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Bisquera A, Turner EB, Ledwaba-Chapman L, et al. Inequalities in developing multimorbidity over time: A population-based cohort study from an urban, multi-ethnic borough in the United Kingdom. Lancet Reg Health Eur. 2021;12:100247doi: 10.1016/j.lanepe.2021.100247.
Bisquera, A., Turner, E. B., Ledwaba-Chapman, L., Dunbar-Rees, R., Hafezparast, N., Gulliford, M., Durbaba, S., Soley-Bori, M., Fox-Rushby, J., Dodhia, H., Ashworth, M., & Wang, Y. (2022). Inequalities in developing multimorbidity over time: A population-based cohort study from an urban, multi-ethnic borough in the United Kingdom. The Lancet regional health. Europe, 12100247. https://doi.org/10.1016/j.lanepe.2021.100247
Bisquera, Alessandra, et al. "Inequalities in developing multimorbidity over time: A population-based cohort study from an urban, multi-ethnic borough in the United Kingdom." The Lancet regional health. Europe vol. 12 (2022): 100247. doi: https://doi.org/10.1016/j.lanepe.2021.100247
Bisquera A, Turner EB, Ledwaba-Chapman L, Dunbar-Rees R, Hafezparast N, Gulliford M, Durbaba S, Soley-Bori M, Fox-Rushby J, Dodhia H, Ashworth M, Wang Y. Inequalities in developing multimorbidity over time: A population-based cohort study from an urban, multi-ethnic borough in the United Kingdom. Lancet Reg Health Eur. 2021 Nov 04;12:100247. doi: 10.1016/j.lanepe.2021.100247. eCollection 2022 Jan. PMID: 34901910; PMCID: PMC8640725.
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Lancet Reg Health Eur. 2021 Nov 04;12:100247. doi: 10.1016/j.lanepe.2021.100247. eCollection 2022 Jan.

Inequalities in developing multimorbidity over time: A population-based cohort study from an urban, multi-ethnic borough in the United Kingdom.

The Lancet regional health. Europe

Alessandra Bisquera, Ellie Bragan Turner, Lesedi Ledwaba-Chapman, Rupert Dunbar-Rees, Nasrin Hafezparast, Martin Gulliford, Stevo Durbaba, Marina Soley-Bori, Julia Fox-Rushby, Hiten Dodhia, Mark Ashworth, Yanzhong Wang

Affiliations

  1. King's College London, School of Population Health & Environmental Sciences, London, UK.
  2. NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.
  3. Outcomes Based Healthcare, Cavendish Square, London, UK.

PMID: 34901910 PMCID: PMC8640725 DOI: 10.1016/j.lanepe.2021.100247

Abstract

BACKGROUND: Social and material deprivation accelerate the development of multimorbidity, yet the mechanisms which drive multimorbidity pathways and trajectories remain unclear. We aimed to examine the association between health inequality, risk factors and accumulation or resolution of LTCs, taking disease sequences into consideration.

METHODS: We conducted a retrospective cohort of adults aged 18 years and over, registered between April 2005 and May 2020 in general practices in one inner London borough (

FINDINGS: Participants were followed up for a median of 4.2 years (IQR = 1·8 - 8·4); 631,760 (76%) entered the study with no LTCs, 121,424 (15%) with 1 LTC, 41,720 (5%) with 2 LTCs, and 31,966 (4%) with three or more LTCs. At the end of follow-up, 194,777 (24%) gained one or more LTCs, while 45,017 (5%) had resolved LTCs and 27,021 (3%) died. In multistate models, deprivation (hazard ratio [HR] between 1·30 to 1·64), female sex (HR 1·13 to 1·20), and Black ethnicity (HR 1·20 to 1·30; vs White) were independently associated with increased risk of transition from one to two LTCs, and shorter time spent in a healthy state. Substance use was the strongest risk factor for multimorbidity with an 85% probability of gaining LTCs over the next year. First order Markov chains identified consistent disease sequences including: chronic pain or osteoarthritis followed by anxiety and depression; alcohol and substance dependency followed by HIV, viral hepatitis, and liver disease; and morbid obesity followed by diabetes, hypertension, and chronic pain.

INTERPRETATION: We examined the relations among 32 LTCs, taking the order of disease occurrence into consideration. Distinctive patterns for the development and accumulation of multimorbidity have emerged, with increased risk of transitioning from no conditions to multimorbidity and mortality related to ethnicity, deprivation and gender. Musculoskeletal disorders, morbid obesity and substance abuse represent common entry points to multimorbidity trajectories.

© 2021 The Authors.

Keywords: IMD, Indices of Multiple Deprivation; LTC, Long term conditions; Long term conditions; MCF, Mean cumulative function; Multi state markov chain; Multimorbidity; Probabilities; QOF, Quality Outcomes Framework; UK, United Kingdom

Conflict of interest statement

The authors declare no conflict of interest.

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