Journey to multimorbidity: longitudinal analysis exploring cardiovascular risk factors and sociodemographic determinants in an urban setting

Objective To study the social determinants and cardiovascular risk factors for multimorbidity and the acquisition sequence of multimorbidity. Design Longitudinal study based on anonymised primary care data. Setting General practices in an urban multiethnic borough in London, UK. Participants 332 353 patients aged ≥18 years. Main outcome measures Clinical and sociodemographic characteristics of patients with multimorbidity, defined as ≥3 of 12 long-term conditions (LTCs) selected according to high predicted healthcare use. Multilevel logistic regression was used to model social determinants and cardiovascular risk factors. Alluvial plots were constructed to illustrate multimorbidity acquisition sequences according to age, ethnicity and social deprivation. Results 5597 (1.7%) patients had ≥3 selected LTCs, the ‘multimorbidity cohort’. The the most common LTCs were diabetes (63.0%) and chronic pain (CP) (42.8%). Social deprivation and ethnicity were independent determinants of multimorbidity: most compared with the least deprived quintile (adjusted OR (AOR) 1.56 (95% CI 1.41 to 1.72)); South Asian compared with white ethnicity (AOR 1.44 (95% CI 1.29 to 1.61)); and black compared with white ethnicity (AOR 0.86 (95% CI 0.80 to 0.92)). The included cardiovascular risk factors were relatively strong determinants of multimorbidity: hypertension (AOR 5.05 (95% CI 4.69 to 5.44)), moderate obesity (AOR 3.41 (95% CI 3.21 to 3.63)) and smoking (AOR 2.30 (95% CI 2.16 to 2.45)). The most common initial onset conditions were diabetes and depression; diabetes particularly in older and black ethnic groups; and depression particularly in younger, more deprived and white ethnicity groups. CP was less common as an initial condition. Conclusion Our findings confirm the importance of age, social deprivation and ethnicity as determinants of multimorbidity. Smoking, obesity and hypertension as cardiovascular risk factors were stronger determinants of multimorbidity than deprivation or ethnicity. The acquisition sequence of multimorbidity is patterned by sociodemographic determinants. Understanding onset conditions of multimorbidity and cardiovascular cardiovascular risk factors may lead to the development of interventions to slow the progression of multimorbidity.