Exploring the contribution of risk factors on major illness: a microsimulation study in England, 2023-2043

Multimorbidity is projected to continue increasing in England and many other countries. Here, we use a validated microsimulation model to quantify the potential impact of improving exposure levels of eight risk factors on the burden of major illness among adults aged 30+ in England between 2023-2043. We find that the biggest contributors to incident major illness are body mass index, smoking, systolic blood pressure, and physical inactivity. Theoretical minimum risk exposure levels of all risk factors could reduce 2043 major illness prevalence by 2 percentage points (95% uncertainty intervals: 1.3, 2.7) compared to the continuing trends (base-case) scenario; under a 10% improvement in all risk factors, we project a 0.3 percentage points (0.2, 0.4) reduction in major illness. The impact on health inequalities is mixed. Our findings show that large improvements in risk factors are unlikely to substantially reduce the major illness burden by 2043 due to population ageing.