What do people die from? The challenges of measuring disease burden posed by multi-morbidity

Multimorbidity as assessed by reporting of multiple causes of death: variations by period, sociodemographic characteristics and place of death among older decedents in England and Wales, 2001-2017

BACKGROUND

Multimorbidity is common at older ages and is associated with disability, frailty and poor quality of life. Research using clinical databases and surveys has shown associations between multimorbidity and indicators of social disadvantage. Use of multiple coded death registration data has been proposed as an additional source which may also provide insights into quality of death certification.

METHODS

We investigate trends in reporting multiple causes of death during 2001-2017 among decedents aged 65 years and over included in a census-based sample of 1% of the England and Wales population (Office for National Statistics Longitudinal Study). Using Poisson regression analysis, we analyse variations in number of mentions of causes of death recorded by time period, place of death, age, sex and marital status at death and indicators of health status and individual and area socioeconomic disadvantage reported at the census prior to death.

RESULTS

Number of mentions of causes recorded at death registration increased 2001-2017, increased with age, peaking among decedents aged 85-9 years, and was positively associated with indicators of prior disadvantage and poor health, although effects were small. Number of mentions was highest for hospital decedents and similar for those dying in care homes or their own homes.

CONCLUSION

Socioeconomic disadvantage, prior poor health, dying in hospital and older age-although not extreme old age-are associated with dying with more recorded conditions. Results may reflect both differences in multimorbidity at death and variations in quality of medical certification of death. Quality of death certification for decedents in care homes needs further investigation.