ArticleThe Lancet regional health. Europe2022
Inequalities in developing multimorbidity over time: A population-based cohort study from an urban, multi-ethnic borough in the United Kingdom.
Article in The Lancet regional health. Europe, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 1 of them a synthesis that pooled it.
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Who cites it
31 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Sociodemographic intersections and risk of multiple long-term conditions: A systematic review.PloS one · 2025Pooled it
- Asthma and Multimorbidity Amongst Ethnic Minority Groups in High Income Countries.Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology · 2026Review
- Learning from scale-up: a qualitative study of scaling-up interventions for people with multiple long-term conditions in primary care.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2026Article
- Understanding Remission of Long-Term Conditions Through Electronic Health Records: Scoping Review.Journal of medical Internet research · 2026Article
- Relationship between socioeconomic inequality and multimorbidity progression in UK Biobank data.Communications medicine · 2026Article
- Determinants of the onset and development of multimorbidity in different subpopulations of older Chinese adults: insights from the China Health and Retirement Longitudinal Study.Annals of medicine · 2025Article
- Intersecting social determinants of health, multimorbidity and quality of life in people of Black ethnicities with HIV in South London.AIDS (London, England) · 2025Article
- Multimorbidity and risk of atrial fibrillation in the Lifelines cohort.European heart journal open · 2025Article
- Chronic pain: prevalence, demographic inequalities, and healthcare utilisation. A primary care database analysis.BJGP open · 2025Article
- Rising to the challenges of research in multiple long-term conditions: health and social care research ecosystem approaches.BMJ open · 2025Review
- Article
- A syndemic approach to the study of Covid-19-related death: a cohort study using UK Biobank data.Journal of public health (Oxford, England) · 2025Article
- Inequality in the accumulation of diseases and medications among older adults: a longitudinal cohort study 2016-2021.BMJ public health · 2025Article
- Racial inequalities in the development of multimorbidity of chronic conditions: results from a Brazilian prospective cohort.International journal for equity in health · 2024Article
- Identifying multi-resolution clusters of diseases in ten million patients with multimorbidity in primary care in England.Communications medicine · 2024Article
- Prevalence of multiple long-term conditions (multimorbidity) in England: a whole population study of over 60 million people.Journal of the Royal Society of Medicine · 2024Article
- Article
- Association between dental visit behavior and mortality: a nationwide longitudinal cohort study from NHANES.Clinical oral investigations · 2023Article
- Sociodemographic characteristics and longitudinal progression of multimorbidity: A multistate modelling analysis of a large primary care records dataset in England.PLoS medicine · 2023Article
- Identifying populations with chronic pain in primary care: developing an algorithm and logic rules applied to coded primary care diagnostic and medication data.BMC primary care · 2023Review
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12 authors.
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Abstract
backgroundSocial and material deprivation accelerate the development of multimorbidity, yet the mechanisms which drive multimorbidity pathways and trajectories remain unclear. We aimed to examine the association between health inequality, risk factors and accumulation or resolution of LTCs, taking disease sequences into consideration.
methodsWe conducted a retrospective cohort of adults aged 18 years and over, registered between April 2005 and May 2020 in general practices in one inner London borough (
findingsParticipants were followed up for a median of 4.2 years (IQR = 1·8 - 8·4); 631,760 (76%) entered the study with no LTCs, 121,424 (15%) with 1 LTC, 41,720 (5%) with 2 LTCs, and 31,966 (4%) with three or more LTCs. At the end of follow-up, 194,777 (24%) gained one or more LTCs, while 45,017 (5%) had resolved LTCs and 27,021 (3%) died. In multistate models, deprivation (hazard ratio [HR] between 1·30 to 1·64), female sex (HR 1·13 to 1·20), and Black ethnicity (HR 1·20 to 1·30; vs White) were independently associated with increased risk of transition from one to two LTCs, and shorter time spent in a healthy state. Substance use was the strongest risk factor for multimorbidity with an 85% probability of gaining LTCs over the next year. First order Markov chains identified consistent disease sequences including: chronic pain or osteoarthritis followed by anxiety and depression; alcohol and substance dependency followed by HIV, viral hepatitis, and liver disease; and morbid obesity followed by diabetes, hypertension, and chronic pain.
interpretationWe examined the relations among 32 LTCs, taking the order of disease occurrence into consideration. Distinctive patterns for the development and accumulation of multimorbidity have emerged, with increased risk of transitioning from no conditions to multimorbidity and mortality related to ethnicity, deprivation and gender. Musculoskeletal disorders, morbid obesity and substance abuse represent common entry points to multimorbidity trajectories.
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