Transition time between long-term conditions among childbearing women in England: a nationwide observational analysis

To examine transition times between long-term conditions (LTCs) and their associated determinants among childbearing women.

A population-based cohort study. We estimated median times to progress from 1 to 2, 2 to 3, 3 to 4 and 4 to ≥5 LTCs, stratified by ethnicity, socioeconomic status and region. 10-year risks of progression from first to second LTC were estimated by entry cohort (pre-2013 vs ≥2013) using Kaplan-Meier methods, with determinants assessed using Weibull survival models.

English primary care records (CPRD Aurum and GOLD) and pregnancy registers.

A total of 2 160 157 women with a first LTC diagnosis during reproductive years (ages 15-49) and at least one recorded pregnancy between 2003 and 2022.

Approximately 65% with one LTC progressed to develop two or more LTCs. The median time to develop additional LTCs decreased progressively: 5.58 years (from 1 to 2), 4.45 years (from 2 to 3), 3.89 years (from 3 to 4) and 3.68 years (from 4 to 5+). Women diagnosed with their first LTC from 2013 onwards transitioned to second LTC faster than those diagnosed before 2013 (χ² = 4260.55, p<0.001). Faster progression was observed among women from the most deprived backgrounds compared with the least deprived (TR 0.79, 95% CI 0.79 to 0.80). Compared with Southwest England, women in the Northwest, West Midlands and Southeast acquired additional LTCs more rapidly. Ethnic variations in the risk of progression were also observed in specific contexts. Furthermore, analysis of baseline condition-specific trajectories showed that women with an initial diagnosis of cardiomyopathy experienced the fastest transition to a subsequent LTC (median survival time (MST) 3.89 years; 95% CI 0.99 to 11.78). This was followed by women with coronary heart disease (MST 4.21 years; 95% CI 1.30 to 11.34), diabetes (MST 4.25 years; 95% CI 1.39 to 9.20) and anxiety (MST 4.29 years; 95% CI 1.46 to 10.12).

LTC accumulation among childbearing women is driven by socioeconomic deprivation, ethnicity and regional disparities. Targeted interventions for high-risk groups, alongside efforts to address structural inequalities, may help slow this progression.