Abstract
BackgroundMultimorbidity is associated with mortality and service use, with specific types of multimorbidity having differential effects. Additionally, multimorbidity is often negatively associated with participation in research cohorts. Therefore, we set out to identify clusters of multimorbidity patients and how they are differentially associated with mortality and service use across age groups in a population-representative sample.MethodsLinked primary and secondary care electronic health records contributed by 382 general practices in England to the Clinical Practice Research Datalink (CPRD) were used. The study included a representative set of multimorbid adults (18 years old or more, N = 113,211) with two or more long-term conditions (a total of 38 conditions were included). A random set of 80% of the multimorbid patients (N = 90,571) were stratified by age groups and clustered using latent class analysis. Consistency between obtained multimorbidity phenotypes, classification quality and associations with demographic characteristics and primary outcomes (GP consultations, hospitalisations, regular medications and mortality) was validated in the remaining 20% of multimorbid patients (N = 22,640).ResultsWe identified 20 patient clusters across four age strata. The clusters with the highest mortality comprised psychoactive substance and alcohol misuse (aged 18–64); coronary heart disease, depression and pain (aged 65–84); and coronary heart disease, heart failure and atrial fibrillation (aged 85+). The clusters with the highest service use coincided with those with the highest mortality for people aged over 65. For people aged 18–64, the cluster with the highest service use comprised depression, anxiety and pain. The majority of 85+-year-old multimorbid patients belonged to the cluster with the lowest service use and mortality for that age range. Pain featured in 13 clusters.ConclusionsThis work has highlighted patterns of multimorbidity that have implications for health services. These include the importance of psychoactive substance and alcohol misuse in people under the age of 65, of co-morbid depression and coronary heart disease in people aged 65–84 and of cardiovascular disease in people aged 85+.
Highlights
Multimorbidity is associated with mortality and service use, with specific types of multimorbidity having differential effects
Data source Our analysis used the Clinical Practice Research Datalink (CPRD)-GOLD database where anonymised and longitudinal primary care clinical data are contributed by UK general practices (GP) who use the Vision health record system [19]
Among the multimorbid patients, all unique combinations of conditions were less than 1% prevalent in the total population with the most prevalent 20 containing only pairs of conditions (Additional file 2: table 2)
Summary
Multimorbidity is associated with mortality and service use, with specific types of multimorbidity having differential effects. We set out to identify clusters of multimorbidity patients and how they are differentially associated with mortality and service use across age groups in a population-representative sample. As a result of improved life expectancy and ageing populations, a growing number of individuals are living with multimorbidity, i.e. more than one long-term condition [1, 2]. Identifying and characterising groups of multimorbid patients that share similar patterns of long-term conditions might facilitate an improvement in their healthcare. Such an approach might aid the development of effective strategies for early diagnosis and prevention of multimorbidity and allow for a better design and delivery of targeted interventions [1, 9]. The validity and generalisability of cluster solutions in new samples is important for decision-making but is often ignored in the current literature [10, 11]
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