Remission of long-term conditions among adults with multiple long-term conditions in England primary care: A retrospective cohort study of 4.7 million people

Abstract

Abstract Background Multiple long-term conditions (MLTC) are increasingly prevalent among UK adults, yet the extent to which remission of long-term conditions is recorded in routine primary care remains poorly understood. Accurate documentation of remission has implications for clinical management, disease trajectories, and the use of electronic health records in research. Examining remission in the context of MLTC is important because remission in one condition may alter overall disease burden and treatment needs in people living with several coexisting conditions. We aimed to describe the frequency and variation of recorded remission across multiple long-term conditions among adults. Methods We conducted a retrospective cohort study using linked primary care, hospital, and CPRD Aurum data. Adults aged ≥ 18 with MLTC (≥ 2 long-term conditions) between Jan 1, 1987, and Dec 31, 2020, were included. Remission was defined using condition-specific criteria based on remission or resolution codes, relevant clinical measurements meeting predefined thresholds, treatment patterns, and condition-specific clinical events recorded in electronic health records. We examined remission for 10 conditions with operationalizable definitions. Analyses were descriptive, summarising remission frequencies and sociodemographic patterns. Results Among 4,745,099 adults followed for a median of 8 years, 900,609 (19%) had recorded remission of at least one condition. Remission varied substantially by condition, with the highest rates observed for anaemia (63.0%), asthma (44.71%), and diabetes (15.51%), calculated among people with an ever-recorded diagnosis of each condition. Those with remission were slightly younger and more often male; Asian and Black ethnic groups were under-represented, while deprivation patterns were broadly similar. Conclusions Recorded remission in MLTC is highly heterogeneous and often rare. Variation between conditions and low rates of sustained remission likely reflect coding practices and clinical recording behaviours. Standardised remission definitions and consistent Systematised Nomenclature of Medicine (SNOMED) coding could improve data quality and support more reliable research on remission and disease trajectories.