• Jonathan Valabhji, Emma Barron, Adrian Pratt, Nasrin Hafezparast, Rupert Dunbar-Rees, Ellie Bragan Turner, Kate Roberts, Jacqueline Mathews, Robbie Deegan, Victoria Cornelius, Jason Pickles, Gary Wainman, Chirag Bakhai, Desmond G Johnston, Edward W Gregg, and Kamlesh Khunti.
• NHS England, Wellington House, London SE1 8UG, UK.
• J R Soc Med. 2024 Mar 1; 117 (3): 104117104-117.

ObjectivesTo determine the prevalence of multiple long-term conditions (MLTC) at whole English population level, stratifying by age, sex, socioeconomic status and ethnicity.DesignA whole population study.SettingIndividuals registered with a general practice in England and alive on 31 March 2020.Participants60,004,883 individuals.Main Outcome MeasuresMLTC prevalence, defined as two or more of 35 conditions derived from a number of national patient-level datasets. Multivariable logistic regression was used to assess the independent associations of age, sex, ethnicity and deprivation decile with odds of MLTC.ResultsThe overall prevalence of MLTC was 14.8% (8,878,231), varying from 0.9% (125,159) in those aged 0-19 years to 68.2% (1,905,979) in those aged 80 years and over. In multivariable regression analyses, compared with the 50-59 reference group, the odds ratio was 0.04 (95% confidence interval (CI): 0.04-0.04; p < 0.001) for those aged 0-19 years and 10.21 (10.18-10.24; p < 0.001) for those aged 80 years and over. Odds were higher for men compared with women, 1.02 (1.02-1.02; p < 0.001), for the most deprived decile compared with the least deprived, 2.26 (2.25-2.27; p < 0.001), and for Asian ethnicity compared with those of white ethnicity, 1.05 (1.04-1.05; p < 0.001). Odds were lower for black, mixed and other ethnicities (0.94 (0.94-0.95) p < 0.001, 0.87 (0.87-0.88) p < 0.001 and 0.57 (0.56-0.57) p < 0.001, respectively). MLTC for persons aged 0-19 years were dominated by asthma, autism and epilepsy, for persons aged 20-49 years by depression and asthma, for persons aged 50-59 years by hypertension and depression and for those aged 60 years and older, by cardiometabolic factors and osteoarthritis. There were large numbers of combinations of conditions in each age group ranging from 5936 in those aged 0-19 years to 205,534 in those aged 80 years and over.ConclusionsWhile this study provides useful insight into the burden across the English population to assist health service delivery planning, the heterogeneity of MLTC presents challenges for delivery optimisation.

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