Identification of the Risk Factors for Complex-Multiple Long-term Conditions (C-MLTC): A Scoping Review

Abstract

AbstractBackgroundComplex multiple long-term conditions (C-MLTC) is commonly defined as the presence of four or more long-term conditions, and its prevalence is projected to increase significantly over the next decade.MethodsWe undertook a scoping review of the literature to identify the available evidence on the risk factors for C-MLTC as well as to map out the potential clusters. We focussed on a subset of 18 chronic conditions because they include the most commonly reported and prevalent conditions in the general population. We searched NICE Clinical Knowledge Summaries (CKS) and PubMed, Register of Controlled Trials (Cochrane CENTRAL), Google Scholar and TRIP database for guidelines and reports.ResultsWe found 53 risk factors associated with 18 long-term conditions. Sixteen of these are linked to C-MLTC, with 11 being modifiable. Although we reviewed 35 systematic reviews, inconsistent reporting made it difficult to quantify the risk factors and conditions associated with C-MLTC. Diabetes mellitus is a risk factor for most other conditions (10), followed by coronary heart disease, hypertension, and chronic kidney disease (each associated with 8 long-term conditions). Additionally, depression and anxiety are commonly associated with other long-term conditions, with 14 and 17 conditions, respectively.ConclusionSeveral risks and conditions contribute to the development of multimorbidity. Anxiety and depression are nearly associated with all long-term conditions. Reporting problems within the existing evidence and a lack of clear definitions prevent adequate quantification of the risks associated with C-MLTC.