Kurland, Jessica S; (2025) Multiple Long-Term Condition Clustering Among Older Adults: Exploring the Modifying Role of Socioeconomic Position on Health-Related Outcomes. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background: Multiple long-term conditions (MLTCs) are associated with many negative health outcomes, representing a major challenge for patients, healthcare systems and governments globally. Socioeconomic inequality in the prevalence of MLTCs is well established, but less is known about inequality in the impacts of MLTCs. The aim of this PhD was to identify distinct and clinically meaningful clusters of MLTCs, and investigate how socioeconomic position modified associations between clusters and two health outcomes – hospital admissions and mortality. Methods: Data from the English Longitudinal Study of Ageing (ELSA) alongside linked Hospital Episode Statistics and National Mortality Registry data were used. Three MLTC clusters – age-related, cardio-metabolic and psychiatric LTCs – and a relatively healthy group were identified using latent class analysis. Survival analysis was used to investigate associations between these clusters and mortality, and negative binomial regression models were applied to analyse associations with hospital admissions over 10 years of follow-up. For each outcome interactions between MLTC cluster and wealth, a domain of socioeconomic position, were investigated. Results: All three MLTC clusters showed worse outcomes compared to the relatively healthy cluster, but no differences were observed between these ‘non-healthy’ clusters. There was some evidence of socioeconomic inequality in the impact of MLTCs on mortality and hospital admissions. Higher wealth may have a protective effect against mortality and elective hospital admission among those with MLTCs. Conclusions: MLTCs have large impacts on health-related outcomes, and these may be worse among more socially disadvantaged groups. Better cluster-focused healthcare guidance is needed to improve treatment of MLTCs. Interventions and policy focused on improving the management of MLTCs among more disadvantaged groups may help reduce the burden of MLTCs on elective care resources.

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