Patterns of multimorbidity in the German National Cohort (NAKO): baseline findings by sex and age

Background

Multimorbidity is globally increasing due to population ageing and high prevalence of lifestyle risk factors. However, large-scale population-based data on multimorbidity in Germany remain scarce. This study aimed to describe multimorbidity patterns across NAKO participants by sex and age.

Methods

This cross-sectional analysis used baseline data from the population-based German National Cohort (NAKO) of adults (20-75 years) assessed 2014-2019. Multimorbidity was defined as having two or more chronic conditions out of 34 diseases assessed through self-reported physician’s diagnosis, including treatment. Frequency of multimorbidity and number of conditions were calculated for the total sample and subgroups. Regression analyses will be used to determine associations between sociodemographic factors and multimorbidity.

Results

Among 204,541 NAKO participants (mean±SD age 45.7±14.1 years, 50.5% women), 17.9% reported no disease, 23.0% reported one disease, 59.1% were multimorbid with at least two diseases, 39.3% reported at least three diseases. More women were multimorbid than men: 64.3% (63.3% excluding gynecological diseases) vs. 53.6%. Presence of multimorbidity was lowest (33.4%) in the youngest age group (19-29 years) and highest (83.8%) among the oldest (60-75 years). First results showed: among those with at least 3 coexisting diseases, the most frequent combinations were allergic rhinitis, migraine, and atopic dermatitis in the youngest, and hypertension, hyperlipidemia, and osteoarthritis in the oldest age group.

Conclusions

This analysis demonstrates that multimorbidity affects the majority of participants in Germany’s largest prospective health study. The substantial frequency even among young adults highlights the need for early prevention strategies. Our findings emphasize the urgent need for healthcare systems and research to shift from single-disease models to integrated approaches that address the complex needs of multimorbid patients.

Key messages

• Nearly 60% of NAKO participants were multimorbid. Younger adults more often reported allergic and autoimmune-related conditions, older adults reported cardiovascular and musculoskeletal conditions.

• Considerable sex differences showed that at baseline, almost two-thirds of the women, as compared to about half of the men in NAKO, were multimorbid.