The Epidemiology of Multimorbidity in Primary Care

17 Jan 2018

Background: Multimorbidity places a substantial burden on patients and the healthcare system but few contemporary data are available. Aim: To describe the epidemiology of multimorbidity in adults in England and quantify associations between multimorbidity and health service utilisation. Design: Retrospective cohort study Setting: A random sample of 403,985 adult patients (≥18 years) in England who were registered with a general practice on 1 January 2012 and included in the Clinical Practice Research Datalink. Methods: We defined multimorbidity as having two or more of 36 long-term conditions recorded in patients’ medical records and quantified associations between multimorbidity and health service utilisation (GP consultations, prescriptions, and hospitalisations) over four years. Results: 27.2% of patients were multimorbid. The most prevalent conditions were hypertension (18.2%), depression or anxiety (10.3%), and chronic pain (10.1%). Prevalence of multimorbidity was higher in females than males (30% vs. 24.4% respectively) and among those with lower socioeconomic status (33.8% in the most deprived quintile vs. 24.2% in the least deprived quintile). Physical-mental comorbidity contributed a much greater proportion of overall morbidity in both younger patients and those patients with lower socioeconomic status. Multimorbidity was strongly associated with health service utilisation. Multimorbid patients accounted for 53% of GP consultations, 79% of prescriptions, and 56% percent 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 multimorbid patients at the practice and national-level.