrial e Comercial Nun\u2019\u00c1lvares, 4900-347 Viana do lo, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,20]]},"reference":[{"key":"ref_1","unstructured":"Worldometer (2021, August 17). COVID-19 Coronavirus Pandemic. Available online: https:\/\/www.worldometers.info\/coronavirus\/."},{"key":"ref_2","unstructured":"DGS (2021, August 17). Ponto de Situa\u00e7\u00e3o Atual em Portugal. Available online: https:\/\/covid19.min-saude.pt\/ponto-de-situacao-atual-em-portugal\/."},{"key":"ref_3","unstructured":"IHME (2021, August 17). COVID-19 Vaccine Efficacy Summary. Available online: http:\/\/www.healthdata.org\/covid\/covid-19-vaccine-efficacy-summary."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1038\/s41562-021-01122-8","article-title":"A global database of COVID-19 vaccinations","volume":"5","author":"Mathieu","year":"2021","journal-title":"Nat. Hum. Behav."},{"key":"ref_5","unstructured":"Our World in Data (2021, August 21). Coronavirus (COVID-19) Vaccinations. Available online: https:\/\/ourworldindata.org\/covid-vaccinations."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1001\/jama.2021.3760","article-title":"COVID-19 in 2021-continuing uncertainty","volume":"325","author":"Malani","year":"2021","journal-title":"JAMA"},{"key":"ref_7","unstructured":"CDC (2020, November 03). Evidence Used to Update the List of Underlying Medical Conditions That Increase a Person\u2019s Risk of Severe Illness from COVID-19, Available online: https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/science\/science-briefs\/underlying-evidence-table.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhcp%2Fclinical-care%2Funderlying-evidence-table.html."},{"key":"ref_8","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":"ref_9","doi-asserted-by":"crossref","unstructured":"Visco, V., Vitale, C., Rispoli, A., Izzo, C., Virtuoso, N., Ferruzzi, G.J., Santopietro, M., Melfi, A., Rusciano, M.R., and Maglio, A. (2022). Post-COVID-19 syndrome: Involvement and interactions between respiratory, cardiovascular and nervous systems. J. Clin. Med., 11.","DOI":"10.3390\/jcm11030524"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1002\/jmv.27309","article-title":"Post-acute COVID-19 syndrome (PCS) and health-related quality of life (HRQoL)-a systematic review and meta-analysis","volume":"94","author":"Malik","year":"2022","journal-title":"J. Med. Virol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1001\/jamainternmed.2020.3539","article-title":"Risk factors associated with mortality among patients with COVID-19 in intensive care units in Lombardy, Italy","volume":"180","author":"Grasselli","year":"2020","journal-title":"JAMA Intern. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2224","DOI":"10.1093\/gerona\/glaa183","article-title":"Preexisting comorbidities predicting COVID-19 and mortality in the UK biobank community cohort","volume":"75","author":"Atkins","year":"2020","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1038\/s41586-020-2521-4","article-title":"Factors associated with COVID-19-related death using OpenSAFELY","volume":"584","author":"Williamson","year":"2020","journal-title":"Nature"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2000547","DOI":"10.1183\/13993003.00547-2020","article-title":"Comorbidity and its impact on 1590 patients with COVID-19 in china: A nationwide analysis","volume":"55","author":"Guan","year":"2020","journal-title":"Eur. Respir. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1016\/j.cmi.2020.04.012","article-title":"Risk factors for disease severity, unimprovement, and mortality in COVID-19 patients in Wuhan, China","volume":"26","author":"Zhang","year":"2020","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Violan, C., Foguet-Boreu, Q., Flores-Mateo, G., Salisbury, C., Blom, J., Freitag, M., Glynn, L., Muth, C., and Valderas, J.M. (2014). Prevalence, determinants and patterns of multimorbidity in primary care: A systematic review of observational studies. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0102149"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e009287","DOI":"10.1136\/bmjopen-2015-009287","article-title":"Prevalence of multimorbidity in the adult population attending primary care in Portugal: A cross-sectional study","volume":"5","author":"Prazeres","year":"2015","journal-title":"BMJ Open"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2235042X20961676","DOI":"10.1177\/2235042X20961676","article-title":"Multimorbidity and the COVID-19 pandemic\u2014An urgent call to action","volume":"10","author":"Mair","year":"2020","journal-title":"J. Comorb."},{"key":"ref_19","first-page":"glaa320","article-title":"Age, multiple chronic conditions, and COVID-19: A literature review","volume":"75","author":"Tisminetzky","year":"2020","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1161\/HYPERTENSIONAHA.120.15324","article-title":"Age and multimorbidity predict death among COVID-19 patients: Results of the sars-ras study of the italian society of hypertension","volume":"76","author":"Iaccarino","year":"2020","journal-title":"Hypertension"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"McQueenie, R., Foster, H.M.E., Jani, B.D., Katikireddi, S.V., Sattar, N., Pell, J.P., Ho, F.K., Niedzwiedz, C.L., Hastie, C.E., and Anderson, J. (2020). Multimorbidity, polypharmacy, and COVID-19 infection within the UK biobank cohort. PLoS ONE, 15.","DOI":"10.1101\/2020.06.10.20127563"},{"key":"ref_22","unstructured":"INE (2021, August 05). Inqu\u00e9rito Nacional de Sa\u00fade. Available online: https:\/\/www.ine.pt\/xportal\/xmain?xpid=INE&xpgid=ine_destaques&DESTAQUESdest_boui=414434213&DESTAQUESmodo=2."},{"key":"ref_23","unstructured":"INE (2019). Inqu\u00e9rito Nacional de Sa\u00fade 2019, C\u00f3digo 616\/Vers\u00e3o 1\u2014Documento Metodol\u00f3gico, DES\/Servi\u00e7o de Estat\u00edsticas das Condi\u00e7\u00f5es de Vida."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"720","DOI":"10.20344\/amp.14222","article-title":"Population-based estimates for high risk of severe COVID-19 disease due to age and underlying health conditions","volume":"33","author":"Laires","year":"2020","journal-title":"Acta Med. Port."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"100156","DOI":"10.1016\/j.ajpc.2021.100156","article-title":"Population at increased risk of severe illness from COVID-19","volume":"6","author":"Ajufo","year":"2021","journal-title":"Am. J. Prev. Cardiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e200087","DOI":"10.1590\/1980-549720200087","article-title":"Differences in the prevalence of risk factors for severe COVID-19 across regions of Sao Paulo city","volume":"23","author":"Thome","year":"2020","journal-title":"Rev. Bras. Epidemiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"75","DOI":"10.12688\/wellcomeopenres.15849.1","article-title":"COVID-19\u2014Exploring the implications of long-term condition type and extent of multimorbidity on years of life lost: A modelling study","volume":"5","author":"Hanlon","year":"2020","journal-title":"Wellcome Open Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1111\/maq.12626","article-title":"Multimorbidity, polyiatrogenesis, and COVID-19","volume":"34","author":"Ecks","year":"2020","journal-title":"Med. Anthropol. Q."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Aoun, M., Khalil, R., Mahfoud, W., Fatfat, H., Bou Khalil, L., Alameddine, R., Afiouni, N., Ibrahim, I., Hassan, M., and Zarzour, H. (2021). Age and multimorbidities as poor prognostic factors for COVID-19 in hemodialysis: A Lebanese national study. BMC Nephrol., 22.","DOI":"10.1186\/s12882-021-02270-9"},{"key":"ref_30","first-page":"30","article-title":"Multimorbidity in Portugal: Results from the first national health examination survey","volume":"32","author":"Kislaya","year":"2019","journal-title":"Acta Med. Port."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"The Lancet Public Health (2020). Education: A neglected social determinant of health. Lancet Public Health, 5, e361.","DOI":"10.1016\/S2468-2667(20)30144-4"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"50","DOI":"10.11606\/s1518-8787.2020054002596","article-title":"Adults at high-risk of severe coronavirus disease-2019 (COVID-19) in Brazil","volume":"54","author":"Rezende","year":"2020","journal-title":"Rev. Saude Publica"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1007\/s11606-020-06325-9","article-title":"The proportion of adult Americans at risk of severe COVID-19 illness","volume":"36","author":"Li","year":"2021","journal-title":"J. Gen. Intern. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1093\/fampra\/cmy014","article-title":"Measuring multimorbidity in family practice-a comparison of two methods","volume":"35","author":"Prazeres","year":"2018","journal-title":"Fam. Pract."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e00129620","DOI":"10.1590\/0102-311x00129620","article-title":"Multimorbidity and population at risk for severe COVID-19 in the Brazilian longitudinal study of aging","volume":"36","author":"Nunes","year":"2020","journal-title":"Cad. Saude Publica"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"392","DOI":"10.3389\/fpubh.2020.00392","article-title":"COVID-19: What is next for Portugal?","volume":"8","author":"Shaaban","year":"2020","journal-title":"Front. 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