Abstract
ObjectiveTo estimate the prevalence and determinants of multimorbidity in an urban, multi-ethnic area over 15-years and investigate the effect of applying resolved/remission codes on prevalence estimates. Study design and settingThis is a population-based retrospective cross-sectional study using electronic health records of adults registered between 2005 –2020 in general practices in one inner London borough (n = 826,936). Classification of resolved/remission was based on clinical coding defined by the patient's general practitioner. ResultsThe crude and age-adjusted prevalence of multimorbidity over the study period were 21.2% (95% CI: 21.1 –21.3) and 30.8% (30.6 –31.0), respectively. Applying resolved/remission codes decreased the crude and age-adjusted prevalence estimates to 18.0% (95% CI: 17.9 –18.1) and 27.5% (27.4 –27.7). Asthma (53.2%) and depression (20.2%) were responsible for most resolved and remission codes. Substance use (Adjusted Odds Ratio 10.62 [95% CI: 10.30 –10.95]), high cholesterol (2.48 [2.44 –2.53]), and moderate obesity (2.19 [2.15 –2.23]) were the strongest risk factor determinants of multimorbidity outside of advanced age. ConclusionOur study highlights the importance of applying resolved/remission codes to obtain an accurate prevalence and the increased burden of multimorbidity in a young, urban, and multi-ethnic population. Understanding modifiable risk factors for multimorbidity can assist policymakers in designing effective interventions to reduce progression to multimorbidity.
Highlights
IntroductionThose with multimorbidity have an increased risk of disability, mental health issues, and a reduced quality of life compared with those without[1,2]
Data on 826,936 patients aged ≥ 18 years were extracted from Lambeth DataNet (LDN). 816,901 were included in the study sample after exclusion of 10,035 patients with missing information on sex (
The crude prevalence of multimorbidity in the study sample was 21.2% and the age-adjusted prevalence was 30.8% (30.6 –31.0; Table 2)
Summary
Those with multimorbidity have an increased risk of disability, mental health issues, and a reduced quality of life compared with those without[1,2]. Individuals with multimorbidity have more consultations, prescriptions, hospital admissions, and longer lengths of hospital stay than those without [3,4,5]. A systematic review found a cut-off point of two or more long term conditions (LTCs) was used in 37% of multimorbidity studies, the considered LTCs ranged from 4 to 147, and 71% created a definition of multimorbidity instead of using an existing definition [7]. Multimorbidity and comorbidity are often used interchangeably, demonstrated by the fact that until 2018 “multimorbidity” was not assigned a distinct MeSH term [8]
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