Multimorbidity in the UK population: understanding disease clustering

 

Tuesday 09 October 2018

The Medical Research Council (MRC) and the National Institute for Health Research (NIHR) are issuing a joint call for research projects into disease clustering in multimorbidity. Awards of up to £600,000 (funders' contribution) are available for up to 36 months. Funding is available for exploratory or hypothesis-driven research that will systematically identify or explore common disease clusters, their distributions in diverse groups, multimorbidity trajectories and/or the underpinning mechanisms across the life course. We encourage applications from cross-disciplinary and cross-institutional teams to develop research in this important field.

A substantial and likely growing number of people around the world suffer from two or more chronic conditions, referred to as multimorbidity. This poses many challenges for individuals, carers and the health and social care system. Understanding of disease co-occurrence, complex interactions of different conditions and the underlying pathways throughout the life course is urgently needed to develop efficient strategies for multimorbidity prevention, early diagnosis, and to design and deliver better interventions for patients.

A report by the Academy of Medical Sciences, Multimorbidity: a priority for global health research, outlined some of the research gaps and priorities in this area. During a recent expert workshop, Advancing research to tackle multimorbidity, co-organised by the MRC, NIHR, the Academy of Medical Sciences and Wellcome, funders acknowledged that addressing the multimorbidity challenge – both at a national level and globally – will require concerted, joint efforts in this field.

The workshop highlighted that while there is some knowledge about a number of common disease associations, progress in this area is limited by the scarcity and fragmented nature of the existing information, and the paucity of methodological research in this area. Therefore, it is important to systematically identify and explore common disease clusters and their distributions in the diverse groups of the UK population to study multimorbidity trajectories across the life course, including the social patterning of multimorbidity, links with sex, ethnicity, income and lifestyle, and the underlying causal pathways. This would support further research into multimorbidities such as basic mechanistic studies into recognised multimorbidity clusters.

To fill this knowledge gap and as part of the ambition to bring multimorbidity into the UK health and social care research landscape, the MRC and NIHR have partnered together to invite proposals that would use an integrative approach to link and analyse data from existing sources to establish prevalence and changes in various disease clusters. This may include identifying common clusters, highly correlated clusters and those clusters considered to be particularly debilitating, as well as the development of new methodological approaches to analyse such data. There is also interest in exploring the social patterning of multimorbidity and health inequalities, and underlying pathways and disease mechanisms.

The outcomes of the projects supported through this funding initiative will identify areas where future research can have the most impact and will build the foundation for mechanistic studies to unravel underpinnings of various multimorbidities, causal effects of shared risk factors and disease interactions. The eventual goal of the research should lead to better preventative and therapeutic approaches and policies to manage multiple conditions, taking into account patient perspectives of living with and managing multimorbidity, as well as those of their families and carers.

The call has been developed to catalyse multimorbidity research by supporting both hypothesis-driven and exploratory studies that, in addition to classical epidemiological methods, would utilise new approaches to complex data collection and analysis of datasets originating from multiple sources (such as primary care, prescription, administrative data, survey data, and environmental factors).

For known clusters of diseases, the call aims to develop a deep understanding of how multimorbidity arises, so that effective interventions can be designed and implemented.

We are particularly keen to support applications from cross-disciplinary and cross-institutional teams involving clinicians, epidemiologists, data scientists, social and behavioural scientists, and basic biomedical researchers to tackle the complexity of multimorbidity at all levels.

The awards will offer support for projects lasting between one to three years (up to a maximum duration of 36 months). These may be used to generate data that would provide a strong evidence base and clear rationale for larger programmes of research. Alternatively, they may support methodological research or explore the underlying basis of already recognised multimorbidity clusters using model systems and mechanistic approaches.

This call is part of a longer-term effort to address the challenge of multimorbidity, find solutions for the UK health and social care sector, and improve the quality of life and health outcomes for people with multimorbidities. This could include younger adults as well as the older population.

The award aims to provide funds to support integrative population and patient studies using existing infrastructure and data sources including established cohorts, surveys, biobanks, and primary and secondary care data to identify new clusters of multimorbidity, biological, environmental, behavioural and socioeconomic multimorbidity risk factors, biomarkers and disease associations underpinned by common mechanistic pathways or induced by a pre-existing condition or its treatment.

We will consider applications that will contribute to building the evidence base for more focused research on specific types of multimorbidity or will generate data to enable larger-scale experimental medicine and stratified medicine studies.

The award is expected to help establish new and galvanise existing research collaborations between clinical and academic experts from different research fields.

The scope of the call includes, but is not limited to the following research topics:

  • disease clustering in defined population/patient groups
  • addressing prevalence and changes in multimorbidity during the life course (such as in childhood, during pregnancy or postpartum period)
  • social patterning and health inequalities associated with multimorbidity
  • shared mechanistic pathways in common co-morbidities
  • multimorbidity biomarkers, early predictors and genetic associations
  • innovative methodological approaches, tools and technologies for capturing and measuring patients' complexities in the context of multimorbidity
  • enriching data for established population and clinical cohorts.

The MRC will administer this call on behalf of the two funders. There will be a one-stage application process for these awards. Applicants are advised to submit their proposals through Je-S. For the purpose of this call when applying on Je-S, please select:

  • council: MRC
  • document type: standard proposal
  • scheme: research grant
  • call: multimorbidity 2018.

All proposals will be assessed by a joint MRC-NIHR panel of experts and will go through a triage process following external peer-review (January/February 2019). Applicants will be contacted via email shortly after the triage panel meeting, to inform them of the panel’s decision and the feedback on their application. Applicants, whose proposals would be deemed competitive for funding through this call (‘triaged in’) will have an opportunity to respond to the reviewers’ criticism and any concerns raised by the panel.

The joint panel will re-convene in March 2019 for the funding decision. Panel decisions are final and there will be no opportunity to respond to the feedback.

Applicants should consider carefully the following criteria, which will be taken into account by the expert review panel when assessing proposals:

  • fit to the aims of the call
  • potential of the outcomes of the proposed research to provide significant new insights into the disease clustering, to provide insight into underlying mechanisms in already recognised multimorbidities, to generate new hypotheses for further mechanistic studies, to identify novel ways to capture and monitor multimorbidity, to improve health and wellbeing of patients with multimorbidities
  • quality of the research team and potential of the proposed collaboration to stimulate and deliver high-quality research of national importance
  • availability of resources – existing links with the major data sources or evidence of negotiated data access
  • appropriateness of requested resources and the effectiveness of the proposed data management structure and plans, and the value for money offered by the proposed research
  • appropriateness of data management and sharing strategies
  • plans for patient and public involvement.

Click here to learn more at the MRC UKRI website.

 

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