Early-onset burdensome multimorbidity: an exploratory analysis of sentinel conditions, condition accrual sequence and duration of three long-term conditions using the 1970 British Cohort Study

Abstract

Objectives: The prevalence of multiple long-term condition (LTC) multimorbidity is increasing with younger onset among socioeconomically deprived populations. Research on life course trajectories towards multimorbidity is limited and early-onset multimorbidity poorly characterised. Understanding sentinel conditions (the first LTC occurring in the life course), the sequence of LTC accrual and the permanency of the reporting of LTCs may help identify time points for prevention efforts. We used a longitudinal birth cohort to estimate the prevalence of a common three-condition early-onset multimorbidity (multiple long-term condition multimorbidity (MLTC-M)) group at midlife, describe the frequency of sentinel conditions, the sequence of LTC accrual and explore the permanency of one of these conditions: psychological distress.

Setting: 1970 British Cohort Study (BCS70).

Participants: 17 196 cohort members born in 1970.

Outcome measures: Prevalence of the most common three-condition multimorbidity group at age 46. The nature and timing of sentinel conditions, the sequencing patterns of subsequent LTC accrual and the permanency of the reporting of psychological distress.

Results: At age 46 high blood pressure, psychological distress and back pain were the most common three-condition MLTC-M group, (4.3%, n=370). A subgroup of 164 (44.3%) people provided complete information on LTC across all time points. Psychological distress measured by the Malaise Index was the most common sentinel condition, occurring in 25.0% (n=41), followed by back pain (22%, n=36). At age 26, 45.1% (75/164) reported their sentinel condition. The most common sequence of LTC accrual was the co-reporting of psychological distress and back pain followed by high blood pressure. Almost one-third (30.5%, n=50) reported a variation of psychological distress across the adult life course.

Conclusion: In these exploratory analyses, psychological distress and back pain were the most common sentinel conditions, and along with high blood pressure these three conditions represented the most common three-condition MLTC-M group. These analyses suggest that birth cohorts, like the BCS70, may usefully inform life course-multimorbidity research.

Keywords: back pain; epidemiology; hypertension; mental health; public health.

Figure 1

Selection flow of multiple long-term condition multimorbidity (MLTC-M) sample at age 46.

Figure 2

Bubble diagram of the percentage distribution of sentinel conditions and the age at which the sentinel condition was reported, for all 164 cohort members who reported the multiple long-term condition multimorbidity (MLTC-M) group of psychological distress, high blood pressure and back pain at age 46 and provided information on long-term condition across the adult sweeps. The area of each bubble represents, for those that reported the MLTC-M group of psychological distress, high blood pressure and back pain at age 46, the reporting of the sentinel condition at each sweep in adulthood. The percentages are included inside each bubble.

Figure 3

Sankey diagram of sequences of long-term condition for all 164 cohort members who reported the multiple long-term condition multimorbidity group of psychological distress (PD), high blood pressure (BP) and back pain (pain) at age 46 and provided information on long-term condition across the adult sweeps. The size of the bar represents the number of people within each pathway. Larger bars representing a greater number of people.

Figure 4

A graph representing the reporting of psychological distress across the adult sweeps for all 164 cohort members who reported the multiple long-term condition multimorbidity group of psychological distress, high blood pressure and back pain at age 46 and provided information on long-term condition across the adult sweeps.