Investigating MUltimorbidity ThroUgh cApacity building (MUTUAL)

全世界超过三分之一的成年人患有一种以上的慢性疾病。这种疾病的积累也被称为多病。现有的多病研究已经确定，在高收入国家（HIC）和低收入和中等收入国家（LMICs）之间，社区中患有多病的人数相似。然而，在中低收入国家开展的研究非常少。并非所有患有多重疾病的人都患有同样的疾病，人们认为存在几种不同的可能模式。这些模式通常被称为群集，因为它们代表了由不同疾病形成的群集。大多数关于集群的研究都是在高收入国家进行的，在中低收入国家进行的研究很少。在卫生保健领域开展的一些现有研究表明，与仅患有身体疾病的人相比，当一个人同时患有身体和精神疾病时，其生活质量较低，死亡风险增加，经济负担更高。然而，这一领域的工作在中低收入国家基本上没有得到充分的研究，部分原因是：a)分析多病症集群具有挑战性，需要在数据分析方面进行高级培训；B)缺乏合适和最新的数据；c)更普遍地忽视中低收入国家的心理健康研究，d)缺乏受过适当技能培训的跨学科研究人员来解决这一复杂性，特别是在中低收入国家。与MUTUAL合作，我们将为中低收入国家主导的高质量研究开发一个平台，以调查我们对中低收入国家精神和身体疾病相关的多发病（MPM）的认识差距。这将通过在巴西、埃塞俄比亚和马来西亚这三个经济发展水平不同的国家、三大洲建立一个能力建设方案来实现。导师和导师将在三个需要的领域提供培训：a)先进的统计方法和流行病学；B)卫生经济学；c)证据合成。这将通过可转移技能（如研究传播、公开演讲、领导能力、影响、数据安全）方面的培训进一步加强。培训资源将在网络之外提供，以便对培训感兴趣的其他研究人员能够访问它。在英国和国内导师的支持下，这三个国家的早期职业研究人员将共同努力，利用生活在这三个国家的人的现有数据集，以及健康状况的详细信息，促进我们对多病的理解。这将使用先进的统计分析进行。卫生经济学技术还将用于了解与特定群集相关的经济影响，以评估哪些是最繁重的。我们的最终目标是创建一个网络和平台，为未来的培训和进一步的研究活动围绕多病的主题。我们希望这个项目能对人们的生活产生直接影响，不仅是患有多种疾病的人，也包括早期的职业研究人员。

More than a third of adults around the world live with more than one chronic condition. This accumulation of diseases is otherwise known as multimorbidity. Existing studies of multimorbidity have identified that the number of people living with multimorbidity in communities is similar between High (HIC) and Low- and Middle-Income Countries (LMICs). However, very fewer studies have been carried out in LMICs. Not everyone who has multimorbidity share the same diseases, and several different possible patterns are thought to exist. These patterns are normally referred to as clusters, as they represent the clusters formed by different diseases. Most of the research on clusters has been carried out in HIC, with very few studies being conducted in LMICs. Some existing studies carried out in HIC have showed that when a person has both physical and mental disorders, their quality of life is lower, their risk of dying is increased, and their economic burden is higher, compared to a person who only has physical illnesses. This area of work has however been largely under-researched in LMICs, partly for the following reasons: a) analysing multimorbidity clusters is challenging and requires advanced training in data analysis; b) lack of suitable and up-to date data; c) neglect of LMICs mental health research more generally, and d) lack of interdisciplinary researchers trained with appropriate skills to address this complexity, especially in LMICs. With MUTUAL we will develop a platform for high-quality, LMIC-led research to investigate knowledge gaps in our understanding of multimorbidity associated with both mental and physical illnesses (MPM) in LMICs. This will be done by creating a capacity building programme taking place across three countries, in three continents, and with different levels of economic development: Brazil, Ethiopia and Malaysia. Training will be delivered by tutors and mentors in 3 areas of need: a) advanced statistical methods and epidemiology; b) health economics; and c) evidence synthesis. This will be further enhanced by training in transferable skills (e.g. research dissemination, public speaking, leadership, impact, data security). Training resources will be made available outside of the network so that other researchers interested in the training will be able to access it. Early career researchers across the three countries, with support of both UK and in-country tutors, will then work mutually to advance our understanding of multimorbidity using existing datasets of people living in the three countries, with detailed information of health status. This will be carried out using advanced statistical analysis. Health economics techniques will also be used to understand the economic impact associated with specific clusters, to assess which are the most burdensome. Our final objective is to create a network and platform for future training and for further research activities around the topic of multimorbidity. We hope that this project will have a direct impact on people's lives, both individuals living with multimorbidity, but also on early career researchers.