Background Health services, guidelines and epidemiology largely focus on single conditions. However, multimorbidity (typically defined as >1 long-term condition), is an increasingly important, but inconsistently conceptualised, socio-economically patterned phenomenon challenging this approach. This paper explores whether using both short and long-term conditions to classify multimorbidity helps to better understand the health outcomes of working-age adults.
Methods Population: adults aged 16–64 in Scotland. Data: 2008–2011 Scottish Health Survey. Sample design: stratified, geographically unclustered, random probability Postcode Address File (PAF) sample (designed to facilitate combined years’ analysis). Interviewers recorded long-term conditions (>1 year) and “any other health problems” verbatim (without objective verification). Six health states were derived, combining long-term conditions (0, 1, >1) and absence/presence of other health problems. Outcomes: GHQ12 score >4; Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) score >1 SD below population mean; life-satisfaction below population mode; bad/very bad self-rated health. Computer-assisted personal interviews and self-completion questionnaires (GHQ12/WEMWBS) were used. The associations between health states and outcomes (adjusted for age, sex and area deprivation), were estimated using logistic regression. The reference category was 1 long-term condition and no other problems (to estimate the effect of multiple conditions, and other problems, separately).
Results Differential selection and non-response weights were applied to percentages and odds ratios (ORs). Denominators are unweighted. Multimorbidity increases markedly with age, so analysis was restricted to ages 16–64 (n=21,369). 36% had >1 long-term condition, 13% reported other health problems (16% of those with multiple long-term conditions, n=3019). For brevity, only GHQ12 results are presented; the patterns for all other outcomes were identical. Compared with people with 1 long-term condition and no additional problems (n=4213), the OR of having a GHQ12 score of >4 were (p > 0.001): >1 long-term condition and additional health problems, 3.5 (95% CI: 2.8–4.4) [n=458]; >1 long-term condition and no additional problems, 2.4 (2.1–2.7) [n=2315]; 1 long-term condition and other health problems, 1.8 (1.5–2.2) [n=631]; No long-term conditions but other health problems, 0.8 (0.7–0.9) [n=1711]; No long-term conditions or other health problems, 0.5 (0.4–0.5) [n=10,482].
Discussion Focusing solely on long-term conditions doesn’t capture the extent of people’s condition burden: having long-term conditions and additional health problems is significantly associated with worse physical and mental health, with the effect-size greatest for people with multiple long-term conditions. Better understanding of the interaction between longer and shorter-term conditions (including better case-finding, iatrogenesis and overtreatment) and their impact on outcomes will help to improve interventions for this highly heterogeneous – and socially disadvantaged – group.
Conclusion Long-term conditions are only part of the story.
- long-term conditions
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.