Meredith, Sam
(2025)
Defining and Geospatially Mapping Multimorbidity
within Emergency Hospital Settings to Inform
Equitable Health and Social Care
PhD thesis, University of Liverpool.
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Text
201036361_May2025.pdf - Author Accepted Manuscript Download (6MB) | Preview |
Abstract
This thesis investigates how multimorbidity, defined as the presence of two or more long-term conditions, manifests within emergency hospital settings in England. It focuses on how multimorbidity is shaped by social determinants, how it can be more consistently defined, and how its burden varies geographically. The work brings together four studies that aim to improve understanding of multimorbidity patterns at the population level and to inform more equitable and efficient healthcare planning. The first study is a systematic literature review examining the relationship between social factors and multimorbidity among adults in emergency hospital settings. Fifteen studies were included, revealing consistent associations between multimorbidity-related emergency use and factors such as socioeconomic deprivation, older age, and male sex. Additional associations were identified with lifestyle and occupational exposures including smoking, physical inactivity, obesity, and manual work. Evidence regarding income, education, and ethnicity was more limited. The second study uses a Delphi consensus approach to define multimorbidity within the context of emergency hospital admissions. Through three rounds of expert input and a follow-up workshop, 122 ICD-10 codes were selected, including a core set of 72 conditions considered essential for defining multimorbidity in this context. The resulting framework reflects expert judgement on chronicity and relevance, aiming to reduce heterogeneity in future research. The third study introduces a Small Area Multimorbidity Indicator (SAMI), developed to support local resource planning by quantifying the burden of multimorbidity-related emergency admissions at the neighbourhood level across England. Choropleth maps reveal that the highest burdens are concentrated in urban areas such as Liverpool, Manchester, Newcastle, and London, as well as in some coastal towns. The analysis also shows that several areas with previously low burdens experienced sharp increases over time. Associations with socioeconomic deprivation and older age were evident, alongside shifts in the disease landscape, with mental health and genitourinary conditions playing an increasingly prominent role. The final study builds on the SAMI by using hierarchical clustering to group areas based on the disease systems driving multimorbidity admissions. This approach identifies distinct area-level disease profiles, offering a typology that may support more tailored local health interventions. The analysis also explores the role of area-level deprivation in shaping cluster patterns. While exploratory and based on aggregated data, the study shows the potential of this method for enhancing spatial understanding of multimorbidity using the SAMI. Together, these studies offer new insights into the social, definitional, and geographic dimensions of multimorbidity in emergency care. They contribute to a more standardised, locally informed evidence base that can support targeted policy, planning, and interventions for people living with complex health needs.
| Item Type: | Thesis (PhD) |
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| Uncontrolled Keywords: | Multimorbidity, Emergency admissions, Emergency Settings |
| Divisions: | Faculty of Health & Life Sciences Faculty of Health & Life Sciences > Inst. Systems, Molec & Integrative Biology Faculty of Health & Life Sciences > Inst. Systems, Molec & Integrative Biology > Inst. Systems, Molec & Integrative Biology |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 11 Feb 2026 10:26 |
| Last Modified: | 11 Feb 2026 10:35 |
| DOI: | 10.17638/03196142 |
| Supervisors: |
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| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3196142 |
| Disclaimer: | The University of Liverpool is not responsible for content contained on other websites from links within repository metadata. Please contact us if you notice anything that appears incorrect or inappropriate. |
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