Drivers

There is a wide range of factors that impact on the development of multiple long-term conditions

Evidence shows that there are underlying drivers that impact on the likelihood of developing multiple long-term conditions. These sit alongside immediate drivers which influence both likelihood and progression from one to several conditions.

In our work, we are particularly interested in how urban environment, high levels of diversity and deprivation affects people’s health. We know that drivers of multiple long-term conditions link with aspects including a person’s socio-economic status and ethnicity.

Research has shown that:

  • People from deprived areas are more likely to develop multiple long-term conditions earlier
  • There is emerging evidence of an association between ethnicity and multiple long-term conditions
  • As people age it is more likely that they’ll have more than one condition
  • A person’s social context, their education and ability to cope with life events such as bereavement, influences the likelihood and severity of long-term conditions

 

Deprivation

There appears to be a strong correlation between local deprivation and prevalence of multiple long-term conditions.

Most people with multiple long-term conditions live in the most deprived areas - typically developing their conditions 10-15 years before people in more affluent ones.

Increasing evidence suggests the prevalence of long-term conditions is concentrated in more deprived wards across Lambeth and Southwark:

  • In the relatively affluent Southwark Village, the prevalence of long-term conditions is ~10% with an income deprivation of 8.2%. In contrast, in the less affluent Nunhead ward, which has an income deprivation of 27.6%, the prevalence of long-term conditions is ~17.6%
  • In Lambeth’s Clapham Common the prevalence of long-term conditions is ~9.4% with an income deprivation of 13.7% whilst in Vassall ward, with an income deprivation of 27.4%, the prevalence of long-term conditions is higher at ~15%
Source: 1:Dodhia H and Crompton J (2016) 'Lambeth DataNet - Long-term Conditions: Multi-morbidity analysis - Summary 2013-2014 data'

 

Diversity

There is emerging evidence of a link between diversity and multiple long-term conditions. 

While the largest number of people with multiple long-term conditions are White, a larger proportion of Black and Asian people have multiple long-term conditions.

There is also a correlation between ethnicity and the number of uncontrolled risk factors – like high blood pressure or BMI – which can lead to the development of long-term conditions. Black or Black British have the largest relative numbers of people with two or more uncontrolled risk factors.

Black and Minority Ethnic populations are more likely to be diagnosed with mental health issues, experience a poor outcome from treatment and disengage from services.

 

Mental ill health

Mental ill health is both a driver of multiple long-term conditions and a consequence of having a physical long-term condition. This can interact with other drivers of multiple long-term conditions – for example, serious mental health disproportionately affects people from Black ethnicity populations.

We know that:

  • People with two or more long-term conditions are seven times more likely to have depression (NICE, 2009)
  • Physical and mental health co-morbidities result in a 45% increase in health costs for each person with both issues - from approximately £3,910 to £5,670 (Naylor et al, 2012)
  • People living with diabetes are two to three times more likely to have depression than the general population
  • Diabetes is two to three times more common in people with severe mental illness than in the general population (Doherty et al, 2015)

We have also learned key lessons from projects we have funded in the past:

  • Our supported 3 Dimensions of Care for Diabetes (3DFD) project showed that almost one third of people with diabetes have depression, which is in turn associated with worse glycaemic control, diabetic complications, increased costs and premature mortality
  • The Integrated Heart Failure Programme works holistically with patients knowing that 30-40% of heart failure patients are also depressed, and that patients with mental health issues and heart failure experience earlier mortality and greater morbidity

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