What is the forecasted prevalence and incidence of long-term conditions in Wales: a rapid evidence map

Why ask this question?

It is generally accepted that as we get older we are likely to suffer from various health problems, for example atrial fibrillation, cancer, stroke, dementia, diabetes, heart failure, hypertension, mental illness, and many other problems. Some of the risks for these health problems could include poor diet/nutrition, obesity and smoking. As the number of people living with these conditions increases, so does the demand on health services. Thus, we need to know how many people will likely be affected by these health problems in the future to better prepare the health services and improve quality of care. Prevalence can show how many people live with a condition at a certain period or point in time, while incidence can describe the number of new diagnoses.

How to answer this question

As can be seen, this could be a very complicated question to answer.  So, it was decided, due to the limited time, that the best way to do it was to carry out a Rapid Evidence Map. Rapid Evidence Maps use shortened review methods to describe the nature, characteristics and volume of evidence for a particular question. This evidence map looked at available research studies presenting data for the whole of UK or for individual nations with a main focus on Wales.

What was found

Modelling studies and datasets that predict the number of people living with certain conditions or the number of new diagnoses over the next 10 years or more, specifically: 2 modelling studies for atrial fibrillation (a form of heart disease that causes an irregular and usually rapid heart rhythm);  7 modelling studies, one UK and one Welsh dataset for cancer; 6 modelling studies and one Welsh dataset for cardiovascular disease including strokes,  8 modelling studies and two Welsh datasets for dementia;  3 modelling studies, one Welsh dataset and data from an organisational website for diabetes, 1 study for hypertension (high or raised blood pressure); 2 modelling studies and 1 Welsh data set for mental health and depression; and 1 modelling study for multi morbidities (multiple long-term conditions). This evidence was taken from 2012-2023.

It was clear that there would be increases in most of these health problems. For example:

• Atrial fibrillation in the UK is expected to increase from 700,000 in 2010 to between 1.3 million and 1.8 million in 2060. No evidence was found for projected increases in Wales.
• For breast cancer in Wales, it is estimated that there will be 61,000 females by 2030, and 85,000 by 2040.
• For prostate cancer, it is estimated that in 2030 there will be 42,000 males living with prostate cancer, and by 2040 this figure would reach 56,000.

While these are only a brief indication of the probable rises in Wales, the evidence clearly shows that most of our health problems are likely to increase in number in the future. There were some gaps in the evidence, as insufficient evidence for Wales in relation to conditions including atrial fibrillation, heart failure, hypertension, and multi morbidities were found. This means that further research will be required in these areas. 

Costs

It can be seen that all these increases in health problems will mean that more funding for healthcare services will be required, as existing costs will drastically increase. For example, the costs of mental health in Wales is £4.8 billion per annum, and dementia £700 million per annum.
 

Conclusions

Further research will be required where gaps have been identified. There will be a need to plan to ensure that we limit the effects of the probable increases in most of the health problems that have been identified. Prevention should be a priority and education of the public regarding their lifestyles and how these can be improved must be addressed. To start we should empower people, support health and care professionals, support clinical care, improve the health of the population, and improve clinical efficacy and safety. We must also ensure adequate funding is available.

Lay summary written by Robert Hall

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