Chronology in multimorbidity clustering and its effect on treatment burden and the utilisation of health and social care services

Abstract

Title: The chronology of multimorbidity clustering and its effect on treatment burden and the utilisation of health and social care services.

Problem: Effectively managing multimorbidity requires understanding how clusters form and their impact on health, social care, and treatment burden to develop targeted interventions.

Aim: To assess how the sequence in which long-term conditions are diagnosed influences multimorbidity clusters and their association with health and social care utilisation and treatment burden.

Approach: A scoping review mapped the literature on multimorbidity clustering. A crosssectional analysis then examined the prevalence and sequence of diagnoses, as well as multimorbidity clusters and their associations with health and social care. The analysis used electronic health records (2019-2023) and employed latent class analysis and regression modelling. Semi-structured interviews, conducted from July to September 2023, explored individuals' treatment burden experiences.

Findings: Forty-two studies identified multimorbidity clusters ranging from 3 to 20, with diabetes, hypertension, and asthma central. Disease patterns were influenced by age and deprivation, and treatment burden was higher among women, younger individuals, and those with more than four conditions. Of 43,082 individuals with multimorbidity (29.1% prevalence, mainly
older, white, females from deprived regions), hypertension and cardiovascular disorders (CVD) were the most common initial conditions. Five clusters were identified, with the CVD and chronic kidney disorder (CKD)-led cluster having the highest risk of ER visits, unplanned hospitalisations, and social care flags.

Date of Award	3 Jul 2025
Original language	English
Awarding Institution	Edge Hill University
Supervisor	GREG IRVING (Director of Studies), Rowan Pritchard Jones (Supervisor), MARIA PAOLA DEY (Supervisor) & Mohammed Moinuddin (Supervisor)