Researchers reveal how patients in urban areas develop multiple, long-term conditions

A study led by Dr Mark Ashworth, Dr Maria Kordowicz and Professor Judith Green, School of Population Health & Environmental Sciences, reveals the complex reasons that patients develop multiple, long-term conditions in urban areas.

Long-term conditions like coronary heart disease, diabetes and COPD are normally defined as having no cure but can be managed with drugs and other treatments. There are about three million people in the UK living with three or more such conditions (known as multimorbidity) and, although this has historically been associated with old age, those in deprived areas often develop multimorbidity up to 15 years earlier.

To better understand this, researchers from the School of Population Health & Environmental Sciences examined the anonymized GP records of patients from the inner-London borough of Lambeth. With a population of about 320,000 this area is densely populated, diverse, young and has high levels of income inequality.

Their analysis, published in a new report by Guy's & St Thomas' Charity, shows that while age is a factor it is certainly not the only one and that people's background and social context also play important roles.

Speaking of the results Dr Ashworth said:

I welcome this report. It shows that multimorbidity matters. And now we know how much it matters: to deprived communities, to ethnic minority groups and to individuals experiencing the burden of multiple illnesses. The data shows, for example, that in Lambeth the black community experiences multimorbidity some 10 years earlier than the white community and that those living in the most deprived areas experience multimorbidity between 10-12 years earlier than those in the least. Further work is needed to explore the reasons why.'The authors also highlight that focussing on later life alone misses opportunities to intervene earlier and that treating individual diseases underestimates the combined impact on a patient and the progression of one condition to another. Depression, for example, is more likely to be diagnosed at a younger age and is a common precursor to diabetes, morbid obesity and chronic pain. Less than ten percent of the local population have diabetes but more than sixty percent of residents with multiple long-term conditions do."

Across Lambeth and neighboring Southwark approximately one in five (140,000) residents live with one long-term condition and over 19,000 live with three or more. Dr Kordowicz, who led the qualitative analysis in both boroughs said:

An ethnographic exploration of multimorbidity revealed a need to move away from a single-disease focus towards greater holism. We also found that working within communities is vital to promote a whole-person approach."