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病。这种疾病的累积也被称为多发病。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(LMIC)之间，社区中患有多病的人数相似。然而，在LMIC中进行的研究非常少。并不是每个患有多发病的人都患有相同的疾病，人们认为存在几种不同的可能模式。这些模式通常被称为集群，因为它们代表由不同疾病形成的集群。大多数关于集群的研究都是在HIC进行的，很少有研究是在LMIC进行的。HIC进行的一些现有研究表明，与只有身体疾病的人相比，当一个人同时患有身体和精神障碍时，他们的生活质量较低，死亡风险增加，经济负担更高。然而，这方面的工作在小岛屿发展中国家很大程度上没有得到充分研究，部分原因如下：a)分析多发病群体具有挑战性，需要进行数据分析方面的高级培训；b)缺乏适当和最新的数据；c)对小岛屿发展中国家的心理健康研究普遍忽视；d)缺乏受过适当技能培训的跨学科研究人员，以解决这一复杂性，特别是在小岛屿发展中国家。我们将与Mutual一起开发一个由LMIC领导的高质量研究平台，以调查我们在了解LMIC中与精神和身体疾病(MPM)相关的多发病方面的知识差距。为此，将在巴西、埃塞俄比亚和马来西亚这三个经济发展水平不同的三个国家制定一个能力建设方案。导师和导师将在3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)证据综合。将通过培训可转让技能(例如，研究传播、公开演讲、领导力、影响力、数据安全)来进一步加强这一点。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。在英国和英国国内导师的支持下，这三个国家的早期职业研究人员将相互合作，利用生活在三个国家的现有数据集和详细的健康状况信息，促进我们对多发病的理解。这将使用先进的统计分析进行。卫生经济学技术还将被用来了解与特定集群相关的经济影响，以评估哪些是最沉重的负担。我们的最终目标是为未来的培训和围绕多发病主题的进一步研究活动创建一个网络和平台。我们希望这个项目将对人们的生活产生直接影响，既包括患有多发病的个人，也包括职业生涯早期的研究人员。

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.