ADOPTED PROJECT: Multidisciplinary Ecosystem to study Lifecourse Determinants and Prevention of Early-onset Burdensome Multimorbidity (MELD-B)

Start date: 1st June 2022

End date: 28th Feb 2025

Contact: s.fraser@soton.ac.uk - link to southampton site listing

Lay summary:

A growing number of people are living with several long-term health conditions like diabetes, heart disease, depression or dementia. We call this multiple long-term condition multimorbidity (MLTC-M). Many things throughout a person’s life influence the chances of developing health conditions. This includes their biology (e.g. age, ethnicity), things that happen to them (e.g. infections, accidents), behaviours (e.g. smoking, diet) and broader experiences (e.g. the environment people grew up in, their education, work, income). People from more disadvantaged backgrounds and/or certain ethnicities are more likely to develop MLTC-M and to develop it earlier. The impact (or ‘burden’) of MLTC-M, and the order that people develop conditions, also vary. Our research will help understand when MLCT-M becomes ‘burdensome’ and the best opportunities for intervention.

AimTo use an Artificial Intelligence (AI) enhanced analysis of birth cohort data and electronic health records to identify lifecourse time points and targets for the prevention of early-onset, burdensome MLTC-M.

Plan

To achieve this aim, our study is composed of five work packages:

1. Undertake a qualitative evidence synthesis and a consensus study (Delphi) to develop deeper understanding of what ‘burdensomeness’ and ‘complexity’ mean to people living with early-onset (by age 65) MLTC-M, carers and healthcare professionals

2. Develop a safe data environments and readiness for AI analyses across large, representative routine healthcare datasets and birth cohorts.

3. In those safe data environments, using the WP1 burdensomeness/complexity indicators and applying AI methods, identify novel early-onset, burdensome MLTC-M clusters. Also in this work package, we will match individuals in birth cohorts into routine data MLTC-M clusters and then identify determinants of burdensome clusters and model trajectories of long-term conditions (LTCs) and burden accrual.

4. By characterising clusters of early-life (pre-birth to 18 years) risk factors for early-onset, burdensome MLTC-M and sentinel conditions (the first LTC to occur in the lifecourse), we will define population groups in early life at risk of future MLTC-M, identify critical time points and targets for prevention, and model counterfactual prevention scenarios of interventions acting on combined risk factors at key timepoints.

5. Engage key stakeholders to prioritise timepoints and targets to prevent/delay specified sentinel conditions and early-onset, burdensome MLTC-M. Partnering with our PPI Advisory Board, and through further stakeholder engagement, we will co-produce public health implementation recommendations

ImpactWe will work with our stakeholders to use the findings from our research to influence policy and practice, and to co-produce public health advice, on preventing burdensome MLTC-M.

Team:

Nisreen A Alwan Associate Professor in Public Health (University of Southampton), Ashley Akbari Senior Research Manager (Swansea University)Mark Ashworth Reader in Primary Care (King’s College London), Ann Berrington Professor of Demography and Social Statistics (University of Southampton), Michael Boniface Professorial Fellow of Information Systems (University of Southampton), Jessica Enright Senior Lecturer in Computing Science (University of Glasgow), Nick Francis Professor of Primary Care Research (University of Southampton), Simon DS Fraser Associate Professor of Public Health (University of Southampton), Martin Gulliford Professor of Public Health (King’s College London), Emilia Holland Specialty Registrar in Public Health/Visiting Academic (University of Southampton), Rebecca Hoyle Professor of Applied Mathematics (University of Southampton), Sara Macdonald Professor of General Practice and Primary Care (University of Glasgow), Frances MairNorie Miller Professor of General Practice (University of Glasgow), Rhiannon Owen Associate Professor, Health Data Science (Swansea University), Shantini Paranjothy Professor and Clinical Chair in Public Health (University of Aberdeen), Ruben Sanchez-Garcia Associate Professor of Pure and Applied Mathematics (University of Southampton), Sebastian Stannard PhD student in Demography and Social Statistics, Becky Wilkinson Consultant in Public Health (Southampton City Council), Zlatko ZlatevSenior Enterprise Fellow, Electronics & Computer Science (University of Southampton)