More than 50% of people over the age of 65 are living with more than one long term condition, also known as multimorbidity. Despite this, people with multimorbidity are often excluded from clinical trials and there has been limited research into identifying the causes of multimorbidity. For example, we often do not know if two common long-term conditions occur together by chance as we get older, whether one leads to the other, or if they share a risk factor. This problem is partly because health care professionals and researchers tend to focus on one condition at a time. For example, there has been a lot of research into the causes and consequences of osteoarthritis but not why people with osteoarthritis have a higher frequency of asthma, even when accounting for sex, age and obesity.
The aim of our research is to uncover new links between long term conditions that could lead to improved interventions including drug treatments or other more focused treatments. These new links could include a better understanding of which cells in the body are most critical to the presence of two conditions in the same patient.
To achieve our aims, we have formed a partnership called the GEMINI (Genetic Evaluation of Multimorbidity towards INdividualisation of Interventions) collaborative. This team includes two people with multimorbidity, health care professionals including those in primary care and experts in statistics and genetics. We will study the causes of multimorbidity with a new approach, using existing databases of DNA sequence information linked to diseases from 10,000s of people.
Using this genetic approach our initial research has identified many new and interesting links between conditions that were not previously well known. We will complement the genetic approach with data from millions of patients in primary care. These patients are representative of the UK as a whole and will allow us to study large numbers of people with combinations of conditions even if these combinations are quite rare.
Our research plans are divided into three parts:
The outputs are primarily an increased understanding of the biological pathways that contribute to multi-morbidity. Importantly GEMINI will help untangle which conditions are shared in patients due to chance or coincidental reasons such as ageing, or relative wealth and general health, and which are shared due to genuine shared biological mechanisms. Only when we know the mechanisms will we be able to design effective interventions.
This is one of 6 programmes supported by UKRI Medical Research Council Strategic Priorities Fund, an £830 million investment in multi- and interdisciplinary research. These projects are working in parallel with similar National Institute for Health and Social Care Research Artificial Intelligence in Multimorbidity (NIHR-AIM) programmes: