Extending an inter-generational cohort to develop a multimorbidity research platform in rural and urbanising India

扩大代际队列，在印度农村和城市化地区开发多病研究平台

• 批准号: MC_PC_MR/T038292/1
• 负责人: Sanjay Kinra
• 金额: $ 25.26万
• 依托单位: London School of Hygiene & Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2020
• 资助国家: 英国
• 起止时间: 2020 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MC_PC_MR%2FT038292%2F1
• 关键词: Extending; inter; generational; cohort; develop

In India, people that have more than one long-term health condition ("multimorbidity") are more likely to have high healthcare costs, which they usually pay out-of-pocket, and to be disabled which can affect their ability to work. As a result, multimorbidity can impact the economic well-being of people's families, potentially pushing them below the poverty line. Rural and urbanising communities are particularly vulnerable to rapid rises in multimorbidity because social changes are affecting behaviours (e.g. people are eating more processed foods) and environmental exposures (e.g. rising air pollution from traffic), while old, poverty-related health issues (e.g. malnutrition) remain common. Healthcare is also lacking in these areas, so people can struggle to manage their conditions. As a result of these factors, rising multimorbidity could inhibit future development in rural and urbanising areas. As such, it is important to understand what causes multimorbidity, so that we can develop ways to prevent it. This study will build on work done over the past 30 years in 29 villages on the outskirts of Hyderabad city, Telangana. The study team has previously collected detailed health data on families within these villages (the Andhra Pradesh Children and Parents Study) (~5% of the village population, N=6,972, aged ~22-50 in 2010-12) who were involved in a trial of nutritional supplements for pregnant women and young children in the 1980s. Our ultimate aim is to follow this cohort up over the long-term to see how conditions develop and cluster together at different life-stages, to examine what causes these clusters, and to develop ways to target these causes to prevent multimorbidity developing. We will particularly investigate how factors at early-life (e.g. malnutrition) and related to the rapidly changing environment (e.g. air pollution) are linked to multimorbidity, as their impact on multimorbidity has not been assessed. Nevertheless, we need to do considerable groundwork to be able to do this accurately. This current study will analyse previously collected data to understand which clusters of conditions and potential causes are important in the local community. We will also collect data on the presence of chronic conditions in the older sub-group of the cohort (N=~2,000, aged ~60 in 2020), who are more likely to experience multiple conditions. This will be analysed in combination with previously collected data (2010) and used to calculate how many community members we need to study to accurately quantify the impact of potential causes on the risk of multimorbidity. We will also interview people with varying severities of multimorbidity (and their family members) and conduct focus-group discussions with wider community members, to understand how multimorbidity affects people's lives and what they wish APCAPs to prioritise and research in the future. A final goal is to investigate how feasible it would be to develop a system that automatically collects data on community members' healthcare records, as this would allow us to collect data over the long-term and at low cost. We will do this by randomly selecting 200 of the surveyed cohort who have used healthcare in the past year, tracking down their records in local facilities, and comparing the diagnosis with results from our own clinical examinations. Working closely with community members and key parties (e.g. local health workers, village leaders), we will use the above findings to develop a research proposal for a multimorbidity research platform, to establish the causes of multimorbidity, assess its impact, and develop and test ways of preventing multimorbidity. We expect our findings will also be applicable to other communities experiencing similar social changes.

在印度，患有一种以上长期健康状况（“多重疾病”）的人更有可能承担高昂的医疗费用（通常需要自费），并且更有可能患有残疾，这可能会影响他们的工作能力。因此，多种疾病会影响人们家庭的经济福祉，有可能使他们陷入贫困线以下。农村和城市化社区特别容易受到多种疾病迅速上升的影响，因为社会变化正在影响人们的行为（例如人们吃更多的加工食品）和环境暴露（例如交通造成的空气污染加剧），而与贫困相关的老旧健康问题（例如营养不良）仍然很常见。这些地区也缺乏医疗保健，因此人们很难控制自己的病情。由于这些因素，多重发病率的上升可能会抑制农村和城市化地区的未来发展。因此，了解导致多重发病的原因非常重要，以便我们能够找到预防方法。这项研究将建立在过去 30 年在泰伦加纳海得拉巴市郊区 29 个村庄所做的工作的基础上。研究小组此前收集了这些村庄内家庭的详细健康数据（安得拉邦儿童和家长研究）（约占村庄人口的 5%，N=6,972，2010-12 年年龄约 22-50 岁），这些家庭参与了 1980 年代孕妇和幼儿营养补充剂试验。我们的最终目标是长期跟踪这一群体，了解不同生命阶段的病症如何发展和聚集在一起，检查导致这些聚集的原因，并开发针对这些原因的方法，以防止多发病的发展。我们将特别研究生命早期的因素（例如营养不良）和与快速变化的环境（例如空气污染）相关的因素如何与多种疾病相关，因为它们对多种疾病的影响尚未得到评估。然而，我们需要做大量的基础工作才能准确地做到这一点。目前的研究将分析之前收集的数据，以了解哪些情况和潜在原因对当地社区很重要。我们还将收集该队列中老年亚组（N=~2,000，2020 年约 60 岁）中存在慢性病的数据，他们更有可能患有多种疾病。这将与之前收集的数据（2010）结合起来进行分析，并用于计算我们需要研究多少社区成员，以准确量化潜在原因对多重发病风险的影响。我们还将采访患有不同严重程度的多种疾病的人（及其家庭成员），并与更广泛的社区成员进行焦点小组讨论，以了解多种疾病如何影响人们的生活以及他们希望 APCAP 未来优先考虑和研究的内容。最终目标是研究开发一个自动收集社区成员医疗记录数据的系统的可行性，因为这将使我们能够长期且低成本地收集数据。为此，我们将随机选择 200 名在过去一年中使用过医疗保健的受访人群，追踪他们在当地机构的记录，并将诊断结果与我们自己的临床检查结果进行比较。我们将与社区成员和关键各方（例如当地卫生工作者、村领导）密切合作，利用上述发现为多发病研究平台制定研究计划，以确定多发病的原因，评估其影响，并开发和测试预防多发病的方法。我们希望我们的发现也适用于经历类似社会变化的其他社区。

项目成果

Advancing multimorbidity management in primary care: a narrative review.

• DOI: 10.1017/s1463423622000238
• 发表时间: 2022-07-01
• 期刊: PRIMARY HEALTH CARE RESEARCH AND DEVELOPMENT
• 影响因子: 1.6
• 作者: Aramrat, Chanchanok;Choksomngam, Yanee;Jiraporncharoen, Wichuda;Wiwatkunupakarn, Nutchar;Pinyopornpanish, Kanokporn;Mallinson, Poppy Alice Carson;Kinra, Sanjay;Angkurawaranon, Chaisiri
• 通讯作者: Angkurawaranon, Chaisiri

The Integration of Clinical Decision Support Systems Into Telemedicine for Patients With Multimorbidity in Primary Care Settings: Scoping Review.

• DOI: 10.2196/45944
• 发表时间: 2023-06-28
• 期刊: Journal of medical Internet research
• 影响因子: 7.4

Burden, determinants, consequences and care of multimorbidity in rural and urbanising Telangana, India: protocol for a mixed-methods study within the APCAPS cohort.

• DOI: 10.1136/bmjopen-2023-073897
• 发表时间: 2023-11-27
• 期刊: BMJ open
• 影响因子: 2.9

The higher dietary inflammation is associated with a higher burden of multimorbidity of cardio-metabolic and mental health disorders in an urbanizing community of southern India: A cross-sectional analysis for the APCAPS cohort

印度南部城市化社区中较高的饮食炎症与较高的心脏代谢和精神健康疾病多发病负担相关：APCAPS 队列的横断面分析

• DOI: 10.1016/j.hnm.2024.200254
• 发表时间: 2024
• 期刊: Human Nutrition & Metabolism
• 作者: Mahajan H