Patients with several medical conditions is common and the UK health system has not been designed to cope with this.
This is the finding from research published online first in The Lancet today.
The study, funded by the Scottish Government Chief Scientist Office, found that contrary to popular belief most patients with two or more conditions are under 65 years of age.
The authors from two Scottish universities estimated the burden of multimorbidity, and of comorbidity involving both physical and mental health disorders, in relation to age and socioeconomic deprivation. They took a snapshot of data on 40 common chronic conditions from a database of 1.75 million people registered with 314 medical practices in Scotland. For each of the 40 conditions, people with only that condition were a minority.
They found that around 2 in 5 patients (42%) had one or more conditions, and almost a quarter (23%) had 2 or more and thus had multimorbidity. Although the prevalence of multimorbidity increased substantially with age and was present in most people aged over 65, the absolute number of people with multimorbidity was higher in those under 65 (210 500 vs 195 000).
Importantly, the onset of multimorbidity occurred 10–15 years earlier in people living in the most deprived areas compared with the most affluent, with socioeconomic deprivation particularly associated with the combination of physical and mental health disorders. The risk of having a mental health disorder increased as the number of physical morbidities increased. Those with five or more physical conditions were around four times more likely to have a co-existing mental disorder while those in deprived areas were twice as likely to have a co-existing mental disorder as those in affluent areas.
“Our findings challenge the single-disease framework by which most health care, medical research, and medical education is configured,” say the authors.
“Existing approaches need to be complemented by support for the work of generalists, mainly but not exclusively in primary care, providing continuity, coordination, and above all a personal approach for people with multimorbidity. To avoid widening inequality, this approach is most needed in socioeconomically deprived areas, where multimorbidity happens earlier, is more common, and more frequently includes physical–mental health comorbidity.”
The authors said the current health system needs to be ‘radically changed’ to cope.
Dr Chris Salisbury School of Social and Community Medicine, University of Bristol, UK, in a linked comment, warned that the expenditure of health care rises exponentially with the number of chronic disorders that an individual has.
“Increasing multimorbidity generates financial pressures. This economic burden heightens the need to manage people with several chronic illnesses in more efficient ways.”
Dr Salisbury suggests that general practitioners in more deprived areas should have lower case loads to account for higher levels of multiple morbidity and that in hospitals, those with multimorbidity should be assigned to a generalist consultant who would be responsible for coordinating their care.
Health Secretary Nicola Sturgeon said the Scottish Government is working in partnership with NHS, primary care providers, patients and the research community to have ‘effective systems in place to address the needs of people with multiple health conditions and to reduce these health inequalities.”