Abstract
Backgroundmodels projecting future disease burden have focussed on one or two diseases. Little is known on how risk factors of younger cohorts will play out in the future burden of multi-morbidity (two or more concurrent long-term conditions).Designa dynamic microsimulation model, the Population Ageing and Care Simulation (PACSim) model, simulates the characteristics (sociodemographic factors, health behaviours, chronic diseases and geriatric conditions) of individuals over the period 2014–2040.Populationabout 303,589 individuals aged 35 years and over (a 1% random sample of the 2014 England population) created from Understanding Society, the English Longitudinal Study of Ageing, and the Cognitive Function and Ageing Study II.Main outcome measuresthe prevalence of, numbers with, and years lived with, chronic diseases, geriatric conditions and multi-morbidity.Resultsbetween 2015 and 2035, multi-morbidity prevalence is estimated to increase, the proportion with 4+ diseases almost doubling (2015:9.8%; 2035:17.0%) and two-thirds of those with 4+ diseases will have mental ill-health (dementia, depression, cognitive impairment no dementia). Multi-morbidity prevalence in incoming cohorts aged 65–74 years will rise (2015:45.7%; 2035:52.8%). Life expectancy gains (men 3.6 years, women: 2.9 years) will be spent mostly with 4+ diseases (men: 2.4 years, 65.9%; women: 2.5 years, 85.2%), resulting from increased prevalence of rather than longer survival with multi-morbidity.Conclusionsour findings indicate that over the next 20 years there will be an expansion of morbidity, particularly complex multi-morbidity (4+ diseases). We advocate for a new focus on prevention of, and appropriate and efficient service provision for those with, complex multi-morbidity.
Highlights
Healthcare delivery was built, and generally remains centred, on the treatment of single diseases
The aim of this paper is to examine how key long-term conditions and multimorbidity will evolve between 2015 and 2035 in the population aged 65 years and over in England, using a new dynamic microsimulation model, Population Ageing and Care Simulation (PACSim)
Between 2015 and 2035 increases of more than 50% are projected in the number of older people affected by most individual diseases and impairments, the largest increases being for numbers having cancer (179.4%) and diabetes (118.1%) (Table 1); exceptions are CHD (22.1%), depression (−15.1%) and CIND (25.6%)
Summary
Healthcare delivery was built, and generally remains centred, on the treatment of single diseases. In addition to multi-morbidity, many of the very old have sensory impairment and incontinence [4], making a single disease-focused model of healthcare unsuitable [6]. Poor health behaviours such as obesity and physical inactivity are risk factors common to a number of diseases, but have received little attention as risk factors for multimorbidity [5]. A systematic review suggests that better risk factor management could be the key to improving outcomes for people with multi-morbidity [8]. Other risk factors for disease have improved in recent decades, with higher levels of education in more recent cohorts contributing to the reduction in prevalence and incidence of dementia [10]
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