southampton

6 October 2022

Becky is a Consultant in Public Health at Southampton City Council and a member of the MELD-B Research Collaboration

It is staggering that 1 in 4 of us are living with two or more long-term health conditions like diabetes, heart disease, depression, or dementia (1), and the numbers are rising. People with multiple long-term conditions are more likely to have a poorer quality of life and a higher risk of dying than those in the general population (2). Even more concerning is the fact that having multiple long-term conditions happens 10-15 years earlier in people living in the most deprived areas, compared to those in the least deprived (3).

The prevalence of multiple long-term conditions is also associated with older age and so with our ageing population this is forecast to increase dramatically over the coming years. For example, 68% of those aged 65+ in the UK are predicted to have 2+ diseases by 2035 (4). The impacts of this for individuals, their families and society are immense. For instance, having a mental health condition is associated with a 45–75% increase in service costs for people with long-term physical health conditions (5).

I work in Public Health in Southampton, and I want to better understand the many different perspectives of this ‘burden’ of ill health and how we can intervene to prevent it. In our city, by the age 60, more than a third of residents have at least three chronic conditions. Furthermore, our most deprived neighbourhoods have over twice the proportion of residents living with 3+ chronic conditions by their mid to late thirties, compared to the least deprived areas.

To help people impacted by multiple conditions, as well as practitioners and policy makers, I have joined forces with a research team called MELD-B to investigate what influences the development of long-term conditions over people’s lifetime and the impact these conditions have for them.

We know that our chance of developing health conditions is impacted by a wide range of factors including our personal characteristics, the things that happen to us, the lifestyle choices available to us and broader experiences, such as the environment we grew up in. We also know that the impact (or ‘burden’) of multiple long-term conditions varies, alongside the order that people develop them. For many people, coping with these conditions can be very challenging as they struggle to manage numerous healthcare appointments, multiple different prescriptions and unplanned hospital visits (5) in a healthcare system that often isn’t set up to coordinate multiple conditions.

The MELD-B team aim to understand what ‘burdensome’ means and to try to find out, from a patient and carer’s perspective, what aspects of having multiple conditions make them burdensome. For instance, is it the onset of chronic pain, the development of further conditions or the increased level of health and social care associated with living with and managing the conditions?

Much of the research on multiple long-term conditions has concentrated on the diseases and circumstances that people have now, whereas we want to look back over time to see how the situations and events in people’s lives can explain their current conditions and their burdensomeness. This way we can also look for opportunities to prevent burdensome multiple long-term conditions – such as interventions very early in life.

To do this we would ideally study very large numbers of people from birth to death, but not enough of this type of data is available. Therefore, some of my colleagues in MELD-B are going to use clever computing methods, called Artificial Intelligence (AI), to learn from the patterns in the data that we do have. These include General Practitioner datasets and ‘birth cohorts’, which are research studies of people all born in the same year and followed throughout their lives.

It is really important to me, and to the rest of the MELD-B team, that our research findings are used by practitioners, policy makers and the general public in the prevention of burdensome multiple long-term conditions. We ultimately want our work to contribute to improving population health and reducing inequalities. Therefore, I’ll be engaging with a whole range of people and organisations to find out what information they need, and to ensure that we report the results of our research in a way that is useful.

This project is just getting started, so there is plenty of opportunity for stakeholders to get involved in steering its direction and its outputs. If you are interested in this area, either from a professional or personal perspective, please do get in touch and help us make it truly valuable.

Funding Statement and Disclaimer:

This project is funded by the NIHR Artificial Intelligence in Multiple Long-Term Conditions (AIM) Programme (NIHR unique award identifier). MELD-B’s unique award identifier is NIHR203988.

The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.