Age, sex, and socioeconomic differences in multimorbidity measured in four ways: UK primary care cross-sectional analysis

Abstract

Background: Multimorbidity poses major challenges to healthcare systems worldwide. Definitions with cut-offs in excess of ≥2 long-term conditions (LTCs) might better capture populations with complexity but are not standardised.

Aim: To examine variation in prevalence using different definitions of multimorbidity.

Design and setting: Cross-sectional study of 1 168 620 people in England.

Method: Comparison of multimorbidity (MM) prevalence using four definitions: MM2+ (≥2 LTCs), MM3+ (≥3 LTCs), MM3+ from 3+ (≥3 LTCs from ≥3 International Classification of Diseases, 10th revision chapters), and mental-physical MM (≥2 LTCs where ≥1 mental health LTC and ≥1 physical health LTC are recorded). Logistic regression was used to examine patient characteristics associated with multimorbidity under all four definitions.

Results: MM2+ was most common (40.4%) followed by MM3+ (27.5%), MM3+ from 3+ (22.6%), and mental-physical MM (18.9%). MM2+, MM3+, and MM3+ from 3+ were strongly associated with oldest age (adjusted odds ratio [aOR] 58.09, 95% confidence interval [CI] = 56.13 to 60.14; aOR 77.69, 95% CI = 75.33 to 80.12; and aOR 102.06, 95% CI = 98.61 to 105.65; respectively), but mental-physical MM was much less strongly associated (aOR 4.32, 95% CI = 4.21 to 4.43). People in the most deprived decile had equivalent rates of multimorbidity at a younger age than those in the least deprived decile. This was most marked in mental-physical MM at 40-45 years younger, followed by MM2+ at 15-20 years younger, and MM3+ and MM3+ from 3+ at 10-15 years younger. Females had higher prevalence of multimorbidity under all definitions, which was most marked for mental-physical MM.

Conclusion: Estimated prevalence of multimorbidity depends on the definition used, and associations with age, sex, and socioeconomic position vary between definitions. Applicable multimorbidity research requires consistency of definitions across studies.

Keywords: epidemiology; multimorbidity; primary care; socioeconomic disparities.

Figure 1.

Prevalence of multimorbidity by age using four different definitions. Multimorbidity 2+ = ≥2 long-term conditions (LTCs). Multimorbidity 3+ = ≥3 LTCs. Multimorbidity 3+ from 3+ = ≥3 LTCs from ≥3 International Classification of Diseases, 10th revision chapters. Mental–physical multimorbidity = ≥2 LTCs where ≥1 mental health LTC and ≥1 physical health LTC are recorded.

Figure 2.

Prevalence of each definition of multimorbidity in the most and least deprived IMD decile, by age. Graphical representation of the estimated multimorbidity prevalence for each of the four definitions, comparing the most and least deprived IMD decile. 95% confidence intervals are represented by coloured vertical lines. Dashed vertical black lines represent the point at which the horizontal gap (difference in multimorbidity prevalence) between most and least deprived IMD deciles is largest (that is, where there is greatest inequality in the age at which people have multimorbidity). IMD = Index of Multiple Deprivation. Multimorbidity 2+ = ≥2 long-term conditions (LTCs). Multimorbidity 3+ = ≥3 LTCs. Multimorbidity 3+ from 3+ = ≥3 LTCs from ≥3 International Classification of Diseases, 10th revision chapters. Mental–physical multimorbidity = ≥2 LTCs where ≥1 mental health LTC and ≥1 physical health LTC are recorded.