The epidemiology of multimorbidity in primary care: a retrospective cohort study

Abstract

Background: Multimorbidity places a substantial burden on patients and the healthcare system, but few contemporary epidemiological data are available.

Aim: To describe the epidemiology of multimorbidity in adults in England, and quantify associations between multimorbidity and health service utilisation.

Design and setting: Retrospective cohort study, undertaken in England.

Method: The study used a random sample of 403 985 adult patients (aged ≥18 years), who were registered with a general practice on 1 January 2012 and included in the Clinical Practice Research Datalink. Multimorbidity was defined as having two or more of 36 long-term conditions recorded in patients' medical records, and associations between multimorbidity and health service utilisation (GP consultations, prescriptions, and hospitalisations) over 4 years were quantified.

Results: In total, 27.2% of the patients involved in the study had multimorbidity. The most prevalent conditions were hypertension (18.2%), depression or anxiety (10.3%), and chronic pain (10.1%). The prevalence of multimorbidity was higher in females than males (30.0% versus 24.4% respectively) and among those with lower socioeconomic status (30.0% in the quintile with the greatest levels of deprivation versus 25.8% in that with the lowest). Physical-mental comorbidity constituted a much greater proportion of overall morbidity in both younger patients (18-44 years) and those patients with a lower socioeconomic status. Multimorbidity was strongly associated with health service utilisation. Patients with multimorbidity accounted for 52.9% of GP consultations, 78.7% of prescriptions, and 56.1% of hospital admissions.

Conclusion: Multimorbidity is common, socially patterned, and associated with increased health service utilisation. These findings support the need to improve the quality and efficiency of health services providing care to patients with multimorbidity at both practice and national level.

Keywords: comorbidity; health service utilisation; multimorbidity; primary health care.

Figure 1.

Study inclusion and exclusion criteria. CPRD = Clinical Practice Research Datalink. IMD = Index of Multiple Deprivation.

Figure 2.

Prevalence of multimorbidity by age and socioeconomic status. ^a1 is the quintile with the least socioeconomic deprivation, 5 is that with the greatest.

Figure 3.

Prevalence of physical–mental comorbidity by age and socioeconomic status. ^a1 is the quintile with the least socioeconomic deprivation, 5 is that with the greatest.