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Research

Multimorbidity / multiple long-term conditions (MLTC)

Summary

Multimorbidity – defined as the co-existence of two or more chronic conditions in a single individual, including mental and physical conditions and long duration infectious diseases – is increasing, both in absolute terms and relative to single diseases, and is associated with a reduction in quality of life, increased use of health services and reduced life expectancy. Research on multimorbidity has been identified as an urgent priority for the UK and globally and is one of the seven health focus themes outlined in the MRC’s Delivery Plan 2019. We are seeking to support and develop research in this important field and work closely with Councils across UKRI, other funders and stakeholders to facilitate the advance in this complex multi-disciplinary area. 

Content

Background

Around one in four people have two or more serious long-term conditions (according to a study by the Health Foundation). This proportion is considerably higher, reaching two thirds, in people aged 65 years and over. The scale of the multimorbidity burden and challenges it poses to the healthcare system require research across different settings and communities to better understand the causes of multimorbidity and to develop new ways to manage and treat multiple conditions.

In 2018, the Academy of Medical Sciences (AMS) published an international policy report evaluating the growing issue of multimorbidity as a global health challenge. The report summarised the existing evidence around multimorbidity and identified the following priorities for multimorbidity research:

  • What are the trends and patterns in multimorbidity?
  • Which multimorbidity clusters cause the greatest burden?
  • What are the determinants of the most common clusters of conditions?
  • What strategies are best able to facilitate the simultaneous or stepwise prevention of chronic conditions that contribute to the most common multimorbidity clusters?
  • What strategies are best able to maximise the benefits and limit the risks of treatment among patients with multimorbidity?
  • How can healthcare systems be better organised to maximise the benefits and limit the risks for patients with multimorbidity?

Following the report, the Academy, MRC, the National Institute for Health Research (NIHR), and Wellcome agreed to come together to coordinate a 'multimorbidity funders group'. Working alongside other charities, this group published a ’cross-funder multimorbidity research framework' in June 2020, with the goal to help funders coordinate their efforts and initiatives, engage with each other and to collectively reach out to their different research communities facilitating broader academic involvement.

Activities

Workshop “Multimorbidity: Cross-sector opportunities for developing new interventions for patients with multiple long-term conditions” (October 2020)

This Academy of Medical Sciences’ FORUM workshop, held in partnership with the MRC and NIHR, explored cross-sector approaches to harnessing new understanding of disease clustering, underlying biological pathways and clinical trials methodology to develop new effective interventions for patients with multimorbidity.

Workshop “Advancing research to tackle multimorbidity: the UK and LMIC perspectives” (June 2018)

The Academy of Medical Sciences, MRC, NIHR, and Wellcome hosted a joint two-day workshop that explored key research priorities in the field in the UK and in the low- and middle-income countries. The workshop provided a platform for discussing opportunities where research could have the most impact in addressing multimorbidity, as well as the enablers and existing barriers of such research, and how the latter could be overcome to improve the evidence-base. The workshop’s report is available here.

How we support research into multiple long-term conditions

Pump-priming calls 2018/2019

Tackling Multimorbidity at Scale – a UKRI initiative in partnership with the NIHR

The £20M Strategic Priorities Fund (SPF) initiative “Tackling multimorbidity at scale: Understanding disease clusters, determinants & biological pathways” jointly funded by the UK Research and Innovation (UKRI) and the Department of Health and Social Care (DHSC), through the NIHR, was launched in 2019 to improve prevention, management and treatment of multiple long-term conditions through building UK’s capacity for transformative research in this area.

We are seeking to develop this new field by moving away from a ‘one-disease, one mechanism’ approach in order to better understand the diverse determinants of multimorbidity, including biological, environmental, psychological and socioeconomic factors, and ultimately unpick and target the common root causes of multiple long-term conditions.

The initiative is delivered by the MRC and NIHR, in partnership with the Economic and Social Research Council, and in collaboration with the Engineering and Physical Sciences Research Council. It aims to build a network of multi-disciplinary Research Collaboratives that will utilise and build on the UK’s strength in having well-powered population and clinical cohorts and datasets with extensive patient phenotyping and stratification to capture and interrogate the dynamic disease-disease interactions and to identify points of intervention to prevent the development of multimorbidity and better manage conditions for patient benefit.

Researcher-led applications to MRC research boards and panels

Research into multiple long-term conditions (multimorbidity) is funded across our boards and panels where it fits their remits and applications can be submitted to our regular calls, including by MRC boards:

Please note that multimorbidity is an opportunity area for our Population and Systems Medicine Board, which supports research related to the physiology and pathophysiology of all the major organs and systems.

Research projects are also eligible for all our training investments. More information about training grants, specifically with respect to fellowships and studentships is available at our Skills & Careers pages.

Supported Studies

The SPF “Tackling Multimorbidity at scale” Initiative

The SPF programme “Tackling multimorbidity at scale: Unpicking disease clustering biological pathways and trajectories” supported two collaboratives in wave 1, with wave 2 awards expected to be made in May 2021.

Wave 1 awards (PDF, 25KB):

Multimorbidity Mechanism and Therapeutics Research Collaborative (MMTRC). This collaboration between UCL, University of Cambridge, University of Bristol, University Hospitals Birmingham and University of Liverpool is being led by Professor Aroon Hingorani, University College London, and will focus on uncovering common mechanisms underlying diverse diseases. Professor Hingorani said: “The MMTRC seeks to better understand the causes of multiple conditions in the same patient to aid the development of new and optimise use of existing medicines to improve patient care. We will use and compare findings from different large national and international data resources including linked NHS electronic health records, UK Biobank, as well as data from genetic studies and clinical trials to ensure our findings are as reliable as they can be. Patient and public perspectives have had a substantial influence on the planning and development of the programme and will play a central part in all the research activities, as well as the communication and dissemination of the findings.”

ADMISSION UK: Multimorbidity Research Collaborative on MLTC in Hospital: from burden and inequalities to underlying mechanisms. The study, led by Professor Avan Aihie Sayer, Newcastle University, brings together scientists, clinicians and patients from five UK universities and hospitals (Newcastle, Birmingham, Manchester Metropolitan, University College London and Dundee) to transform understanding of multiple long-term conditions in hospital patients. Professor Sayer said: “Living with multiple long-term conditions, also known as multimorbidity, is very common among people admitted to hospital. These patients often stay in hospital for longer, are more likely to die and, for patients who recover, this may take much longer. However, the way that care is delivered in hospital is not ideal; in a system that was designed for the treatment of single conditions, the care of patients with multimorbidity can be unsatisfactory, inefficient and expensive. To date there has been little research on multimorbidity in hospital patients which is crucial to understand how services need to be changed.

Harnessing the power of ‘big data’ from routinely-collected hospital, primary and social care records, along with research studies such as UK Biobank and the Scottish Health Research Register (SHARE), ADMISSION will use cutting-edge data science, computing and statistical techniques, care pathway analysis, qualitative methods, genetic epidemiology and phenotypic characterisation. This will enable identification of clusters of long-term conditions in hospital patients, the occurrence of inequalities, the biological causes underlying these clusters, and their consequences. ADMISSION will lay foundations for new approaches to the recognition and treatment of multimorbidity in hospital and inform the design of future care, with potential to improve health outcomes for the millions of patients with multimorbidity admitted to hospital each year.”

Consolidator grants:

Eleven groups were awarded 6-month developmental Consolidator grants to help them develop and test their approaches, acquire preliminary data or expand the expertise of the team. The list of the supported projects could be downloaded here.

Pump-priming call Multimorbidity in the UK population: understanding disease clustering

This joint MRC-NIHR call aimed to pump-prime research that would systematically identify or explore common disease clusters, their distributions in diverse groups and explore multimorbidity trajectories across the life course. Five projects were supported through this call (download the list).

GCRF Global Multimorbidity – Seed-funding

The GCRF global multimorbidity seed-funding call was an MRC initiative developed in collaboration with Wellcome, NIHR, and AMS. The call supported seed-funding projects seeking to develop and test innovative ideas, foster interdisciplinary collaboration, build capacity, and lay the groundwork for future large-scale activity aimed at understanding and tackling multimorbidity in LMICs. 13 projects were supported through this call (download the list (PDF, 88KB)).

Contact

For any queries or for more information related to multimorbidity, please contact multimorbidity@mrc.ukri.org.