A National Health Service in Serious Trouble: what do multiple long-term conditions tell us about deterioration in health among people accessing hospital care in the North East of England?

Background: The transformation of the National Health Service (NHS), outlined in the 10 Year Health Plan for England, must take account of the inexorable rise in the prevalence of multiple long-term conditions (MLTC). However, most evidence on MLTC is based on primary care data preceding the COVID-19 pandemic and, data from hospitals are scarce. We aimed to analyse routinely-collected electronic health records to estimate the prevalence of MLTC among adults accessing hospital care in North East England before and after the COVID-19 pandemic, and to test associations between sociodemographic characteristics and MLTC within these populations. Methods and Findings: All adults with at least one admission to Newcastle upon Tyne Hospitals NHS Foundation Trust (NuTH) between July 2018 and June 2019 (N= 88,117, 51% women) or between July 2021 and June 2022 (N=83,036, 51% women) were included in analyses. MLTC was defined as the presence of two or more long-term conditions from an established list of 60 conditions. Poisson regression models were used to test associations of age, sex, ethnicity and index of multiple deprivation with MLTC. Among people admitted to NuTH at least once between July 2018 and June 2019, overall prevalence of MLTC was 49.6% and between July 2021 and June 2022 it was 61.0%. Older age and neighbourhood deprivation were associated with increased risk of MLTC; people living in the most deprived neighbourhoods had a prevalence of MLTC equivalent to people from the least deprived neighbourhoods a decade older. Associations between neighbourhood deprivation and MLTC were stronger in younger adults; those aged 30-39y living in the most deprived neighbourhoods had 1.74 (95% confidence interval: 1.49-2.02) times higher risk of MLTC than those living in the least deprived neighbourhoods. Conclusions: Among adults accessing inpatient hospital care in North East England, the prevalence of MLTC is high, has increased since the COVID-19 pandemic and has a greater impact on younger adults from the most deprived neighbourhoods. This highlights the sheer scale of the challenge that MLTC present in hospitals which must be addressed when redesigning services fit for the future.