Understanding the journey to developing multiple long-term conditions

The aim of this research was to develop and test approaches to population segmentation in Lambeth and Southwark to help identify people who are at the highest risk of rapid progression from one long-term condition to developing multiple conditions.

The research, led by Mark Ashworth, professor of primary care at King’s College London, focused on three approaches to better understanding health inequalities in relation to MLTCs:

1. statistical analysis: to identify the issues of MLTCs which cluster in deprived or ethnic minority communities
2. health economics: to identify health service use rates, and their relation to health inequalities
3. ethnographic and qualitative research: to capture people’s experiences of MLTCs and the impact of health inequalities.

The research was carried out across five work packages (WP):

• WP1: Agreed a common definition of MLTCs across Lambeth and Southwark, enabling more effective comparison of trends, clusters, populations and to enable comparison with other studies
• WP2: Explored the social context within which MLTCs arise and are experienced. This included understanding the impact of factors such as socioeconomic deprivation on the prevalence, distribution and the nature of clusters of disease and risk factors that will enable those communities with the highest prevalence of MLTCs to be identified.
• WP3: Developed and tested approaches to population segmentation identifying the most common clusters of conditions and risk factors, their impact on people and their use of health and social care services.
• WP4: Explored how the prevalence, distribution and clustering of long-term and multiple long-term conditions changes over time. This will enable researchers to model the journey to developing MLTCs and develop hypotheses on what influences change and rate of progression.
• WP5: An ethnographic study of MLTCs in Lambeth and Southwark, which explored how MLTCs have been conceptualised by key stakeholders; explored the ways in which social factors (such as deprivation, location, ethnicity) shape patients’ experiences of developing and living with MLTCs; identified potential points and strategies of intervention to slow the progression to MLTCs.

The project was funded by the GSTT Charity.

Find out more

• Three year focus on multimorbidity in south London highlights inequality (kcl.ac.uk)

• One in five people in south London live with multiple long-term conditions

• Impact of multimorbidity on healthcare costs and utilisation: a systematic review of the UK literature