Intended for healthcare professionals


Multimorbidity and the inverse care law in primary care

BMJ 2012; 344 doi: (Published 19 June 2012) Cite this as: BMJ 2012;344:e4152
  1. Stewart W Mercer, professor of primary care research1,
  2. Bruce Guthrie, professor of primary care medicine2,
  3. John Furler, senior research fellow3,
  4. Graham C M Watt, professor of general practice1,
  5. Julian Tudor Hart, retired general practitioner and research fellow4
  1. 1General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 9LX, UK
  2. 2Population Health Sciences Division, Medical Research Institute University of Dundee, Dundee, UK
  3. 3Primary Care Research Unit, Department of General Practice, University of Melbourne, Vic, Australia
  4. 4Swansea Medical School, University of Wales, Swansea, UK
  1. stewart.mercer{at}

Inequalities set to rise as criteria for funding change in the UK

Multimorbidity, usually defined as the coexistence of two or more long term conditions within an individual, is rapidly becoming the norm among people with chronic disease. Although often seen as a problem of elderly people, it affects large numbers of younger people too. Multimorbidity is not simply a problem of chronological ageing, but neither is it randomly distributed.1 In a recent Scottish study of almost 1.8 million people, more people with multimorbidity were aged below 65 years than above,2 and similar findings have been reported outside the United Kingdom.3 The level of deprivation influences not just the amount but also the type of multimorbidity that people experience. Multimorbidity is more common and occurs 10-15 years earlier in the most deprived areas than in the most affluent ones.2 4 A greater mix of mental and physical problems …

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