Household clustering of multimorbidity and associations with health and social care need

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Background More than one in four people in the UK live with two or more long-term conditions ("multimorbidity"). Older people and people living in less affluent areas are more likely to have multiple long-term conditions. People with multiple long-term conditions often find it hard to do everything they want in their lives, are more likely to be frail and have falls, and frequently require emergency care such as hospital admissions. Clinical services and health research focuses mainly on individuals. However, where people live will also influence their health. People living in the same household or neighbourhood may have similar diets and lifestyles and may therefore also be at risk of developing long-term conditions. How people cope with illness may depend on who they live with. Living alone, or living with someone who is also ill, often affects how well a person can manage their own health. We do not properly understand how people with long-term conditions 'group' together in households and in neighbourhoods. Also, we do not understand the effect of other factors, such as who someone lives with and where they live, on their need for health and social care services. This is important because in order to address the needs of people with multiple long-term conditions, we must understand how to best organise services. Aim The aim is to investigate patterns of where people with multiple long-term conditions live by looking at individuals, households, and neighbourhoods, and in what ways this relates to how people use health and social care services (for example, emergency admission to hospital or a care home) and their likelihood of premature death. Objectives 1. To review the published research on how people with multiple long-term conditions are grouped by household and neighbourhood, and how this relates to people's use of health and social care. Using data from the population of NHS Lothian (Scotland): 2. To examine geographical patterns of multiple long-term conditions in individuals, people living in the same household, and people living in the same neighbourhood. 3. To examine whether patterns in the distribution of people with multiple long-term conditions are related to their use of health and social care and their likelihood of premature death over the study period. And using data from the population of Wales: 4. To apply objectives 2 & 3 to the population of Wales and compare with the findings from Scotland to identify if these are the same or different. This will help build understanding of how long-term conditions and place are related. Potential benefits to patients and the NHS This study will improve our understanding of where people with multiple long-term conditions live at the individual, household and neighbourhood level. It will examine how these patterns are associated with the ways in which people use health and social care, and their likelihood of premature death. Understanding this will help us design health and social care services that better support people with multiple long-term conditions. People with multiple long-term conditions are among the most vulnerable people in society and their numbers are increasing due to an ageing population, making this an issue of great importance.