Background/Purpose: Musculoskeletal conditions (MSKC) are among the most common chronic conditions. Increasingly, patients suffer from more than one disease. Moreover, the presence of a co-morbid disease adds to the burden of single diseases worldwide. The aim of this study was to understand 1) what is the impact of the number of morbidities on health and 2) whether MSKC has a higher impact on health compared with other diseases or has an important impact when being a co-morbidity.

Methods: In a Dutch cross-sectional study, 8904 subjects (>18 years old, random sample) completed a questionnaire on socio-demographic factors (age, gender, education, work status, origin and place of residence (postal code code)), BMI, self-reported physician-diagnosed diseases and the 12-Item Short-Form Health Survey (SF-12). Complete cases (n=7600) were analyzed. Multivariable linear regression was computed to identify 1) whether multimorbidity in terms of number of diseases was significantly associated with the SF-12 physical (PCS) and mental (MCS) subscales and 2)which diseases contributed the most to changes in health related quality of life (HrQol). Interactions of all diseases with MSKC were checked. Models were adjusted for age, gender, education (5 groups, from no education to university) origin (western vs. non-western) and BMI.

Results: Multimorbidity was present in 1432 subjects (19%). MSKC confirmed by a physician was reported by 1438 (19%) participants. 408 (5%) reported diabetes, 1460 (19%) CVD, 199 (3%) cancer, 547 (7%) a respiratory condition, 526 (7%) a skin condition, 462 (6%) a mental disorder, 334 (4%) migraine and 262 (3%) bowel disease. A linear relation between the number of diseases and health (both univariably and in fully adjusted model) was observed (Table 1). MSKC had the highest negative impact on PCS compared to other diseases (Table 2).

Conclusion: An increasing number of morbidities is negatively associated with physical and mental HrQol. MSKC are responsible for the largest decrease of physical health.

Table 1: Association of number of morbidities and health (physical and mental component SF-12)
Number of morbidities	SF-12
	Physical Component B1  [95% CI]		Mental Component B1 [95% CI]
	univariable	multivariable*	univariable	multivariable**
1	– 4.83 [-5.01 ; -4.65]	– 4.06 [-4.24 ; -3.87]	-1.62 [-1.82 ; -1.43]	-2.07 [-2.27 ; -1.87]
2	– 9.66 [-10.03 ; -9.30]	–  8.11 [-8.49 ; -7.73]	-3.25 [-3.63 ; -2.87]	-4.14 [-4.54; -3.74]
3	– 14.49 [-15.04 ; -13.94]	– 12.17 [-12.73 ; -11.61]	-4.87 [-5.45 ; -4.29]	-6.20 [-6.81 ; -5.59]
4	– 19.32 [-20.05 ; -18.59]	– 16.22 [-16.97 ; -15.47]	-6.50 [-7.27 ; -5.73]	-8.27 [-9.08 ; -7.46]
5	– 24.15 [-25.06 ; -23.24]	– 20.28 [-21.22; -19.34]	-8.12 [-9.08 ; -7.16]	-10.34 [-11.35 ; -9.33]
	1understandardized coefficient	*adjusted for age, gender, education (5 groups, from no education to university), BMI		**adjusted for age, gender, education (5 groups, from no education to university),origin (western vs. non-western),BMI

 

Table 2: Association of type of morbidity and health (physical and mental component SF-12)
Type of morbidity	SF-12
	Physical Component B1 [95% CI]		Mental Component B1 [95% CI]
	univariable	multivariable*	univariable	multivariable**
CVD	-6.55 [-7.04 ; -6.05]	-2.60 [-3.07 ; -2.13]	-0.17 [-0.65 ; 0.30]	-0,91 [-1.40 ; -0.42]
Diabetes	-6.70 [-7.59 ; -5.81]	-2.05[-2.83 ;-1.281]	-0.20 [-0.63 ; 1.04]	-0.46  [-1.27 ; 0.34]
Cancer	-9.80 [-9.06 ; -6.54]	-5.24 [-6.29 ; -4.19]	-0.80 [-1.98 ; 0.38]	-1.05 [-2.146 ; 0.05]
Respiratory condition	-7.41 [-8.18 ; -6.64]	-3.92 [-4.57 ; -3.27]	-1.73 [-2.46; -1.00]	– 0.62 [-1.30 ; 0 .07]
Skin condition	-2.99 [-3.79 ; -2.19]	-0.49 [-1.15 ; 0.17]	-2.13 [-2.87 ; -1.39]	-1.17 [-1.86 ; -0.48]
Mental disorder	-4.13 [-4.98 ; -3.28]	-1.82 [-2.53 ; -1.11]	-14.82 [-15.54 ; -14.10]	-13.93 [-14.66 ; -13.19]
MSKC	-11.38 [-11.84 ; -10.92]	-8.93 [-9.37 ; -8.48]	-1.25 [-1.73 ; -0.77]	– 0.30 [- 0.76 ; 0.16]
Migraine	-4.56 [-5.54 ; -3.57]	-2.37 [-3.20 ; -1.55]	-3.73 [-4.65 ; -2.82]	-1.44 [-2.30 ; -0.58]
Bowel disease	-9.26 [-10.35 ; -8.17]	-4.68 [-5.61 ; -3.75]	-3.99 [-5.02 ; -2.97]	-1.42 [-2.39 ; -0.46]
	1understandardized coefficient	*adjusted for age, gender, education (5 groups, from no education to university), BMI		**adjusted for age, gender, education (5 groups, from no education to university),origin (western vs. non-western),BMI

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