The effective management of multimorbidity generally defined as two or more health conditions - is a major challenge for the NHS. Multimorbidity rises with age so, with an ageing population, we are likely to see increasing numbers of people with multimorbidity placing pressure on NHS resources.
We aim to determine how use of health services by middle-aged and older people (aged 50 and over), and the associated costs of care, rise with each additional chronic health condition. This can help the NHS target resources toward older patients who are most likely to have high use of services due to multimorbidity.
Our research questions include the following. How much do the number of health conditions affect health care costs among older people? Does the increase in costs for each additional condition differ by age, gender, deprivation and whether the conditions include dementia or depression?
We will address these questions through analyses of a large data set, the Clinical Practice Research Datalink. We will use our analyses to estimate expected lifetime costs of health care from age 50 upward.
Estimates of the number of people with common conditions by geographical region were used from this project to comment on the possible impact of Covid-19 during the 2020 pandemic.
The aim of the study is to understand how use of health services by middle-aged and older people (aged 50 and over), and the associated costs of health care, rise with each additional health condition. This is intended to help the NHS to target resources toward those patients who are most likely to have high use of services in future due to multimorbidity.
We will conduct multi-variate analyses of a CPRD data sample to examine the relationship between health care utilisation in primary and secondary care and the number of health conditions (comorbidities) controlling for patient age, gender and deprivation (IMD) of area of residence.
Costs of health care services utilised by patients will include the cost of primary and secondary services they receive. We will use data on costs from the NHS Reference Costs and the PSSRU Unit Cost reports (Curtis and Burns).
From this analysis we will develop a Markov model, using our estimated transition rates and estimated costs of care by number of health conditions, to estimate expected lifetime costs of care from age 50 upward. This information will be made available via a user-friendly tool published on a website.
Prevalence estimates of common co-morbidities by geographical region were used from this project to comment on the possible impact of Covid-19 during the 2020 pandemic.
1. Numbers of chronic conditions (co-morbidities)
2. Utilisation of health services, i.e. number of GP consultations, A&E attendances, hospital admissions etc.
3. Costs of primary and secondary health care received, to be calculated from utilisation data
4. Annual probabilities of transition between morbidity categories defined by number of health conditions, to be analysed as a function of the persons current number of health conditions, age, gender, deprivation of area of residence and diagnosis of dementia or depression
Raphael Wittenberg - Chief Investigator - University of Oxford
Catia Nicodemo - Corresponding Applicant - University of Oxford
Chris Salisbury - Collaborator - University of Bristol
Clare Bankhead - Collaborator - University of Oxford
Cynthia Wright Drakesmith - Collaborator - University of Oxford
Kamal Mahtani - Collaborator - University of Oxford
Margaret Smith - Collaborator - University of Oxford
Peter Bower - Collaborator - University of Manchester
Rafael Perera - Collaborator - University of Oxford
Richard Hobbs - Collaborator - University of Oxford
Robert Anderson - Collaborator - University of Oxford
Sarah Lay-Flurrie - Collaborator - University of Oxford
Stuart Redding - Collaborator - University of Oxford
2011 Rural-Urban Classification at LSOA level;HES Accident and Emergency;HES Admitted Patient Care;HES Diagnostic Imaging Dataset;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation