The prevalence of multimorbidity (people living with multiple long-term conditions at the same time) is growing, and this is even more widespread in disadvantaged communities. ARC North Thames researcher Lizzie Ingram shares findings from a study exploring the link between living conditions and multimorbidity among residents in Barking and Dagenham, and how she overcame key challenges through effective community partnerships.
What are the issues we are trying to address?
The number of those living with multiple chronic conditions (‘multimorbidity’) is rising. People living in the most disadvantaged circumstances are more likely to develop multimorbidity earlier in life and have co-occurring physical and mental health conditions.
There is currently little research that looks at the associations between social and financial factors related to people’s households and multimorbidity amongst working age adults (16-65 years old). For example, household tenure, which describes the legal status under which people have the right to occupy their accommodation, can affect a person’s likelihood to develop co-existing physical and mental health conditions, and also impact their access to care and support. Common forms of household tenure include home ownership, private rented and social rented housing.
There is also no one way to define ‘multimorbidity’ as people often include or exclude different conditions depending on what they are asked. In the data we used for this study - the Care City cohort - we had information on the presence of 38 specific conditions among residents in Barking and Dagenham. However, some of these 38 conditions are typically more burdensome to individuals and health services than others. Some may also be poorly recorded in GP data, so we are not always getting the whole picture on how a specific condition affects people.
We needed to work with our residents to better understand their experiences and to collaboratively decide whether to include all 38 conditions in our definition of multimorbidity or exclude selected conditions.
What did we do to address this problem?
Our research aimed to:
- Calculate how many working age adults living in Barking and Dagenham in 2019/20 had multimorbidity
- Examine and measure associations between household tenure and multimorbidity amongst working age adults living in Barking and Dagenham in 2019/20.
We did this by analysing the Care City cohort, a unique dataset linking data of Barking and Dagenham residents across local health services, from 2011 onwards.
The value of public partnerships
On 11th February 2021, we held a joint meeting with public and patient partners, including members of the ARC North Thames Research Advisory Panel and the Care City Community Board.
At that meeting, we discussed this study and the conditions that we had information on.
From these conversations, we recorded a list of conditions that people felt were, in general, less burdensome, required less health service use or may be poorly recorded in GP data.
Based on their input, we decided to
- Include all 38 conditions in another analysis, to ensure we captured all working age adults residing in Barking and Dagenham with multimorbidity.
- Conducted what are known as ‘sensitivity analyses’, to see if and how our study results changed if we excluded certain conditions from our definition of multimorbidity.
What were our findings?
After accounting for differences in a range of sociodemographic characteristics, we found that:
- Working age residents of Barking and Dagenham living in social housing had just over 30% higher chances of having multimorbidity than owner occupiers. Chances were even higher (nearly 50% higher) if an individual also had depression or anxiety.
- Working age residents of Barking and Dagenham who were private renters had a 20% less chance of having multimorbidity than owner occupiers.
- These results did not change in our sensitivity analyses. This is where we excluded conditions that were highlighted in our meeting as generally being less burdensome, requiring less health service use or poorly recorded in GP data.
What will we do with these findings?
These findings are important for helping us to think about how we define multimorbidity in future studies. We are due to present these findings to help inform local service planners who design health and care services.
I want to say a big thank you to all of our public partners for sharing their experiences and expertise – their contributions are crucial to ensuring that future research into multimorbidity aligns with the needs and experiences of our communities, and ultimately improves health and care services.
This blog is written by Lizzie Ingram, a PhD researcher within the Department of Applied Health research at University College London (UCL). The findings discussed are taken from the research paper Household and area-level social determinants of multimorbidity: a systematic review.
This research is part of Lizzie's PhD project on Using linked NHS and council data to advance understanding of the social determinants of multimorbidity, funded by NIHR ARC North Thames and NIHR School for Public Health Research.
The views expressed in this blog are those of the author(s) and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care.