Hyperlipidaemia and hypertension are the most common co-occurring conditions in Singapore.In a study evaluating multimorbidity combinations in older adults seeking chronic care within the public primary care setting in Singapore, hyperlipidaemia (HLD) and hypertension (HTN) emerged as the most common co-occurring conditions.
“In this study, multimorbidity was defined as the presence of ≥3 chronic conditions based on the consensus-derived definition of multimorbidity to identify a smaller number of patients with higher needs,” the investigators noted.
The multimorbidity combinations were heterogeneous, but the most prevalent chronic conditions that commonly co-occurred were HLD and HTN. [J Multimorb Comorb 2026;doi:10.1177/26335565261417399]
This underpins the importance of synchronizing the management of common multimorbidity combinations, pointing to a potential for developing practice guidelines that could guide the management of disease combinations, the researchers said.
HLD was the number one condition managed in the local public primary care setting (72.9 percent), followed by HTN (64.6 percent) and diabetes (40.9 percent).
The five most prevalent and costly combinations were HLD/HTN/diabetes (8 percent), HLD/HTN/diabetes/functional limitation (2 percent), HLD/HTN/functional limitation (2 percent), HLD/HTN/diabetes/cardiovascular disease (1.7 percent), and HLD/HTN/diabetes/arthritis (1.6 percent).
The total healthcare cost incurred between July 2018 and June 2019 was SGD2,171,979,618. For the HLD/HTN/diabetes combo, the total healthcare cost was SGD163,765,386.
The mean total healthcare costs were higher among individuals with multimorbidity than those without (1–2 conditions; SGD4,925 vs 3,434), as were the mean polyclinic (SGD720 vs 300), specialist outpatient centre (SGD1,147 vs 965), emergency department (SGD149 vs 104), and hospital costs (SGD2,908 vs 2,065).
Guidelines focus on single diseases
“[The] management of multimorbidity can be challenging, as clinical practice guidelines are conventionally developed based on evidence focused on single diseases,” the researchers noted. Applying multiple single-disease guidelines in developing a care plan for patients with multimorbidity may lead to treatment burden and introduce drug-drug interactions. [Singapore Med J 2020;61:584-590; Prim Health Care Res Dev 2022;23:e36]
Moreover, the burden of multimorbidity on Singapore’s local health system is further compounded by the rapidly ageing population. [https://www.pmo.gov.sg/newsroom/pm-lee-hsien-loong-at-the-singapore-ageing-issues-and-challenges-ahead-book-launch, accessed 23 Sept 2026] Evidence shows that the proportion of older residents in Singapore with ≥3 chronic diseases in 2009 has doubled by 2017. [https://www.duke-nus.edu.sg/docs/librariesprovider3/research-policy-brief-docs/care-special-issue-1---changes-in-the-profile-of-older-singaporeans.pdf, accessed 23 Sept 2026] As such, the resultant socioeconomic and disease burden due to multimorbidity is expected to increase significantly.
Multimorbidity also has a significant impact on quality of life. [Qual Life Res 2022;31:551-565] “Patients often experience fragmented care, treatment burden, and challenges in navigating complex care pathways, especially in the face of social and functional limitations,” they said.
At the macro level, the increasing prevalence of multimorbidity with population ageing places strain on healthcare financing and workforce capacity, with long-term implications for population health and economic productivity. [Scand J Work Environ Health 2020;46:218-227; N Z Med J 2018;131:78-90]
This cross-sectional study included 502,036 unique polyclinic patients. Approximately 54 percent of participants were women, 37.6 percent were between ages 60 and 69 years, and 79.5 percent were of Chinese ethnicity. Sixty percent of participants had multimorbidity, with approximately one-quarter (23.9 percent) having three co-occurring chronic conditions.
“By providing insights into the distribution and impact of multimorbidity in a real-world primary care context, our findings underscore the need for more integrated, person-centred models of care,” they said.
“[The results underscore the] need to optimize clinical outcomes for common multimorbidity combinations rather than simply aggregating outcomes for all conditions within the combination,” the researchers concluded.