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To investigate the use of latent class growth analysis (LCGA) in understanding onset and changes in multimorbidity over time in older adults.This study used primary care consultations for 42 consensus-defined chronic morbidities over 3 years (2003-2005) by 24,615 people aged >50 years at 10 UK general practices, which contribute to the Consultations in Primary Care Archive database. Distinct groups of people who had similar progression of multimorbidity over time were identified using LCGA. These derived trajectories were tested in another primary care consultation data set with linked self-reported health status.Five clusters of people representing different trajectories were identified: those who had no recorded chronic problems (40%), those who developed a first chronic morbidity over 3 years (10%), a developing multimorbidity group (37%), a group with increasing number of chronic morbidities (12%), and a multi-chronic group with many chronic morbidities (1%). These trajectories were also identified using another consultation database and associated with self-reported physical and mental health.There are distinct trajectories in the development of multimorbidity in primary care populations, which are associated with poor health. Future research needs to incorporate such trajectories when assessing progression of disease and deterioration of health.

Original publication




Journal article


Journal of clinical epidemiology

Publication Date





1163 - 1171


Arthritis Research UK Primary Care Centre, Keele University, the Institute of Primary Care and Health Sciences, Keele, Staffordshire ST5 5BG, United Kingdom; Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford OX3 7LD, United Kingdom. Electronic address:


Humans, Chronic Disease, Medical Records, Cluster Analysis, Longitudinal Studies, Comorbidity, Aged, Middle Aged, Primary Health Care, Female, Male, General Practice, Diagnostic Self Evaluation, United Kingdom