Descriptive Epidemiology of Multimorbidity in Primary Care: A Cross-Sectional Study

Date of Approval: 
2016-05-03 00:00:00
Lay Summary: 
Increasing numbers of people have more than one long term illness, such as diabetes or depression. While healthcare delivery and research has traditionally focused on treatment of individual diseases, the presence of two or more chronic diseases, known as multimorbidity, has become an increasingly common medical issue. Individuals with multimorbidity tend to have more complicated healthcare needs, often leading to increased doctors visits and hospitalisations. The primary aim of this study is to use routinely collected medical record data to describe the prevalence of multimorbidity in English adults. We will examine the percentage of people in a sample of English patients that have multimorbidity, and the association of individual characteristics including age, sex, and ethnicity with multimorbidity. Additionally, we will assess the association of multimorbidity with usage of health services based on a patient's number of GP visits, number of prescriptions, and how often they are admitted to hospital. This work has the potential to benefit patients and health service providers. Through understanding how sociodemographic characteristics impact multimorbidity, we may be able to more appropriately target interventions for multimorbid patients. Additionally, it will allow for better planning and distribution of resources to better care for patients suffering from multimorbidity.
Technical Summary: 
Multimorbidity is becoming increasingly prevalent in England, and the effective management of multimorbid patients should be a priority of primary care medicine. In order to effectively plan health services to treat multimorbid patients, we must understand the epidemiology of this condition, and the current relationship between multimorbidity and health service usage. This research is primarily a descriptive epidemiological study looking at the burden of multimorbidity in primary care in England. It will consist of both a cross-sectional, descriptive study of the prevalence of multimorbidity, and a follow-on retrospective cohort analysis investigating the relationship between multimorbidity and health service utilisation. Using a random of sample of 425,400 patient records, we will describe the prevalence of multimorbidity, and will investigate differences in multimorbidity among various sociodemographic covariate groups. Additionally, we will investigate any linkages between mental and physical comorbidities, and patterns of the most common comorbidities. In the four-year retrospective cohort aspect of our study, we will use regression models to examine how health service utilisation may differ according to the presence of multimorbidity. Our primary outcomes will be the number of GP consultations, the number of prescriptions dispensed, and the number of hospitalisations.
Health Outcomes to be Measured: 
The outcome of our descriptive analysis is the prevalence of multimorbidity, and we will define multimorbidity using a list of 36 comorbidities. In addition to describing the prevalence of multimorbidity, as part of our descriptive analysis we are interested in the pairing and clustering of different comorbidities. To assess the frequency of the most commonly paired comorbidities, our outcome will be pairs of any two separate morbidities from the code list of 36 comorbidities. Additionally, to evaluate our final descriptive outcome relating to the prevalence of physical-mental health comorbidities, mental health comorbidities will be defined as Depression and Anxiety, Alcohol Problems, Dementia, Learning Disability, and Schizophrenia or Bipolar Disorder. All other morbidities will be defined as physical.
Application Number: 

Duncan Edwards - Chief Investigator - University of Cambridge
Steven Kiddle - Corresponding Applicant - Astra Zeneca Ltd - UK Headquarters
Amelia Harshfield - Collaborator - University of Cambridge
Kirsty Rhodes - Collaborator - University of Cambridge
Paul Kirk - Collaborator - University of Cambridge
Rupert Payne - Collaborator - University of Bristol
Simon Griffin - Collaborator - University of Cambridge
Sylvia Richardson - Collaborator - University of Cambridge
Yajing Zhu - Collaborator - University of Cambridge

HES Admitted Patient Care;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation