OPINION
Multiple long term conditions, multimorbidity, and co-morbidities: we
1 Diabetes Research Centre, University
of Leicester, Leicester General
Hospital, Leicester, LE5 4PW, UK.
2 National Institute for Health Research
Applied Research Collaboration East
Midlands, University of Leicester, UK.
3 Collaboration and Knowledge
Exchange group, University of Lincoln
Medical School
Cite this as: BMJ 2023;383:p2327
http://dx.doi.org/10.1136/bmj.p2327
Published: 13 October 2023
the bmj | BMJ 2023;383:p2327 | doi: 10.1136/bmj.p2327
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should reconsider the terminology we use
Kamlesh Khunti, 1, 2 Harini Sathanapally, 2 Pauline Mountain3
There is an increasing global interest in multiple long chronic condition such as diabetes mellitus, stroke,
term conditions—defined as the co-occurrence of at depression and asthma 8
least two chronic conditions in the same
In discussion with patients we should avoid the use
individual—and also known as “multimorbidity.”1
of the term multimorbidity and instead use other
People with multiple long term conditions have a
terms such as people with multiple long term
poorer quality of life, have greater healthcare needs
conditions. With the increasing prevalence of
and increased mortality. The prevalence of multiple
multiple long term conditions, there is an urgent need
long term conditions is increasing and therefore there
to revisit the terminology we are using.
is now a shift in healthcare from traditional single
disease management approaches to ways of
Competing interests: KK and HS are supported by the National Institute for Health
managing more complex health needs.2 In view of Research (NIHR) Applied Research Collaboration East Midlands (ARC EM). KK is
the huge impact on health and social care, the co-director of cross NIHR Collaboration for Multiple Long Term Conditions
National Institute for Health and Care Excellence (MLTCs), director of the Global Research Centre for MLTC and National NIHR
ARC Lead for MLTCs.
(NICE) has issued guidelines for the management of
people with multiple long term conditions
1 Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M. Defining
emphasising a person-centred holistic approach.3 comorbidity: implications for understanding health and health services.
Ann Fam Med 2009;7:-63. doi: 10.1370/afm.983 pmid: 19597174
However, for people suffering with multiple long term
2 Ho IS, Azcoaga-Lorenzo A, Akbari A, etal. Variation in the estimated
conditions there is also the added challenge of the prevalence of multimorbidity: systematic review and meta-analysis of 193
term “multimorbidity.” A taskforce on multiple international studies. BMJ Open 2022;12:e057017.
conditions led by the Richmond Group of charities doi: 10.1136/bmjopen-2021-057017 pmid: 35487738
reported that people do not find multimorbidity an 3 National Institute for Health and Care Excellence. (2019) Multimorbidity:
acceptable term to describe their condition.4 The term clinical assessment and management, 2019. Available at:
https://www.nice.org.uk/guidance/NG56. Accessed 26/08/, 2022.
“multimorbidity” is associated with a negative image 4 The Richmond Group of charities (2022) the taskforce on Multiple
and gives the impression to patients that they are in conditions. Available at: https://richmondgroupofcharities.org.uk/taskforce-
poor health, their body is failing them, they may be multiple-conditions. Accessed 26/08/, 2022.
dying soon, and there is nothing they can do about 5 Fortin M. “It-that-must-not-be-named”: Addressing patient discomfort with
the condition.5 Patients report that they do not the term multimorbidity. Can Fam Physician 2018;64:-2.pmid: 30541799
6 National Institute for Health and Care Research. (2020) NIHR Strategic
understand the term and do not consider themselves
Framework for Multiple Long-Term Conditions (Multimorbidity) MLTC-M
as multi-morbid,6 as “morbidity” implies fatality, Research, 2020. Available at: https://www.nihr.ac.uk/documents/nihr-
which reinforces a negative association with the term strategic-framework-for-multiple-long-term-conditions-multimorbidity-mltc-
multimorbidity.7 Research suggests that patients m-research/24639#:~:text=The%20Multiple%20Long%2Dterm%20Con-
ditions%20(Multimorbidity)%20Strategic%20Framework,-
think that the term “multimorbidity” is non-specific, MLTC%2DM%20is&text=The%20NIHR%20will%3A,their%20trajecto-
adds little value in everyday clinical practice, and ries%20among%20the%20population. Accessed 30/08/, 2022.
also suggests that it refers to a single condition, thus 7 Chew-Graham C, O’Toole L, Taylor J, Salisbury C. ‘Multimorbidity’: an
reinforcing the biomedical model of care.7 acceptable term for patients or time for a rebrand?Br J Gen Pract 2019;69:-3.
doi: 10.3399/bjgp19X704681 pmid: 31345795
The National Institute for Health and Care Research 8 Tugwell P, Knottnerus JA. Multimorbidity and Comorbidity are now separate
(NIHR) has made multiple long term conditions a MESH headings. J Clin Epidemiol 2019;105:-viii.
priority and has been leading the funding for research doi: 10.1016/j.jclinepi.2018.11.019 pmid: 30522770
into this. The NIHR Strategic Framework has
emphasised that their preferred term is multiple long
term conditions.6 In contrast to multimorbidity, the
term “multiple long term conditions” conveys a sense
of longevity, and with this, a better sense of hope for
the management of the long term conditions. The
term also has more clinical relevance, as it better
conveys the interplay between co-existing long term
conditions, which is a key focus of clinical
management and research in this field.
Despite the unacceptability of the term by patients,
the term multimorbidity continues to be used widely
in publications and clinical practice. The other
complexity is the use of the terms comorbidity and
multimorbidity which are often used interchangeably.
The term comorbidity refers to combined effects of
additional conditions in reference to the index
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