The epidemiology of multimorbidity in primary care: a retrospective cohort study
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Open Access
- 12 March 2018
- journal article
- research article
- Published by Royal College of General Practitioners in British Journal of General Practice
- Vol. 68 (669), e245-e251
- https://doi.org/10.3399/bjgp18x695465
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
This publication has 16 references indexed in Scilit:
- Prevalence of polypharmacy in a Scottish primary care populationEuropean Journal of Clinical Pharmacology, 2014
- Completeness and usability of ethnicity data in UK-based primary care and hospital databasesJournal of Public Health, 2013
- The effect of physical multimorbidity, mental health conditions and socioeconomic deprivation on unplanned admissions to hospital: a retrospective cohort studyCMAJ : Canadian Medical Association Journal, 2013
- Comparing measures of multimorbidity to predict outcomes in primary care: a cross sectional studyFamily Practice, 2012
- Multimorbidity and comorbidity in the Dutch population – data from general practicesBMC Public Health, 2012
- Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional studyThe Lancet, 2012
- Epidemiology and impact of multimorbidity in primary care: a retrospective cohort studyBritish Journal of General Practice, 2011
- Multimorbidity - not just an older person's issue. Results from an Australian biomedical studyBMC Public Health, 2010
- Causes and consequences of comorbidity: A reviewJournal of Clinical Epidemiology, 2001
- Deprivation and cause specific morbidity: evidence from the Somerset and Avon survey of healthBMJ, 1996