Exploring trends in and the interplay between infection, multimorbidity and deprivation in Scotland
Project reference: RAS-25-380
Approval date: 13 May 2026
Lead organisation | Principal Investigator |
|---|---|
University of St Andrews | Rebecca Stout |
Plain English summary
This project aims to understand how much of the burden of disease which falls on hospitals in Scotland is linked to infections, how infectious diseases overlap and interact with long-term health conditions, and whether people living in greater socio-economic deprivation have worse outcomes when they are admitted to hospital. Healthcare resources are often allocated assuming infectious diseases and long-term conditions are separate problems. In reality, many patients have both. For example, a person with heart disease, diabetes, lung disease, or kidney disease may be more likely to develop a serious infection and may recover more slowly. Multimorbidity refers to individuals who have two or more chronic conditions at the same time, and this group may be at a higher risk of infection and poor infection outcomes than those without multimorbidity. People living in more deprived areas may also be at higher risk of both long-term illness and infection. This means that infection and chronic illness may combine to increase the chance of ill health, longer hospital stays, readmission, or death.
The main aim of the project is to investigate the scale of this problem in Scotland using hospital data. We want to describe how often patients are admitted with infections, with non-infectious conditions, or with both together, and to compare their outcomes. We also want to examine whether the burden of infection is higher in people who already have multimorbidity, and whether deprivation adds further complications.
This project would look at all hospital admissions within Scotland over a 25-year period, from 1999 to 2023 inclusive. The cohort would come from acute hospital admissions (SMR01) and maternity admissions (SMR02), and outcomes would be linked from the following datasets: acute hospital admissions (SMR01), maternity admissions (SMR02), National Records of Scotland (NRS) deaths and prescribing data. The findings of the study will help with health service planning within Scotland, and will inform whether particular groups of patients are at a higher risk of poor outcomes. This will help to ensure that future infection prevention interventions are directed towards those most at risk.
Statement of public good
This project aims to understand how much of the pressure on hospitals in Scotland is linked to infections, how this overlaps with long-term health conditions, and whether people living in more deprived circumstances experience worse outcomes when they are admitted to hospital. At present, there is no publicly available information showing how many hospital admissions are related to infections in Scotland. This makes it difficult to plan healthcare services and allocate resources in a way that reflects real patient need. By providing this evidence, the project will support better decision-making within NHS Scotland and help ensure that resources are used more effectively.
Inclusion of children and pregnant women is important because these groups are often under-represented in research. These groups also have distinct patterns of infection, healthcare use, and outcomes, and are often under-represented in research. Children account for a substantial proportion of infection-related hospital admissions and antibiotic use, while maternity care frequently involves infection prevention and treatment, including the use of antibiotics. Their inclusion will ensure that the study captures the full burden of infection-related admissions, and produces findings which are relevant, representative, and applicable across the population and can better inform equitable service planning and clinical care.
Healthcare is often organised into separate areas for infectious diseases and long-term conditions. However, many patients experience both at the same time. For example, people with conditions such as diabetes or weakened immune systems may be more likely to develop serious infections. In turn, infections may contribute to the development or worsening of long-term conditions such as heart disease, stroke, or dementia. Despite this, the relationship between infections and chronic illness is not well understood at a population level in Scotland.
This research will address that gap by examining how infections, long-term conditions, and deprivation interact in people admitted to hospital. It will help identify whether certain groups are at higher risk of poor outcomes, such as longer hospital stays or increased risk of death. The public benefit of this work is that it will provide a stronger evidence base for health policy and service planning in Scotland. It will support a more joined-up approach to healthcare, rather than treating infections and long-term conditions as separate issues. It will also contribute to a better understanding of health inequalities, by identifying whether people living in more deprived areas are disproportionately affected. Overall, the findings will help improve how healthcare services are designed and delivered, with the aim of improving outcomes for patients and ensuring that NHS resources are directed where they are most needed.
Datasets used