Multiple long-term conditions

Identifying those most at risk of progressing to multiple long-term conditions

We're commissioning research to explore who is most at risk of progression to multiple conditions, and to define a working set of long-term health conditions to guide our work.

Key partnership information

Partners: King’s College London and Outcomes Based Healthcare

Funding amount: £178,000

Duration: November 2018 – February 2019 (full research project lasts until 2021)

Programme: multiple long-term conditions

What we’re doing together

We’re working in partnership with academics at King’s College London and population data specialists Outcomes Based Healthcare, building on our initial research into people’s journeys to multiple long-term health conditions and explore further who is most at risk of progression to multiple conditions.

Aims of the partnership

As one of the first key milestones from the research, the teams from both organisations devised a rigorous method in consultation with patient representatives, partners from the NHS, local government and the voluntary sector to arrive at a definition of 32 long-term conditions and six risk factors. This work is relevant not only for our programme and people living in Lambeth and Southwark, but for anyone looking to address the issue in the UK and beyond.

There is no ‘right’ answer to what should be defined as multiple long-term conditions. This tailored definition is designed to be both specific to our local area while also nationally relevant based on detailed analysis, as well as consensus from local consultation.

We analysed national and international definitions of long-term conditions and consulted experts in the subject. Among other criteria, the research focused on:

Analysis of existing national and international definitions of long-term conditions
Impact of long-term conditions on people’s lives
Opportunity for prevention and/or whether a condition is amenable to change
Treatment burden
Likelihood of progression to further long-term conditions
Age of onset
Data quality for each condition

The work produced a recommended definition for a long-term condition as health conditions for which there is currently no cure, but which can be managed with drugs and other treatments. A long-term condition is one that lasts a year or longer and impacts on a person’s life.

As well as a recommended definition for multiple long-term conditions as the presence of two or more long-term conditions each of which is either:

A physical non-communicable disease of long duration, such as cardiovascular disease or cancer
A mental health condition of long duration, such as a mood disorder or dementia
An infectious disease of long duration, such as HIV or hepatitis C

Based on these factors, our definition of multiple long-term conditions includes 32 conditions – like diabetes, heart failure or depression – and six risk factors including high cholesterol, smoking and obesity.

Our programme will focus on these and, with our partners, we’ll be working on understanding more about people’s progression to multiple long-term conditions.

Our programme focus: 32 long-term conditions

Connection to our strategy

There is little evidence about who is at greatest risk of progression to multiple conditions or what is most effective in slowing down people’s journey. High blood pressure, obesity, smoking and drinking are risk factors that play a role, as do genetics, biology and the social determinants of health – the conditions in which people are born, grow, live, work and age.

While it’s not yet clear which factors contribute more than others, our initial research, From One to Many, explored how residents of Lambeth and Southwark journey towards multiple long-term conditions.

This and other work to date show significant variation in the length of time between people developing one and subsequent conditions. For example, in Lambeth, people living in the areas with the highest levels of deprivation are developing long-term conditions on average ten years earlier than those living in the most affluent.

We also do not know which groups of people are at a higher risk of becoming ill quickly or the best way to prevent this. We believe people’s progression from one to multiple long-term conditions is influenced by a complex mix of factors such as personal finances, housing and employment.

However, gaps in the evidence base mean we need to test and build evidenced interventions to better understand how to improve and protect our health. Through our programme, we’re focusing on what can be done to buck the trend and protect the health of people most at risk.