Disability, Economic Toll of Multimorbidity Climb in Older Adults

The economic burden of multimorbidity in older adults increased more than 4-fold worldwide between 2000 and 2023, reaching an estimated $363.25 billion, while the disability burden tied to the same condition combinations rose much more slowly, according to an economic evaluation published in JAMA Network Open.¹ The analysis modeled 78 pairings and triplets of physical, psychological, and cognitive conditions among adults 60 years or older in 204 countries and territories.

From 2000 to 2023, years lived with disability (YLDs) attributable to these combinations climbed from 2367.81 to 2941.68 per 100,000 population, for an average annual percentage change (AAPC) of 0.93% (95% CI, 0.87%-0.99%). Economic losses, measured in 2021 international dollars adjusted for purchasing power parity, had an AAPC of 6.70% (95% CI, 6.57%-6.82%), and the 2023 total represented about 0.3% of global gross domestic product (GDP).

Multimorbidity Burden in an Aging Global Population

The World Health Organization projects that roughly 1.4 billion people, or 1 in 6 worldwide, will be 60 years or older by 2030, rising to about 2.1 billion by 2050, and notes that the odds of living with several conditions at once climb with age.²

Ji and colleagues argued that prior work has generally examined health outcomes and costs separately and within single regions or limited condition sets.¹

“Yet, health care delivery remains largely organized around single diseases, with limited integration of physical, mental, and cognitive health or attention to long-term functional outcomes,” they wrote.

How the Study Modeled Health and Economic Losses

The investigators drew on Global Burden of Disease 2023 estimates for 11 conditions in 3 domains. The physical domain included ischemic heart disease, stroke, diabetes, chronic obstructive pulmonary disease, and osteoarthritis. The psychological domain included schizophrenia and depressive, bipolar, and anxiety disorders. The cognitive domain comprised Parkinson disease, Alzheimer disease, and other dementias. Pairing conditions from 2 different domains, or taking 1 from each of the 3, yielded 78 combinations, 40 of which spanned all 3 domains. Joint prevalence was estimated assuming the conditions occur independently.

The team then linked the health estimates with World Bank, World Health Organization, and United Nations data for 180 countries and territories. Losses equaled treatment spending attributed to each combination plus the capital accumulation forgone because that money was not saved and invested, an approach the authors chose because many people in this age group have left paid work.

Osteoarthritis Combinations Lead Disability and Cost Burden

Osteoarthritis paired with Alzheimer disease and other dementias produced the highest 2-condition YLD rate in 2023, at 369.87 per 100,000 population (95% UI, 163.86-752.23). The costliest 2023 pairing was osteoarthritis with anxiety disorders, at $48.51 billion (95% UI, $31.68-$76.57 billion), displacing osteoarthritis with depressive disorders, which led in 2000. In the 3-condition group, osteoarthritis, depressive disorders, and dementia carried the most disability, while osteoarthritis, anxiety disorders, and dementia generated the largest 2023 losses.

Anxiety disorders with Parkinson disease grew fastest among pairs, with AAPCs of 2.83% for YLDs and 8.73% for economic losses. Among triplets, diabetes, anxiety disorders, and Parkinson disease grew fastest (YLD AAPC, 3.94%; 95% CI, 3.79%-4.08%; economic loss AAPC, 9.92%; 95% CI, 9.69%-10.13%). Pairings of physical and psychological conditions made up the biggest share of total burden, with physical-cognitive pairings next.

Women had higher YLDs and losses than men throughout the study period, most clearly for combinations involving osteoarthritis or dementia, while men predominated in Parkinson disease–related combinations. The US led in 2023 on both absolute losses and losses relative to its economy, and China, Germany, and Japan saw large increases as well. Disability rates followed a different map, with Syria, Trinidad and Tobago, and Lebanon posting the highest 2023 YLD rates.

“In LMICs [low- and middle-income countries], lower measured economic losses may reflect lower health spending and limited savings rather than lower societal impact,” the authors wrote.

Because the work depended on pooled secondary data and on assumptions built into the Global Burden of Disease models, uncertainty is inherent. Treating conditions as independent cannot reflect shared risk factors or compounding effects on severity and cost, and the authors noted that the resulting bias could run in either direction. The economic measure also omitted mortality-related losses, informal caregiving time, and lost productivity among older adults who still work, which may have led to underestimation. The estimates could not be validated against observed costs, and the authors advised caution in reading the jump in losses around 2020, which overlapped with the COVID-19 pandemic.

“The divergence between YLDs and economic losses suggests that multimorbidity policy should move beyond single-condition programs and consider integrated care, financial protection, and prevention of high-burden combinations,” the authors concluded.

References

1. Ji W, Zheng J, Guan S, et al; Global Aging Multimorbidity Collaboration. Dual health and economic burden of multimorbidity in aging populations. JAMA Netw Open. 2026;9(10):e2633002. doi:10.1001/jamanetworkopen.2026.33002

2. Ageing and health. World Health Organization. October 1, 2025. Accessed October 30, 2026. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health