Socioeconomic deprivation and multiple conditions

The risk of having multiple conditions is greater in socioeconomically deprived areas. For example, 28% of people 65–74 years of age in the most-deprived fifth of England had 4+ conditions, compared with 16% in the least-deprived fifth. As shown in Figure 8, there is a graded relationship between deprivation and multiple conditions – even those with a medium level of deprivation have a greater risk of multiple conditions than those in the least deprived areas. Therefore, while initiatives targeted at the most disadvantaged areas may be a priority, it is also important to consider patients across the full socioeconomic spectrum when aiming to reducing the prevalence of multiple conditions.

Figure 8: Percentage of people with 4+ conditions by age and level of socioeconomic deprivation

It is well known that the risk of having multiple conditions rises with age, but it is striking how deprivation adds to this risk. People living in the least-deprived fifth of England had an average of two conditions when they were aged 71, whereas those living in the most-deprived fifth reached the same level of illness a decade earlier, at 61 years of age (Figure 9).

Figure 9: Average number of conditions by age and level of socioeconomic deprivation

A similar picture was seen in a large Scottish study. Young and middle-aged adults in the most socioeconomically deprived areas had the same number of multiple conditions as those 10–15 years older in the least-deprived areas. These findings suggest that socioeconomic disadvantage accelerates when patients develop conditions and illness often associated with old age,,, resulting in high levels of multiple conditions among younger people in deprived areas. Having multiple conditions is a barrier to remaining in work. Policies to increase productivity and to extend working lives need to consider the impact of multiple conditions on working hours and workforce exit. Policies to reduce health inequalities require a focus on improving care for people with multiple conditions, since this group is concentrated in more disadvantaged areas.

Although living with multiple conditions is often thought of as a challenge of old age, our analysis and earlier studies have found that the number of people under 65 years of age with 2+ conditions is higher than the number aged 65 and over., Almost a third of people with 4+ conditions are under 65 years of age. At all ages, having multiple conditions is associated with greater use of health services. These analyses show that attention should be paid to multiple conditions in all parts of the NHS and other sectors, not only in services targeting frail, elderly people.

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