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

MacRae, C. et al. (2023) Age, sex, and socioeconomic differences in multimorbidity measured in four ways: UK primary care cross-sectional analysis. British Journal of General Practice, 73(729), e249-e256. (doi: 10.3399/BJGP.2022.0405) (PMID:36997222) (PMCID:PMC9923763)

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.

• Item Type: Articles
• Additional Information: Bruce Guthrie, Stewart W Mercer, Daniel R Morales, and Emily Jefferson received funding for this study from the Chief Scientist Office (reference: HIPS/18/30). Clare MacRae received funding for this study from an NHS Education for Scotland Academic Fellowship and Medical Research Council fellowship (reference: MR/W000253/1).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McAllister, Professor David and McMinn, Dr Megan and Jefferson, Professor Emily and Henderson, David and Mercer, Professor Stewart
• Authors: MacRae, C., Mercer, S. W., Henderson, D., McMinn, M., Morales, D. R., Jefferson, E., Lyons, R. A., Lyons, J., Dibben, C., McAllister, D. A., and Guthrie, B.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
• Journal Name: British Journal of General Practice
• Publisher: Royal College of General Practitioners
• ISSN: 0960-1643
• ISSN (Online): 1478-5242
• Published Online: 30 March 2023
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in British Journal of General Practice 73(729): e249-e256
• Publisher Policy: Reproduced under a Creative Commons License