Specific combinations of long-term conditions – or multimorbidity – are linked to a worse health-related quality of life and should be taken into account when assessing patients, a new UK-wide study suggests.
Research led by the University of Glasgow identified 24 clusters of multimorbidity which, when occurring in specific combinations, such as chronic pain, depression and cardiovascular disease, alongside other long-term conditions, were found to be associated with a reduced health-related quality of life.
The findings, published in the journal BMC Medicine, highlight the urgent need for targeted, cost-effective healthcare strategies to treat patients with multimorbidity.
In the UK, around 20-40% of adults live with multimorbidity, rising to over half in people aged 65 and over. Improved treatments and changing lifestyles mean more people live longer but are more likely to develop multimorbidity.
In socioeconomically deprived areas in the UK, the onset of multimorbidity can occur two decades earlier than in more affluent areas. Currently, healthcare systems most commonly treat single health conditions, leaving people with multimorbidity experiencing a high burden of treatment and disconnected healthcare, resulting in an increased morbidity risk.
Using data from over half a million people in the UK Biobank and the UK Household Longitudinal Study (UKHLS), the researchers identified age-stratified clusters of multimorbidity across four age strata: 18–36, 37–54, 55–73, and 74 years and over, and adjusted for sociodemographic and lifestyle variations.
The analysis showed 24 different multimorbidity clusters. Clusters of conditions related to pulmonary and cardiometabolic long-term conditions were common across all age groups. High blood pressure was also common across clusters in all age groups. In younger age groups, depression featured in multimorbidity clusters, and chronic pain and arthritis were associated with clusters of multimorbidity from middle age onwards.
Clusters involving chronic pain, depression and cardiovascular disease were all associated with worse overall quality of life. The data analysed from the UK Biobank showed that clusters of multimorbidity with a high prevalence of painful conditions were associated with the lowest quality of life. In the UKHLS data, cardiometabolic disease clusters were linked to a low quality of life.
The researchers found that those living with pain-related multimorbidity consistently experienced a low quality of life, regardless of the number of painful conditions they had.
Dr Bhautesh Jani, a clinical senior lecturer and honorary consultant at the School of Health and Wellbeing at the University of Glasgow, who was involved in the study, said: ‘Treatment and monitoring of long-term conditions is largely organised with a one-size-fits-all approach.
‘This study has identified potential combinations of long-term health conditions which often have the worst impact on long-term health-related quality of life. People with these combinations may benefit from tailored treatment and monitoring, which in turn may improve their long-term health and quality of life.’
A version of this article was originally published by our sister publication Nursing in Practice.
