Multimorbidity (co-existing health conditions)
Multimorbidity, defined as the coexistence of two or more chronic conditions in the same individual, is now a priority for global health research (1). Life expectancy is rising rapidly across LMICs, creating a growing burden of non-communicable diseases (NCDs). However, communicable diseases, with both short- and longer-term sequelae (e.g. HIV and tuberculosis), continue to affect millions of people every year. Multimorbidity is becoming the norm in LMICs where a unique mix of communicable and non-communicable diseases co-occur.
Certain morbidities that share a common biological aetiology cluster together, such as coronary heart disease and cerebrovascular disease, but so do multimorbidities with shared social determinants such as adverse living conditions and lifelong socioeconomic disadvantage, such as depression, cardiometabolic disorders and musculoskeletal conditions. Such clustered multimorbidities are associated with poorer clinical outcomes, lower quality of life, and increased risk of premature mortality (2). The majority of LMIC health-care systems are organised to treat single conditions. Hence patients often must attend multiple providers who work in silos; this inefficient and non-collaborative approach risks suboptimal patient care. Beyond treatment, prevention – an essential requirement for meeting SDG 3 - requires greater attention to the complex societal determinants of multimorbidity.
The 2016 the WHO Technical Series on Multimorbidity called for a systems-based approach to this ‘major health care challenge facing all countries in the world’, aiming for a proactive, life cycle approach, including preventive strategies informed by a sound evidence-base (3). This series underlined the strong link between deprivation and multimorbidity. While the 2018 Academy of Medical Sciences report, ‘Multimorbidity: a priority for global health research’, highlighted the ‘true global health challenge’ of the ‘huge problems' that multimorbidity brings and raised concern that ‘there is surprisingly little research into its impact on patients, healthcare systems and society at large’ (4). In July 2019 the UK MRC, NIHR, and Wellcome Trust joined forces to coordinate a 'multimorbidity funders group', working alongside numerous other charities to overcome the structural and cultural barriers facing multimorbidity research and support the research needed to better understand the trends, clusters, mechanisms and causes, burden, prevention and management of multimorbidity.
Research at Bristol seeks to contribute to this cutting-edge research agenda through a range of projects with LMIC partners, including work at the intersections between musculoskeletal conditions associated with female ageing and HIV; investigating relationships between poverty and chronic health conditions; and exploring the role of physical activity on the development of multimorbidities.
1. WHO Technical Series on Safer Primary Care: Multimorbidity
2. Johnston M, Black C, Mercer S, Prescott G, Crilly M. Prevalence of secondary care multimorbidity in mid-life and its association with premature mortality in a large longitudinal cohort study. BMJ Open