Tackling multimorbidity at scale: Understanding disease clusters, determinants & biological pathways

Multimorbidity is associated with a reduction in quality of life, increased use of health services and reduced life expectancy. As the number of conditions an individual has increases, so does the likelihood of increased healthcare costs. Multimorbidity has suffered scientifically from being seen as a random assortment of diseases, making it difficult to address. However, with new understanding of the impact of various factors (including biological, social, behavioural, environmental and others), multimorbidity can be seen as series of non-random clusters of disease. While some clusters are obvious (e.g. obesity with cardiovascular disease-osteoarthritis & several cancers), others need further identification (particularly physical and mental health comorbidities) and follow on mechanistic exploration. This will require new multi-disciplinary approaches to mapping and tackling multimorbidity, at scale.

Better understanding of disease clusters and underlying mechanisms, taking a broad approach that can encompass the biological, and wider determinants as appropriate, will make clinical, public health and scientific progress more achievable.

Research to explore disease clusters and associations, and to better measure and understand multimorbidity across the UK population has already begun via the Medical Research Council (MRC) – National Institute for Health Research (NIHR) pump-priming initiative and by Health Data Research UK (HDR UK), through its national multimorbidity resource project.

However, large multi-disciplinary research collaborative efforts are needed to address current research gaps and achieve the required cohesion in this field. To this end, this

Strategic Priorities Fund (SPF) research call, jointly funded by the UK Research and

Innovation (UKRI) and the Department of Health and Social Care (DHSC) through the National Institute for Health Research (NIHR), will bring together multi-disciplinary collaborations with a range of scientific, methodological, and clinical knowledge and skills to build manageable, focussed “Multimorbidity Research Collaboratives”. These collaboratives will be expected to have strong patient involvement, as benefits the remit of the project, and add significant understanding to a broad range of topics including, for example:

  • Identification of new disease clusters
  • Multimorbidity over different stages across the life-course taking a comprehensive multi- disciplinary approach
  • Discovery, validation and targeting of underlying mechanistic and pathobiological pathways

Recognising the potential to identify new patterns of multimorbidity and contributing factors, and the more advanced nature of research on more established multimorbidity clusters, the call is designed in two streams:

  • For those groups that need time to consolidate existing data or collaborations and/or obtain preliminary data there is an option to apply for a rapid and modest “Consolidator grant”. These grants will serve as a test bed, bringing new disciplines together and provide proof-of-concept data, enabling the best groupings and ideas to mature to a second “Research Collaborative award” stage.
  • For those other groups that have already developed multi-disciplinary networks and supporting data, there will be the option to move straight to the “Research Collaborative award” stage.

1. Background

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