New research on multiple medical conditions

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New research showing that having several medical conditions is not just a feature of old age has been published online in The Lancet.

The study, which was funded by the Scottish Government Chief Scientist Office, was led by Bruce Guthrie, Professor of Primary Care Medicine at the School of Medicine and colleagues here and at Glasgow University.

It involved taking a snapshot of data on 40 common chronic conditions from a database of 1.75 million people registered with 314 medical practices in Scotland. For each of the 40 conditions, people with only that condition were a minority.

The research team found that around 2 in 5 patients (42%) had one or more conditions, and almost a quarter (23%) had 2 or more and thus had multimorbidity. Although the prevalence of multimorbidity increased substantially with age and was present in most people aged over 65, the absolute number of people with multimorbidity was higher in those under 65.

Importantly, the onset of multimorbidity occurred 10-15 years earlier in people living in the most deprived areas compared with the most affluent, with socioeconomic deprivation particularly associated with the combination of physical and mental health disorders.

The risk of having a mental health disorder increased as the number of physical morbidities increased. Those with five or more physical conditions were around four times more likely to have a co-existing mental disorder while those in deprived areas were twice as likely to have a co-existing mental disorder as those in affluent areas.

"Our findings challenge the single-disease framework by which most health care, medical research, and medical education is configured,” the authors said. “Existing approaches need to be complemented by support for the work of generalists, mainly but not exclusively in primary care, providing continuity, coordination, and above all a personal approach for people with multimorbidity.

“To avoid widening inequality, this approach is most needed in socioeconomically deprived areas, where multimorbidity happens earlier, is more common, and more frequently includes physical-mental health comorbidity.”