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

多病是指一个人同时出现两种甚至几种以上的主要健康状况。在英国，这是一个日益严重的问题，部分原因是寿命延长和不健康的生活方式相结合。虽然多重发病在老年人中最常见，但不良饮食、缺乏运动和青年和中年的肥胖可能是多重发病倾向的重要原因。我们怀疑糖尿病、高血压和抑郁症这三种疾病会导致很大一部分多重疾病，因为它们共同作用，影响了身体的许多系统。如果是这样的话，那么有针对性的生活方式干预方案可能会在预防多重发病方面产生重大影响。不幸的是，很难知道青年和中年的这些情况如何影响多发病，以及如何预防多发病，因为在衡量干预措施的影响时，没有研究跟踪人口在生命的许多阶段。本研究计划将分三个部分来解决这些问题。首先，它将使用来自英国和伦敦人口的长期数据来发现最常见的疾病组合，以及它们的形成是否有特定的步骤和途径。在找到这些组合并估计它们在生命中不同时期的发展速度之后，我们将构建一个新的基于计算机的模型，称为“生命历程模拟模型”，该模型可以确定生命中的最佳时期、行为组合、风险因素和导致生命中最大疾病的疾病。该计算机模型还将检查预防多种疾病积累的不同方法的效果，例如使用重点支持来改变高血压，糖尿病和抑郁症风险人群的生活方式。研究项目的第三部分将使用这些数据和计算机模型来衡量两项国民健康服务倡议的效果，这些倡议支持有糖尿病风险的人或糖尿病患者改变生活方式。由于生活方式对高血压、抑郁症和其他疾病也至关重要，这些“自然实验”可能对多种疾病也有很大影响。这项工作将需要一个拥有不同领域专业知识的团队——包括医疗保健、流行病学、行为改变、数学和计算机建模。这项研究将回答一些重要的问题，比如什么类型的疾病导致了最多的多重发病，以及什么是预防多重发病的最佳方法。计算机模型和研究结果将为医生、健康规划师和公众在未来几年改善社区健康提供新的途径。这项工作将是同类工作中首次评估慢性疾病，因为它们是在青年到老年期间形成的。它还将采用计算机模型和自然实验相结合的方式，找出减少多重疾病的最佳方法。

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.