Multiple long-term conditions

From one to many

20 July 2018

Exploring people’s progression to multiple long-term conditions in an urban environment

In brief

Over 15 million people in the UK live with one long-term health condition and around three million have three or more. It is a complex and growing phenomenon which has a significant impact on people, their carers and communities. It also places huge pressure on our health and care systems. Our aim is to use this work as a starting point for a wider conversation around multiple long-term conditions, the implications for people and systems, and potential opportunities for intervention.

Executive summary

Over 15 million people in the UK live with one long-term health condition and around three million have three or more. By better understanding the diseases that people develop over time or people’s progression to multiple health conditions, we may begin to understand some of the complexity, underlying issues and impact on quality of life. And by focusing on the lives of people with multiple long-term conditions rather than a set of individual conditions, we begin to understand more about how we might be able to intervene early to prevent progression from one to many long-term conditions.

Key observations

This is not just a problem of old age

The common view of multiple long-term conditions is that it is just about older people. Whilst age is clearly a major factor, this narrative does not take into account where progression from single to multiple conditions begins, the role of risk factors, nor significant influences of ethnicity and gender and the complex interplay between them.

Whilst old age is a significant factor in predicting the likely prevalence of multiple long-term conditions, it is by no means the only factor. In Lambeth, around a third of people with multiple long-term conditions are diagnosed under the age of 65. People living in deprived areas are more likely to develop multiple long-term conditions on average 13 years earlier than people living in more affluent areas.

Our analysis also suggests that there may be a link between ethnicity and the risk of developing multiple long-term conditions. Our evidence has shown that members of the South Asian and black communities acquire them at a younger age than the white population.

A single disease focus may miss the combined impact on the person

Rather than managing many sets of individual symptoms, our analysis shows common patterns in people’s diagnosis of long-term conditions. Looking at the most frequent journeys to multiple health conditions can help us identify patterns of acquisition and how best to tackle these. For example, diabetes is the starting point for the majority of the most common journeys and chronic pain is a common feature in more than half of recorded journeys in Lambeth.

Our view is that multiple long-term conditions and the progression from one to many should be approached as a collective, specific and complex issue, requiring particular care, treatment and support.

I’ve got chronic pains. I was going to the pain clinic thinking that I would finally find a cure for it. No, they don’t have a cure for pain. I said to her, I said, ‘Well, what do I do?’ She said, ‘You just have to learn to manage it and use things to manage it.’

Jacqueline, 54

The importance of social context

Like many urban areas, Lambeth and Southwark’s dense environment, complex ethnic and social mix and high levels of income inequality provide important context to the health of residents.

A close review of Lambeth data suggests that a person’s ethnicity may play a role as a driver of multiple long-term conditions. Both black and Asian ethnic groups are overrepresented in the total multiple long-term conditions patient group. The data indicate that, as well as developing multiple conditions on average 10 years earlier than white people, black people are doing so over a timespan that is 11.5 years shorter.

This suggests that black people are more likely to live longer with complex health conditions, disproportionately impacting their lives. Similarly, there are clear patterns of health inequalities linked to levels of deprivation in Lambeth. Data from people attending A&E in Lambeth show that people from the most deprived areas acquire multiple long-term conditions around five years earlier than those living in the least deprived areas by the time they’re 50.

Our data do not confirm whether ethnicity and deprivation are compounding factors that would predict even earlier diagnosis of initial or multiple long-term conditions. However, they provide a signal, down to neighbourhood level, that a person’s social context plays a role in their progression to multiple conditions.

Building on these insights

This research is just getting going and, by its nature, raises more questions than it gives answers. These questions may give helpful hints as to how we, and we hope others, can build on these insights, especially given the embryonic stage of research into multiple long-term conditions. We would like to work with others to explore some key points:

How do we reframe the issue of multiple long-term conditions as a challenge distinct from a collection of individual diseases and something that affects people of all ages?
How do we better understand progression to multiple long-term conditions by understanding the experience of individuals and utilising existing data?
How do we work with communities that are disproportionately affected to identify opportunities to act – to slow down progression and improve the quality of lives for people living with multiple long-term conditions?