Impact of deprivation on occurrence, outcomes and health care costs of people with multiple morbidity

J Health Serv Res Policy. 2013 Oct;18(4):215-23. doi: 10.1177/1355819613493772. Epub 2013 Aug 14.


Objective: This study aimed to estimate the impact of deprivation on the occurrence, health outcomes and health care costs of people with multiple morbidity in England.

Methods: Cohort study in the UK Clinical Practice Research Datalink, using deprivation quintile (IMD2010) at individual postcode level. Incidence and mortality from diabetes mellitus, coronary heart disease, stroke and colorectal cancer, and prevalence of depression, were used to define multidisease states. Costs of health care use were estimated for each state from a two-part model.

Results: Data were analysed for 141,535 men and 141,352 women aged ≥30 years, with 33,862 disease incidence events, and 13,933 deaths. Among incidences of single conditions, 22% were in the most deprived quintile and 19% in the least deprived; dual conditions, most deprived 26%, least deprived 16% and triple conditions, most deprived 29%, least deprived 14%. Deaths in participants without disease were distributed most deprived 22%, least deprived 19%; in participants with single conditions, most deprived 24%, least deprived 18%; dual conditions, most deprived 27%, least deprived 15%, and triple conditions, most deprived 33%, least deprived 17%. The relative rate of depression in most deprived participants with triple conditions, compared with least deprived and no disease, was 2.48 (1.74 to 3.54). Costs of health care use were associated with increasing deprivation and level of morbidity.

Conclusions: The higher incidence of disease, associated with deprivation, channels deprived populations into categories of multiple morbidity with a greater prevalence of depression, higher mortality and higher costs. This has implications for the way that resources are allocated in England's National Health Service.

Keywords: comorbidity; coronary heart disease; depression; deprivation; diabetes; equity; health care costs; health care utilization; primary care; socioeconomic inequalities; stroke.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cohort Studies
  • Comorbidity*
  • Confidence Intervals
  • England
  • Female
  • Health Expenditures*
  • Health Services / statistics & numerical data
  • Health Status Disparities*
  • Healthcare Disparities
  • Humans
  • Male
  • Poverty*
  • State Medicine
  • Treatment Outcome*