Pathways and Levers for prevention of Multi-morbidity from Young and Middle Adulthood

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Multimorbidity is the presence of two or even several more major health condition at the same time within a single person. It is a growing problem in the United Kingdom in part of the combination of increasing lifespans with unhealthy lifestyles. Although multimorbidity is most common in older age, poor diet, physical inactivity, and obesity in young adulthood and middle-age are likely important causes of the tendency to multimorbidity. We suspect that 3 conditions in particular - diabetes, hypertension, and depression - cause a large portion of multimorbidity because of the way that they work together to affect so many systems of the body. If this is the case, then programmes for focused lifestyle interventions could make a big difference in preventing multimorbidity. Unfortunately, it is difficult to know how these conditions in young and middle-age affect multimorbidity and what works to prevent it because no studies track population across many stage of life, while measuring the impact of interventions. This research progamme will tackle these questions with 3 parts. First, it will use long-term data from the UK and London populations to uncover the most common combinations of diseases occurring and whether there are particular steps and pathways in their formation. After finding those combinations and estimating how rapidly they develop at different times in life, we will construct a new computer-based model, called a "life-course simulation model" that can identify the optimal times in life, combinations of behaviors, risk factors, and diseases that cause the greatest illness over life. The computer model will also examine the effect of different ways of preventing the accumulation of multimorbidity, such as using focused support to change lifestyle in people at risk for hypertension, diabetes, and depression. The third part of the research programme will use these data and the computer model to measure the effect of two National Health Service initiatives that support people at risk of diabetes or with diabetes to change lifestyle diabetes. Since lifestyle behaviors are also crucial to hypertension, depression, and other conditions, these "natural experiments" may have a big effect on multimorbidity as well. This work will require a team with expertise in diverse areas - including medical care, epidemiology, behaviour change, mathematics, and computer modeling. This study will answer important questions about what types of conditions are causing the most multimorbidity and what are the best ways to act to prevent them. The computer model and research that results will give doctors, health planners, and the public new way to improve health in communities for the years to come. The work will be first-of-its-kind in the way that it assesses chronic conditions as they form in combination from young adulthood to older adulthood. It will also be new in the way it uses computer models and natural experiments in combination to find out what works best to reduce multimorbidity.