Definitions and Prevalence of Multimorbidity in Large Database Studies: A Scoping Review

Round 1

Reviewer 1 Report

This is an important and interesting study about "definitions and prevalence of multimorbidity in large database studies: a scoping review". I believe that the conclusion drawn by the author (based on the large database) would certainly add value to understanding multimorbidity and development of a consensus statement which is crucial in clinical practice. Overall, this manuscript is well prepared. Below are minor comments. 

1. Introduction section: typo error; disease databases ¬¬¬[7]. Correct it
2. Methods: Only three databases were searched. It is always good to include a few more databases, for example, SCOPUS, Web of Science and Cochrane library which are also large databases. Why only three databases were included? 
3. Methods/searching: was an expert librarian involved in the data base search? It is generally recommended to include an expert librarian in the systematic review and scoping review. 
4. References: Add a few recent and relevant reference from 2020

Thank you

Definitions and prevalence of multimorbidity in large database studies: a scoping review

Author Response

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Author Response File: Author Response.docx

Reviewer 2 Report

Thank you for your work on the definitions and prevalence of multimorbidity through a scoping review process. Your study is of a great quality and I have very few comments below.

 

• Some grammatical errors detected, i.e. ‘specialists played a greater role in management of specific conditions, but not comorbid conditions present in the patient’ in 2^nd para of introduction is not understood.
• In the 3^rd para of the introduction you mention that acute conditions are not included in the definition of multimorbidity in your review as these usually do not result in significant, long-lasting impact on patients’ lives. Could you please provide a citation for this statement? Considering that your focus is on chronic multimorbidity, could you add this in your title and abstract in order to help the reader? For example ‘Definitions and prevalence of chronic multimorbidity in large data-base studies: a scoping review’.

Author Response

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Author Response File: Author Response.docx

Reviewer 3 Report

I would like to commend the authors of putting this paper together, it is well structured and easy to follow (refreshingly so)!

I am currently in the process of preparing a manuscript of multimorbidity from primary care data and am facing many of the challenges outlined in this paper around the inconsistency of definitions used so this paper was a very timely read for me.

The only specific comments I have are in relation to section 4.3 on the inclusion of mental health:

Seven articles grouped chronic conditions into physical and mental health conditions, of which four articles separately analysed the prevalence of physical-mental, purely physical or mental health multimorbidity.

This sentence I’m not 100% sure about- do you mean that 7 articles grouped each of the conditions into an overarching “physical” and an overarching “mental” category or did the 4 articles?  Adding the word “overarching” or “individual” diagnosis categories may help clarify this sentence a bit further as to which group of studies did what.

This is more of a personal curiosity rather than a suggested change but I’m also wondering if any of these articles also looked at the added impact of alcohol and other drug (AOD) disorders. This may just be from my background in homelessness, but there is an added difficulty in treatment planning and health care outcomes when working with patients with a tri-morbidity (i.e. physical, mental and AOD).

Author Response

Please see the attachment. 

Author Response File: Author Response.docx