The Challenge
As global populations live longer, people living with multiple long-term health conditions (also known as multimorbidity) are a major health concern worldwide. In the UK, more than 25% of adults have two or more long-term health conditions. This increases to 65% for people older than 65 years, and to almost 82% for those aged 85 or older. Those living with multiple long-term conditions often experience increased use of healthcare services and medications, greater difficulty with day-to-day tasks, reduced quality of life and reduced length of life.
This study led by Professor Rhiannon Owen and funded by Health Data Research UK, assessed how psychosis, diabetes and congestive heart failure develops over time, and the impact this can have on life expectancy. Opportunities for prevention and targeted intervention to improve outcomes for people living with multiple long-term conditions were also identified.
Professor Owen’s research focuses on the development and application of novel statistical methods to address important and complex health questions. This study used a novel application of statistical models to examine the order of developing psychosis, diabetes and congestive heart failure, the related impact on life expectancy, and factors associated with an increased risk of developing further disease and reduced life expectancy.
This study used data held within the SAIL databank, which provides secure access to routinely collected anonymous health and administrative records for the population of Wales. More than 1.6 million adults aged 25 and over were included in the research to analyse the development of these conditions over a 20-year period.
Patients and the public from across the UK shared their experience of living with multiple long-term conditions to further inform the research design and its findings.
The Impact
The study found that the order in which people developed these multiple long-term conditions had an important and complex impact on their life expectancy.
People who developed diabetes, psychosis and congestive heart failure, in that order, had the largest loss in life expectancy (approximately 13 years, on average). People who developed the same conditions in a different order had a higher life expectancy.
People who developed diabetes, then psychosis and finally congestive heart failure in that order had an increased risk of developing the next long-term health condition within five years of their last diagnosis.
However, the development of further conditions is not always life-limiting. For example, people diagnosed with psychosis and diabetes (in any order) had a higher life expectancy than those diagnosed with psychosis alone. This may be because people with diabetes have more regular contact with the health service through diabetic clinics, for example, which may improve their overall health.
This is the first study to examine how the order and timing of developing multiple long-term conditions affects a person’s life expectancy. This research could be used to inform patients, healthcare providers and decision-makers on factors that may increase a person’s risk of developing disease, as well as identifying potential opportunities for disease screening and earlier intervention to improve outcomes for people living with multiple long-term conditions and the NHS.
