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Research

The epidemiology of multimorbidity in primary care: a retrospective cohort study

Anna Cassell, Duncan Edwards, Amelia Harshfield, Kirsty Rhodes, James Brimicombe, Rupert Payne and Simon Griffin
Br J Gen Pract 2018; 68 (669): e245-e251. DOI: https://doi.org/10.3399/bjgp18X695465
Anna Cassell
School of Medicine, University of Utah, Salt Lake City, US.
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Duncan Edwards
Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
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Amelia Harshfield
Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
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Kirsty Rhodes
MRC Biostatistics Unit, University of Cambridge, Cambridge, UK.
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James Brimicombe
Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
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Rupert Payne
Centre for Academic Primary Care, University of Bristol, Bristol, UK.
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Simon Griffin
Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
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Abstract

Background Multimorbidity places a substantial burden on patients and the healthcare system, but few contemporary epidemiological data are available.

Aim To describe the epidemiology of multimorbidity in adults in England, and quantify associations between multimorbidity and health service utilisation.

Design and setting Retrospective cohort study, undertaken in England.

Method The study used a random sample of 403 985 adult patients (aged ≥18 years), who were registered with a general practice on 1 January 2012 and included in the Clinical Practice Research Datalink. Multimorbidity was defined as having two or more of 36 long-term conditions recorded in patients’ medical records, and associations between multimorbidity and health service utilisation (GP consultations, prescriptions, and hospitalisations) over 4 years were quantified.

Results In total, 27.2% of the patients involved in the study had multimorbidity. The most prevalent conditions were hypertension (18.2%), depression or anxiety (10.3%), and chronic pain (10.1%). The prevalence of multimorbidity was higher in females than males (30.0% versus 24.4% respectively) and among those with lower socioeconomic status (30.0% in the quintile with the greatest levels of deprivation versus 25.8% in that with the lowest). Physical–mental comorbidity constituted a much greater proportion of overall morbidity in both younger patients (18–44 years) and those patients with a lower socioeconomic status. Multimorbidity was strongly associated with health service utilisation. Patients with multimorbidity accounted for 52.9% of GP consultations, 78.7% of prescriptions, and 56.1% of hospital admissions.

Conclusion Multimorbidity is common, socially patterned, and associated with increased health service utilisation. These findings support the need to improve the quality and efficiency of health services providing care to patients with multimorbidity at both practice and national level.

  • comorbidity
  • health service utilisation
  • multimorbidity
  • primary health care
  • Received October 30, 2017.
  • Revision requested November 28, 2017.
  • Accepted January 9, 2018.
  • © British Journal of General Practice 2018

This article is Open Access: CC BY-NC 4.0 licence (http://creativecommons.org/licences/by-nc/4.0/).

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British Journal of General Practice: 68 (669)
Br J Gen Pract
Vol. 68, Issue 669
April 2018
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The epidemiology of multimorbidity in primary care: a retrospective cohort study
Anna Cassell, Duncan Edwards, Amelia Harshfield, Kirsty Rhodes, James Brimicombe, Rupert Payne, Simon Griffin
Br J Gen Pract 2018; 68 (669): e245-e251. DOI: 10.3399/bjgp18X695465

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The epidemiology of multimorbidity in primary care: a retrospective cohort study
Anna Cassell, Duncan Edwards, Amelia Harshfield, Kirsty Rhodes, James Brimicombe, Rupert Payne, Simon Griffin
Br J Gen Pract 2018; 68 (669): e245-e251. DOI: 10.3399/bjgp18X695465
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Keywords

  • comorbidity
  • health service utilisation
  • multimorbidity
  • primary health care

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© 2018 British Journal of General Practice

Print ISSN: 0960-1643
Online ISSN: 1478-5242