Multimorbidity within households and health and social care utilisation and cost: retrospective cohort study using administrative data

Background The daily management of long-term conditions falls primarily on individuals and their informal carers, but the household context and its impact on health and social care activity among people with multimorbidity is understudied. Methods Linked data from health providers and local government in Barking and Dagenham provided a retrospective cohort of people aged 50+ in two-person households between April 2016 and March 2018. Two-part regression models were applied to estimate annualised use and cost of hospital, primary, community, mental health and social care by multimorbidity status of individuals and co-residents, adjusted for age, gender and deprivation. Applicability at the national level was tested using the Clinical Practice Research Datalink. Results Over 45% of multimorbid people in two-person households were co-resident with another multimorbid person. They were 1.14 (95% CI 1.00, 1.30) times as likely to have any community care activity and 1.24 (95% CI 0.99,1.54) times as likely to have any mental health care activity compared to those co-resident with a healthy person. They had more primary care visits (8.5 (95% CI 8.2,8.8) vs 7.9 (95% CI 7.7,8.2)) and higher primary care costs. Outpatient care and elective admissions did not differ between these groups. Findings in the national data were similar. Conclusions Care utilisation for people with multimorbidity varies by household context. There may be potential for connecting health and other community service input across household members.