Identifying profiles, trajectories, burden, social and biological factors in 3.3 million individuals with multimorbidity in England

Multimorbidity, the co-occurrence of multiple chronic conditions in an individual, has become a global health challenge affecting populations in high-income and low- to middle- income countries. Despite its increasing prevalence, critical gaps remain in understanding its progression, burden, and determinants to better guide prevention and treatment. Here, by leveraging linked primary care, hospitalisation, and mortality records from 3.3 million individuals with multimorbidity in England, we conducted a longitudinal cohort study to characterise multimorbidity across multiple dimensions, including condition profiling, progression trajectories, healthcare burden, and associated social and biological factors. Specifically, we identified 21 distinct multimorbidity profiles in males and 18 in females, uncovering life-course progression pathways. We assessed the differential burden of these profiles on mortality and hospitalisation. The study also highlights how social inequalities shape distinct patterns of multimorbidity. Furthermore, by developing an interpretable machine learning framework, we identified key biological markers associated with specific multimorbidity profiles. Together, these results offer valuable insights to inform prevention strategies, public health initiatives and potential interventions aimed at mitigating the growing burden of multimorbidity.