HILL

Summary

The prevention and management of chronic non-communicable disease represents one of the greatest challenges facing the economy and healthcare systems of the West Midlands. Primary care has a critical role in the response to this challenge and information from this setting is increasingly recognised as a driver and resource for public health policy, clinical practice, and research. In up to 25 general practices we will undertake a cross-sectional postal survey of up to 27,000 adults aged over 35 years, with linkage (among consenting survey respondents) to high-quality primary care electronic health records. Cross-sectional analyses will determine the occurrence, impact, and healthcare outcomes of adults with selected major long-term conditions, with particular focus on multimorbidity, disability, and work. We will examine the extent of health inequalities in these and in the key social and behavioural risk factors that are believed to determine them. A series of ‘Spotlight Studies’ will offer local doctors in training a range of supervised research projects, based on local health data, in key areas of importance and supervisory expertise. Our study will also produce long-term legacies through the creation of a world-class source of data for health research on long-term conditions across the adult lifespan. Future plans to extend the survey to all practices that contribute to our electronic health record database and repeat it on a 5-yearly cycle offer further scope for substantial development.

Study design

This is an observational cross-sectional survey.

Aim and objectives

The aim of this study is to provide new evidence and insights that will underpin and inform the prevention and management of chronic non-communicable diseases that cause the greatest burden in years lived with disability in West Midlands. Through a large-scale cross-sectional survey of key patient-reported outcomes and ‘psychosocial vital signs’ of the adult population and with linkage to high-quality electronic health record data among consenting respondents, our proposal will provide a detailed description of health, key comorbidity and care among consulters in one geographical area. The survey will address the following primary research questions:

1. What are the most common and disabling patterns of long-term condition multimorbidity in the local population and how are such individuals currently being managed?
2. Which long-term conditions, health outcomes and risk factors are most strongly patterned by socioeconomic status (education, occupation, and income), how evident are these social gradients in young, middle, and late adulthood, and are social gradients most evident in multimorbidity and more severe disease?
3. What is the extent of the impact of long term health conditions on healthy working life expectancy and the number of years of life with disability in the West Midlands, and how does this differ by occupation?