Our paper “Progression of multiple long-term conditions (multimorbidity) in England: a population-based descriptive study of 49.6 million adults” has been published in The Lancet Public Health.

After months of analysis, writing, iteration, and robust peer-review following first submission nine months ago, OBH are delighted to share the results of the largest ever study of multiple long term condition (MLTC) progression. We want to give a huge thanks to our collaborators and coauthors in the amazing Multiple Long Term Conditions (MLTC) Working Group from many partner organisations who have made this possible.

We measured the rate of progression of MLTC (acquisition of an additional long-term condition) across adults in England, examining the association with sociodemographic factors and initial condition count. We also measured age and sex-specific incidence of 28 significant long term conditions that are considered essential to include in multimorbidity analyses (results in supplementary appendix).

Key findings:

  •  The eight most commonly occurring first conditions in adults (first described here as potential “gateway conditions” to MLTC) all have known associations with both smoking and obesity.
  • Progression rate was strongly associated with the initial number of conditions, even within the same age groups. For example, the progression rate in people in their 30s and 40s with two long-term conditions is almost 50% higher than those with only one long-term condition. This suggests that primary prevention of potential “gateway conditions” may have a disproportionate impact on later progression to MLTCs.
  • MLTC progression rate is strongly associated with socioeconomic deprivation in all ethnic groups, except for the black ethnic group in which it is uniformly high, even among less deprived groups.

These findings are important as they:

  •  Highlight the importance of preventative interventions early in life to avoid or delay the onset of first conditions and slow the progression of MLTC.
  • Show the value of intersectional approaches to health research and policy, to understand the interaction between individual sociodemographic characteristics.
  • Demonstrate the utility of longitudinal whole-population data for gaining granular insights into the health dynamics of the population to inform prevention and public health policy.

The Lancet Editorial comments that the findings “could have profound implications for the design of health systems and for public health practice”.

Read the paper here