ArticleBMJ open2019
Journey to multimorbidity: longitudinal analysis exploring cardiovascular risk factors and sociodemographic determinants in an urban setting.
Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 62 papers, 2 of them syntheses that pooled it.
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Who cites it
62 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Sociodemographic intersections and risk of multiple long-term conditions: A systematic review.PloS one · 2025Pooled it
- Ethnic inequalities in multiple long-term health conditions in the United Kingdom: a systematic review and narrative synthesis.BMC public health · 2023Pooled it
- Antidepressant use at the threshold: people prescribed antidepressants around the time of a dementia diagnosis.Age and ageing · 2026Article
- Cardiovascular-Kidney-Metabolic (CKM) Syndrome Staging and Relevance to Precision Nutrition.Nutrients · 2026Review
- Cultural Adaptations of Healthcare Interventions: A Step-by-Step Guide.Health expectations : an international journal of public participation in health care and health policy · 2026Article
- Is living on the coast associated with midlife multimorbidity in England and Wales? A cross-birth cohort analysis of the relationship between long-term residence and selective migration.BMJ public health · 2026Article
- Cardiovascular risk assessed by the conicity index in Brazilian adults: findings from the national health survey.Frontiers in nutrition · 2026Article
- Metabolic obesity phenotypes and their transitions as determinants of multimorbidity trajectories: evidence from global aging cohorts.Diabetology & metabolic syndrome · 2025Article
- Letter to the editor: Reassessing predictive models for hypertension control in resource-constrained settings.International journal of cardiology. Cardiovascular risk and prevention · 2025Article
- Long-term accrual of conditions following myocardial infarction: a study of disease trajectories in the Wales Multimorbidity e-Cohort.BMC medicine · 2025Article
- Quantifying cost and health-related quality of life outcomes in different multimorbidity trajectories: a systematic review protocol.BMJ open · 2025Article
- Sequential Patterns and Transition Timelines of Chronic Disease Comorbidities in Obesity: Evidence from the ELSA database.Research square · 2025Article
- Navigating Complexities: Clinical Decision-Making in Patients With Multiple Comorbidities.Cureus · 2025Article
- Prevalence, combination patterns, and quality of life factors of multimorbidity among older adults in southern China based on the health ecological model.Journal of global health · 2025Article
- Investigation of multimorbidity patterns and association rules in patients with type 2 diabetes mellitus using association rules mining algorithm.Scientific reports · 2025Article
- Clustering and visualisation of the GABRIEL network expertise in the field of infectious diseases.BMJ global health · 2025Article
- Multimorbidity Patterns, Hospital Uses and Mortality by Race and Ethnicity Among Oldest-Old Patients.Journal of racial and ethnic health disparities · 2025Article
- Article
- Identifying multimorbidity risks in older adults: a cross-sectional study using the RGA screening data.Frontiers in public health · 2025Article
- From curing to caring: exploring social care needs after the onset of chronic conditions among European older adults (50+).Innovation in aging · 2025Article
2 more citing papers are in PubMed but not listed here.
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo study the social determinants and cardiovascular risk factors for multimorbidity and the acquisition sequence of multimorbidity.
designLongitudinal study based on anonymised primary care data.
settingGeneral practices in an urban multiethnic borough in London, UK.
participants332 353 patients aged ≥18 years.
main outcome measuresClinical and sociodemographic characteristics of patients with multimorbidity, defined as ≥3 of 12 long-term conditions (LTCs) selected according to high predicted healthcare use. Multilevel logistic regression was used to model social determinants and cardiovascular risk factors. Alluvial plots were constructed to illustrate multimorbidity acquisition sequences according to age, ethnicity and social deprivation.
results5597 (1.7%) patients had ≥3 selected LTCs, the 'multimorbidity cohort'. The the most common LTCs were diabetes (63.0%) and chronic pain (CP) (42.8%). Social deprivation and ethnicity were independent determinants of multimorbidity: most compared with the least deprived quintile (adjusted OR (AOR) 1.56 (95% CI 1.41 to 1.72)); South Asian compared with white ethnicity (AOR 1.44 (95% CI 1.29 to 1.61)); and black compared with white ethnicity (AOR 0.86 (95% CI 0.80 to 0.92)). The included cardiovascular risk factors were relatively strong determinants of multimorbidity: hypertension (AOR 5.05 (95% CI 4.69 to 5.44)), moderate obesity (AOR 3.41 (95% CI 3.21 to 3.63)) and smoking (AOR 2.30 (95% CI 2.16 to 2.45)). The most common initial onset conditions were diabetes and depression; diabetes particularly in older and black ethnic groups; and depression particularly in younger, more deprived and white ethnicity groups. CP was less common as an initial condition.
conclusionOur findings confirm the importance of age, social deprivation and ethnicity as determinants of multimorbidity. Smoking, obesity and hypertension as cardiovascular risk factors were stronger determinants of multimorbidity than deprivation or ethnicity. The acquisition sequence of multimorbidity is patterned by sociodemographic determinants. Understanding onset conditions of multimorbidity and cardiovascular cardiovascular risk factors may lead to the development of interventions to slow the progression of multimorbidity.
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