Multimorbidity - and what it means for NHS winter pressures

More and more patients in Scotland are living with multiple chronic conditions, especially as they get older.

This increases the risk of complications which can result in hospital admission or death, particularly during winter.

However, research published this week suggests that some disease combinations are much more likely than others to contribute to "winter pressures" for the NHS.

What did it find?

According to a study published in the journal, BMJ Medicine, people living with cancer, kidney disease, cardiovascular disease, and type 2 diabetes were 11 times more likely to be admitted to hospital over winter than someone without any of these conditions.

Of all the 59 long term conditions included in the analysis, this was the highest risk combination.

When it came to mortality, however, patients with a combination of kidney disease, cardiovascular disease, dementia, and osteoarthritis were 24 times more likely to die between December and March.

Those with cardiovascular disease and dementia were 15 times more likely to die.

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The findings, which were based on a total of 4.7 million hospital admissions and nearly 177,000 deaths recorded in England between 2021 and 2022, were adjusted to remove any skewing effect from factors such as age, sex, ethnicity, and deprivation status.

Of the 10 disease combinations associated with the highest increased risk of hospitalisation, cardiovascular disease featured in all but one.

It also featured in all 10 of the riskiest combinations for death, while the dual combination of cardiovascular disease plus dementia was found to have a substantially higher mortality rate of death than many three, four, or five combinations of long-term conditions.

Why does it matter?

Around two million people in Scotland are living with at least one long-term condition, and a quarter have 'multimorbidity' (defined as living with two or more medical conditions simultaneously). 

Across the UK, current projections forecast that 70% of the population will fall into this latter category by the year 2035 - most of them people over the age of 65. 

As well as being associated with increased risks of hospitalisation and death, people with multimorbidity have much greater need for social care and require much more time with GPs. 

Could more be done to reduce unplanned admissions during winter among patients living with multiple long-term conditions? (Image: PA) Colder weather, seasonal viruses, and increased isolation and loneliness during winter can all play a role in aggravating symptoms, which comes on top of higher levels of bed occupancy and staff absences in the NHS. 

The researchers - based at Southampton University's Primary Care Research Centre - argue that multimorbidity tends to be considered as "one homogeneous condition" under current clinical guidance, whereas their evaluation found that the risk of hospitalisation and death clearly "varied by the combination of conditions".

They suggest that the findings could "inform planning for winter pressures on the NHS and help policy makers allocate resources where they are needed most". 

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Dr Jonathan Batty, an expert in multimorbidity from Leeds University, said the findings could also inform a new approach to prevention. 

On the one hand, the most hazardous combinations of long-term conditions had "common risk factors, including smoking, obesity, and a sedentary lifestyle" so there were benefits to be gained from "prioritising the management of these risk factors earlier in an individual's life course". 

Furthermore, the findings could inform work to "identify those people at greatest risk of unplanned admission" in order to develop "targeted, evidence-based interventions to prevent hospital admission, including enhanced community based care and vaccination against winter viruses".