Ethnic differences in early onset multimorbidity and associations with health service use, long-term prescribing, years of life lost, and mortality: A cross-sectional study using clustering in the UK Clinical Practice Research Datalink

Fabiola Eto*, Miriam Samuel, Rafael Henkin, Meera Mahesh, Tahania Ahmad, Alisha Angdembe, R. Hamish McAllister-Williams, Paolo Missier, Nick J. Reynolds, Michael R. Barnes, Sally Hull, Sarah Finer, Rohini Mathur

*Corresponding author for this work

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Abstract

Background: The population prevalence of multimorbidity (the existence of at least 2 or more long-term conditions [LTCs] in an individual) is increasing among young adults, particularly in minority ethnic groups and individuals living in socioeconomically deprived areas. In this study, we applied a data-driven approach to identify clusters of individuals who had an early onset multimorbidity in an ethnically and socioeconomically diverse population. We identified associations between clusters and a range of health outcomes.

Methods and findings: Using linked primary and secondary care data from the Clinical Practice Research Datalink GOLD (CPRD GOLD), we conducted a cross-sectional study of 837,869 individuals with early onset multimorbidity (aged between 16 and 39 years old when the second LTC was recorded) registered with an English general practice between 2010 and 2020. The study population included 777,906 people of White ethnicity (93%), 33,915 people of South Asian ethnicity (4%), and 26,048 people of Black African/Caribbean ethnicity (3%). A total of 204 LTCs were considered. Latent class analysis stratified by ethnicity identified 4 clusters of multimorbidity in White groups and 3 clusters in South Asian and Black groups. We found that early onset multimorbidity was more common among South Asian (59%, 33,915) and Black (56% 26,048) groups compared to the White population (42%, 777,906). Latent class analysis revealed physical and mental health conditions that were common across all ethnic groups (i.e., hypertension, depression, and painful conditions). However, each ethnic group also presented exclusive LTCs and different sociodemographic profiles: In White groups, the cluster with the highest rates/odds of the outcomes was predominantly male (54%, 44,150) and more socioeconomically deprived than the cluster with the lowest rates/odds of the outcomes. On the other hand, South Asian and Black groups were more socioeconomically deprived than White groups, with a consistent deprivation gradient across all multimorbidity clusters. At the end of the study, 4% (34,922) of the White early onset multimorbidity population had died compared to 2% of the South Asian and Black early onset multimorbidity populations (535 and 570, respectively); however, the latter groups died younger and lost more years of life. The 3 ethnic groups each displayed a cluster of individuals with increased rates of primary care consultations, hospitalisations, long-term prescribing, and odds of mortality. Study limitations include the exclusion of individuals with missing ethnicity information, the age of diagnosis not reflecting the actual age of onset, and the exclusion of people from Mixed, Chinese, and other ethnic groups due to insufficient power to investigate associations between multimorbidity and health-related outcomes in these groups.

Conclusions: These findings emphasise the need to identify, prevent, and manage multimorbidity early in the life course. Our work provides additional insights into the excess burden of early onset multimorbidity in those from socioeconomically deprived and diverse groups who are disproportionately and more severely affected by multimorbidity and highlights the need to ensure healthcare improvements are equitable.

Original languageEnglish
Article numbere1004300
Number of pages23
JournalPLoS Medicine
Volume20
Issue number10
DOIs
Publication statusPublished - 27 Oct 2023

Bibliographical note

Funding:
This work (and salary costs to SF, RM, SH, FE) was supported by MRC (MR/S027297/1). “Multimorbidity clusters, trajectories and genetic risk in British south Asians, 2020-2023”. Link: https://gtr.ukri.org/projects?ref=MR%2FS027297%2F1. RM is supported by Barts Charity (MGU0504). Additional support for this and related work (SF, MRB, NJR, PM, RHM, RH, AA, MS, FE) is from NIHR 31672 AI-MULTIPLY, 2022-2025, and NIHR 202635 (SF, NJR, MRB, PM). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Copyright:
Copyright: © 2023 Eto et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Keywords

  • Young Adult
  • Humans
  • Male
  • Adolescent
  • Adult
  • Female
  • Multimorbidity
  • Cross-Sectional Studies
  • Cluster Analysis
  • United Kingdom/epidemiology
  • Patient Acceptance of Health Care

ASJC Scopus subject areas

  • General Medicine

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