New research has found that specific combinations of chronic health conditions have a major role in the additional pressures the NHS faces every winter.
Winter pressures are prompted by the worsening of health issues as a result of colder weather, seasonal viruses, increased isolation and loneliness, plus systems level difficulties caused by higher bed occupancy and staff absences. These additional pressures usually cover the period from 1 December to 31 March. In addition, living with multiple long-term conditions is associated with significantly higher risks of hospital admissions and death.
To delve deeper into these links, researchers reviewed routinely collected and linked primary and secondary care health data for adults in England, during the winter pressures period of 2021-22, to identify the reasons for hospital admission. This period coincided with the COVID-19 pandemic when health and social care services were substantially disrupted. They accessed data via the BHF Data Science Centre‘s CVD-COVID-UK/COVID-IMPACT Consortium.
“Our research identified combinations of long-term conditions that are associated with substantially higher risks of winter hospitalisation and deaths. These findings will help inform more targeted planning for winter pressures, enabling resources to be allocated where they are needed the most,” comments lead author Dr Nazrul Islam, Associate Professor of Epidemiology and Medical Statistics at the University of Southampton.
The team found that the risk of hospital admission was 11 times higher among those with the quartet of cardiovascular disease, cancer, kidney disease, and type 2 diabetes than it was among those without any of these conditions. And people with cardiovascular disease, kidney disease, dementia, and osteoarthritis were 24 times more likely to die compared to those who didn’t have these conditions.
The number of people in England with two or more long-term conditions is projected to include almost 70% of the population by 2035. And while previously published research has established the increased health service demand related to multiple long-term conditions during the winter, it’s not clear exactly which combinations might be the most critical.
Complete data were available for 48.3 million people, just over half of whom were women (51%). Their average age was 49, and 81% of them were White. The researchers selected 59 long-term conditions which were categorised into 19 groups, based on feedback from clinicians, patients, and policy-makers.
During the study period, 4,710,675 hospital admissions and 176,895 deaths were recorded. Overall, nearly 20 million people (40.5%) had no long-term conditions; 13.5 million (28%) had one; and nearly a third (15 million or 31%) had two or more.
Analysis of the data showed that particular combinations of long-term conditions were associated with heightened risks of hospital admission and death. Among the 10 combinations that contributed to the highest rates of hospital admissions, cardiovascular disease featured in all but one.
Analysis of the deaths linked to particular combinations of long-term conditions showed that cardiovascular disease featured in all 10 of the riskiest combinations, and cardiovascular disease plus dementia also featured in all of the top 5 riskiest combinations. This duo was associated with a substantially higher rate of death than many 3, 4, and 5 long-term condition combinations.
This is an observational study, meaning that it’s difficult to untangle the direction of cause and effect. The researchers also acknowledge various limitations to their findings, including the lack of information about the length or severity of illness or frailty among those with long-term conditions.
But they point out: “Current policy and clinical guidance consider the risk of hospital admission and death for multiple long-term conditions during the winter season as one homogenous condition,” when this is clearly not the case. And they suggest that the findings could help inform more targeted planning for winter pressures, enabling resources to be allocated where they are needed the most.
