Understanding clusters and mechanisms of complex multimorbidity in people with common allergic conditions

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Multimorbidity is a term used to mean having two or more longterm physical or mental illnesses. Multimorbidity is important because it affects what happens to people throughout their life and how their doctors can treat them. Conditions which can be associated with allergy, such as asthma and eczema, are very common particularly in children and young adults (at least 1 in 5 children), and are known to have major effects on quality of life and costs to the NHS. Previous work has shown people with allergic diseases are at risk of lots of different mental and physical health problems (multimorbidity), possibly due to their allergic disease. We don't yet understand how these diseases group together ("cluster") and why they occur. Our work will help us understand how and why allergic diseases are associated with other mental and physical illnesses (multimorbidity) in order to work out how to treat people with allergic diseases better. In this preparatory phase (also called a consolidator grant), we will first explore how allergic diseases occur in groups together with multiple other medical and psychiatric conditions and how these "clusters" develop over time. Some of these "clusters" will include conditions we already know can be associated with allergic diseases, but we also expect that we might find new associated diseases. We will do this analysis using data collected as part of usual healthcare, which has been stripped of identifiers (e.g., names). We have data collected on large numbers of people (for example 500,000 adults with eczema) over long periods of time with information about health issues, medications, doctors' visits and whether people smoke or drink alcohol. This work will be complex, so we will need to run workshops involving different kinds of experts, such as data scientists, statisticians, doctors who treat patients with allergic diseases, and patient representatives. In this preparation phase, we will also spend time finalising the most important questions for the main body of work (focusing on working out why people with allergic diseases have other mental and physical conditions) and how we can answer those questions in the best possible way. In the main body of work (also known as a "collaborative" grant), we will use advanced statistical techniques to understand why common allergic disorders are associated with other physical and mental health problems. We will look at factors in people's environment and lifestyle, or medications that doctors use to treat allergic conditions to see if these might play a role in these "clusters". This collaborative programme will help us move away from doctors focusing on only one problem at a time, to an approach that looks at all of the problems that people have that tend to cluster together. This "joined up" thinking will help us treat people better and might help us avoid some of those health problems in future.