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

Sobia Ambreen; Adeniyi Fagbamigbe; Amanda Rodrigues Amorim Adegboye; Abiodun Adanikin

doi:10.1136/fmch-2026-003904

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

Sobia Ambreen
, Adeniyi Fagbamigbe
, Amanda Rodrigues Amorim Adegboye
, Abiodun Adanikin

Centre for Healthcare and Community Transformation (HCT)

Research output: Contribution to journal › Article › peer-review

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Abstract

Abstract

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

Design 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.

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

Participants 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.

Results 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).

Conclusion 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.

Original language	English
Number of pages	10
Journal	Family Medicine and Community Health
Volume	14
Issue number	1
DOIs	https://doi.org/10.1136/fmch-2026-003904
Publication status	Published - 18 Mar 2026

Bibliographical note

© Author(s) (or their employer(s)) 2026. Re- use permitted under CC BY- NC. No commercial re- use. See rights and permissions. Published by BMJ Group.
This is an open access article distributed in accordance with the
Creative Commons Attribution Non Commercial (CC BY- NC 4.0) license, which
permits others to distribute, remix, adapt, build upon this work non- commercially,
and license their derivative works on different terms, provided the original work is
properly cited, appropriate credit is given, any changes made indicated, and the use
is non- commercial. See: https://creativecommons.org/licenses/by-nc/4.0/

Funding

This research was funded by the Trailblazers Early-Career Researcher and Doctoral Studentship Partnering Scheme at Coventry University (Award No. 13771‑93) awarded to AA. The funder was not involved in the study’s design, data collection, analysis, interpretation or the preparation of this report.

Funders	Funder number
Coventry University	13771‑93

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Multiple Chronic Conditions
Reproductive Health
Reproductive Health Services
Women's Health
Women's Health Services

Access to Document

10.1136/fmch-2026-003904Licence: CC BY-NC

LRH - Rate of Accumulation of LTCAccepted author manuscript, 296 KBLicence: CC BY-NC
Ambreen2026VoRFinal published version, 538 KBLicence: CC BY-NC

Cite this

@article{44c4fcbba1644c82afe6d1d68e01c998,

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

abstract = "Abstract Objective To examine transition times between long-term conditions (LTCs) and their associated determinants among childbearing women. Design 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. Setting English primary care records (CPRD Aurum and GOLD) and pregnancy registers. Participants 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. Results 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). Conclusion 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.",

keywords = "Multiple Chronic Conditions, Reproductive Health, Reproductive Health Services, Women's Health, Women's Health Services",

author = "Sobia Ambreen and Adeniyi Fagbamigbe and \{Rodrigues Amorim Adegboye\}, Amanda and Abiodun Adanikin",

note = "{\textcopyright} Author(s) (or their employer(s)) 2026. Re- use permitted under CC BY- NC. No commercial re- use. See rights and permissions. Published by BMJ Group. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY- NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non- commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non- commercial. See: https://creativecommons.org/licenses/by-nc/4.0/",

year = "2026",

month = mar,

day = "18",

doi = "10.1136/fmch-2026-003904",

language = "English",

volume = "14",

journal = "Family Medicine and Community Health",

issn = "2305-6983",

publisher = "BMJ Publishing Group",

number = "1",

}

TY - JOUR

T1 - Transition time between long-term conditions among childbearing women in England

T2 - a nationwide observational analysis

AU - Ambreen, Sobia

AU - Fagbamigbe, Adeniyi

AU - Rodrigues Amorim Adegboye, Amanda

AU - Adanikin, Abiodun

N1 - © Author(s) (or their employer(s)) 2026. Re- use permitted under CC BY- NC. No commercial re- use. See rights and permissions. Published by BMJ Group. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY- NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non- commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non- commercial. See: https://creativecommons.org/licenses/by-nc/4.0/

PY - 2026/3/18

Y1 - 2026/3/18

N2 - Abstract Objective To examine transition times between long-term conditions (LTCs) and their associated determinants among childbearing women. Design 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. Setting English primary care records (CPRD Aurum and GOLD) and pregnancy registers. Participants 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. Results 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). Conclusion 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.

AB - Abstract Objective To examine transition times between long-term conditions (LTCs) and their associated determinants among childbearing women. Design 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. Setting English primary care records (CPRD Aurum and GOLD) and pregnancy registers. Participants 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. Results 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). Conclusion 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.

KW - Multiple Chronic Conditions

KW - Reproductive Health

KW - Reproductive Health Services

KW - Women's Health

KW - Women's Health Services

UR - https://www.scopus.com/pages/publications/105033751166

U2 - 10.1136/fmch-2026-003904

DO - 10.1136/fmch-2026-003904

M3 - Article

SN - 2305-6983

VL - 14

JO - Family Medicine and Community Health

JF - Family Medicine and Community Health

IS - 1

ER -

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

Abstract

Bibliographical note

Funding

UN SDGs

Keywords

Access to Document

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