The influence of socioeconomic deprivation on multimorbidity at different ages: a cross-sectional study

Gary McLean; Jane Gunn; Sally Wyke; Bruce Guthrie; Graham CM Watt; David N Blane; Stewart W Mercer

doi:10.3399/bjgp14X680545

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Figure 1
Number and type of chronic condition for overall population by number of patients (least and most deprived deciles).
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Figure 2
Prevalence of most common conditions in multimorbid patients, by age and deprivation. CKD = chronic kidney disease. CHD = coronary heart disease

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Table 1

Prevalence of chronic morbidity

Age group, years	Adult population (n = 1 272 685) n (%, 95% CI)	No conditions (n = 597 363) n (%, 95% CI)	One condition (n = 279 015) n (%, 95% CI)	Two or more conditions (n = 396 307) n (%, 95% CI)
25–34	229 396 (18.0)	169 747 (74.0)	40 962 (17.9)	18 687 (8.1)
	(17.9 to 18.1)	(73.8 to 74.0)	(17.7 to 18.0)	(8.0 to 8.2)
35–44	278 993 (21.9)	179 338 (64.3)	60 771 (21.8)	38 884 (13.9)
	(21.8 to 22.0)	(64.2 to 64.4)	(21.7 to 21.9)	(13.8 to 14.0)
45–54	253 794 (19.9)	131 920 (52.0)	63 453 (25.0)	58 421 (23.0)
	(19.8 to 20.0)	(51.0 to 52.1)	(24.9 to 25.1)	(22.8 to 23.2)
55–64	219 333 (17.2)	75 843 (34.6)	58 171 (26.5)	85 319 (38.9)
	(17.1 to 17.3)	(34.5 to 34.7)	(26.3 to 26.7)	(38.7 to 39.1)
65–74	155 280 (12.2)	28 662 (18.5)	35 068 (22.6)	91 550 (59.0)
	(12.1 to 12.3)	(18.3 to 18.7)	(22.4 to 22.8)	(58.7 to 59.2)
≥75	135 889 (10.7)	11 853 (8.7)	20 590 (15.2)	103 446 (76.1)
	(10.6 to 10.8)	(8.5 to 8.9)	(15.0 to 15.3)	(75.9 to 76.3)

Analysis based on 40 chronic conditions: 32 physical and eight mental. Percentages in ‘adult population’ column relate to distribution of age groups within the sample, whereas percentages in the conditions columns relate to distribution within each separate age group.

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Table 2

Type of multimorbidity for people with any multimorbidity

Age group	Physical-only multimorbidity n (%, 95% CI)	Mental-only multimorbidity n (%, 95% CI)	Mixed physical and mental multimorbidity n (%, 95% CI)
25–34 (n = 18 687)	5110 (27.3)	4019 (21.5)	9558 (51.1)
	(26.7 to 28.0)	(20.9 to 22.1)	(50.4 to 51.9)
35–44 (n = 38 884)	13 240 (34.0)	4987 (12.8)	20 657 (53.1)
	(33.5 to 34.5)	(12.4 to 13.2)	(52.6 to 53.6)
45–54 (n = 58 421)	26 642 (45.6)	3138 (5.4)	28 641 (49.0)
	(45.1 to 46.0)	(5.1 to 5.5)	(48.6 to 49.4)
55–64 (n = 85 319)	49 771 (58.3)	1626 (1.9)	33 922 (39.8)
	(58.0 to 58.6)	(1.8 to 2.0)	(39.4 to 40.1)
65–74 (n = 91 550)	62 536 (68.3)	665 (0.7)	28 349 (31.0)
	(68.0 to 68.6)	(0.6 to 0.8)	(30.7 to 31.3)
≥75 (n = 103 446)	65 912 (63.7)	586 (0.6)	36 948 (35.7)
	(63.4 to 67.0)	(0.5 to 0.7)	(35.4 to 36.0)
Total	223 211 (56.3)	15 021 (3.8)	158 075 (39.9)
	(56.1 to 56.4)	(3.7 to 3.9)	(39.7 to 40.0)

Analysis based on 40 chronic conditions: 32 physical and eight mental. Percentages are the % in each age group.

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Table 3

Differences between types of multimorbidity by age group and deprivation

Age group, years	Physical-only multimorbidity n (%, 95% CI)		Mental-only multimorbidity n (%, 95% CI)		Mixed physical and mental multimorbidity n (%, 95% CI)
Age group, years	Most deprived	Least deprived	Most deprived	Least deprived	Most deprived	Least deprived
25–34	447 (1.9)	340 (1.9)	613 (2.6)	159 (0.9)	1289 (5.4)	465 (2.7)
	(1.7 to 2.1)	(1.7 to 2.1)	(2.4 to 2.8)	(0.7 to 1.1)	(5.1 to 5.6)	(2.4 to 2.9)
35–44	1061 (4.3)	1040 (4.1)	815 (3.3)	231 (0.9)	2844 (11.5)	1006 (3.9)
	(4.1 to 4.5)	(3.8 to 4.3)	(3.0 to 3.5)	(0.7 to 1.1)	(11.1 to 11.9)	(3.7 to 4.1)
45–54	2087 (10.3)	2279 (8.9)	440 (2.2)	184 (0.7)	3795 (18.8)	1567 (6.1)
	(10.0 to 10.7)	(8.5 to 9.2)	(2.0 to 2.4)	(6.2 to 8.3)	(18.2 to 19.3)	(5.8 to 6.4)
55–64	3301 (22.9)	4556 (20.4)	147 (1.0)	123 (0.6)	3705 (25.7)	2156 (9.7)
	(22.1 to 23.8)	(19.9 to 20.9)	(0.8 to 1.2)	(4.5 to 6.5)	(24.9 to 26.4)	(9.2 to 10.0)
65–74	4423 (39.1)	5316 (37.9)	50 (0.4)	65 (0.5)	3128 (27.6)	1902 (13.6)
	(38.2 to 39.9)	(37.1 to 38.7)	(0.2 to 0.4)	(0.3 to 0.5)	(26.8 to 28.4)	(13.0 to 14.1)
≥75	4177(46.1)	6200 (48.1)	37 (0.4)	52 (0.4)	2887 (31.8)	3488 (27.0)
	(45.0 to 47.1)	(47.2 to 48.9)	(0.2 to 0.5)	(0.3 to 0.5)	(30.8 to 32.8)	(26.2 to 27.8)

Analysis based on 40 chronic conditions: 32 physical and eight mental. Percentages are the % in each age group/deprivation group (n = 103 695 most deprived, 117 708 least deprived).

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Table 4

Age differences between the top 10 most prevalent conditions in multimorbid patients

Rank order of conditions	Age 25–34 % (95% CI) n = 18 687	Age 35–44 % (95% CI) n = 38 884	Age 45–54 % (95% CI) n = 58 421	Age 55–64 % (95% CI) n = 85 319	Age 65–74 % (95% CI) n = 91 550	Age ≥75 % (95% CI) n = 103 446
1	Depression 46.1 (45.3 to 46.8)	Depression 46.9 (46.4 to 47.4)	Depression 38.8 (38.4 to 39.2)	Hypertension 48.5 (49.2 to 48.9)	Hypertension 58.3 (58.0 to 58.6)	Hypertension 61.9 (61.5 to 62.3)
2	Drug misuse 25.9 (25.2 to 26.5)	Pain 26.4 (25.9 to 26.8)	Hypertension 30.9 (30.4 to 31.2)	Pain 31.3 (31.0 to 31.6)	Pain 30.0 (29.7 to 30.3)	CHD 31.2 (30.9 to 31.5)
3	Asthma 23.1 (22.4 to 23.7)	Asthma 19.0 (18.6 to 19.4)	Pain 29.6 (29.2 to 30.0)	Depression 28.0 (27.8 to 28.3)	CHD 26.1 (25.8 to 26.4)	Pain 23.6 (23.3 to 23.8)
4	Anxiety 19.8 (19.3 to 20.4)	Anxiety 17.8 (17.4 to 18.1)	Dyspepsia 18.4 (18.1 to 18.7)	Diabetes 17.7 (17.4 to 18.0)	Diabetes 21.1 (20.8 to 21.4)	CKD 18.5 (18.2 to 18.7)
5	Pain 19.1 (18.6 to 19.7)	Dyspepsia 16.5 (16.1 to 16.8)	Asthma 14.2 (13.9 to 14.4)	Dyspepsia 17.2 (16.9 to 17.4)	Depression 18.5 (18.3 to 18.8)	Depression 17.2 (17.0 to 17.4)
6	Alcohol dependence 14.5 (14.0 to 15.0)	IBS 15.2 (14.8 to 15.5)	Diabetes 13.6 (13.4 to 13.9)	CHD 15.9 (15.6 to 16.1)	Dyspepsia 15.9 (15.7 to 16.2)	Diabetes 17.2 (17.0 to 17.5)
7	IBS 14.4 (13.9 to 14.9)	Drug misuse 14.8 (14.4 to 15.1)	Anxiety 13.6 (13.3 to 13.9)	Thyroid 13.9 (13.7 to 14.2)	COPD 14.6 (14.4 to 14.8)	Constipation 17.0 (16.7 to 17.2)
8	Dyspepsia 10.4 (10.0 to 10.8)	Hypertension 13.7 (13.3 to 14.0)	IBS 13.5 (13.3 to 13.8)	IPA 13.3 (13.1 to 13.7)	Thyroid 14.5 (14.3 to 14.8)	Stroke 16.6 (16.4 to 16.8)
9	Thyroid 7.5 (7.1 to 7.8)	Alcohol dependence 13.3 (13.0 to 13.6)	Thyroid 13.1 (12.8 to 13.4)	COPD 11.1 (10.8 to 11.3)	IPA 13.7 (13.5 to 13.9)	Thyroid 15.9 (15.7 to 16.1)
10	Hearing loss 6.9 (6.6 to 7.3)	Thyroid 10.9 (10.6 to 11.2)	Alcohol dependence 12.3 (12.0 to 12.6)	Anxiety 10.8 (10.6 to 11.0)	Stroke 10.5 (10.3 to 10.7)	Hearing loss 15.5 (15.3 to 15.7)

CKD = chronic kidney disease. CHD = coronary heart disease. COPD = chronic obstructive pulmonary disease. IBS = irritable bowel syndrome. IPA = Inflammatory poly-arthropathy and includes rheumatoid arthritis and related conditions, systemic connective tissue disorders, and gout. Drug misuse includes prescription drug misuse of varying degrees.