  From a public health perspective, previous research on comorbidity tends to
have focused on identifying the most prevalent groupings of illnesses that
demonstrate comorbidity, particularly among the elderly population, already in
receipt of care. In contrast, little attention has been paid to possible
socio-economic factors associated with increased rates of comorbidity or to the
possibility of wider unrevealed need. Given the known relationship between CVD,
diabetes and obesity and the strong socio-economic gradients in risk factors
for each of the three diseases as single morbidities, this paper uses the
Health Survey for England to examine the demographic and socio-economic
determinants of each of the seven disease combinations in the English
population. Using a multinomial logistic model, this research finds that gender
is a significant predictor for all seven disease combinations. However, gender
was not as influential as individual age or socio-economic profile. With regard
to ethnicity, the black population presents a high obesity, diabetes and
diabetes-related comorbidity risk, whilst the Asian population presents a high
risk for diabetes and diabetes-related comorbidity but a low risk for obesity
and comorbidity. Across the seven disease combinations, risk was lowest for
those individuals with a high income (4 out of 7), in-work (4 out of 7), home
owning (3 out of 7) and degree educated (3 out of 7). Finally, smokers have a
lower risk rate of obesity (and related) than ex-smokers relative to
individuals that never smoked (in all cases controlling for all other factors).
The important influence of socioeconomic factors has implications for the
spatial demand for services and the policy solutions adopted to tackle the
increasing prevalence of comorbidity.
