Multi-morbidity and Mortality in Northern Ireland: An investigation of the association between self-reported multiple health disorders and subsequently recorded mortality.

Multi-morbidity is becoming an increasingly pertinent public health issue and challenge, given advancement of research, policy and treatment and an ageing population. One of the consequences of increased life expectancy is increased risk of accumulation of multiple disorders, with the prevalence of multi-morbidity thought to be in excess of 65% of the elderly population (Banjaree, 2015). While multi-morbidity is more prevalent at older ages, in absolute terms over half of multi-morbid cases are aged under sixty-five. Despite multi-morbidity now being the norm for individuals with chronic diseases rather than the exception, existing health systems, clinical practice, guidance and training are dominated by single-disease approaches (Barnett et al., 2012).

In order to inform the effective management of individuals with multi-morbid conditions, more research is required to determine how multiple disorders develop and accumulate, the relationship between these disorders, and their association with a range of outcomes, including mortality.

The proposed study aims to contribute to the evidence base in this area by examining the association between specific self-reported morbidities derived from the 2011 Census (and combinations of these) and subsequent mortality (both underlying mortality and additional causal aspects enabled by the inclusion of supplemental causes of death). Because of the structure of the NIMS databases we will also examine multi-morbidity in relation to the household. Specifically this study will:

• Examine the relationship between multi-morbidity and socio-demographic and socio-economic factors;
• Examine the extent of co-morbidity within households;
• Examine the relationship of different indicators of self-reported morbidity to risk of death;
• Examine the relationship between the extent and combinations of multi-morbidity and all-cause and cause-specific mortality risk;
• Examine the differential association of ‘pure physical’, ‘pure mental’ and ‘mental-physical’ comorbidities on mortality and causes of death;
• Compare the nature and accumulation of multi-morbidity among older and younger age-cohorts and determine whether mortality causes reflect differences in cohort comorbidity.

Publications and Outputs:

T Paul de Cock, Michael Rosato, Finola Ferry, Emma Curran, Gerard Leavey, Patterns of long-term conditions in older age and subsequent mortality: a national study of inequalities in health, European Journal of Public Health, , ckz194, https://doi.org/10.1093/eurpub/ckz194