Understanding clusters and mechanisms of complex multimorbidity in people with common allergic conditions
Lead Research Organisation:
London School of Hygiene & Tropical Medicine
Department Name: Epidemiology and Population Health
Abstract
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.
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.
Technical Summary
Multimorbidity is a term used to describe people with two or more chronic physical or mental illnesses. Multimorbidity (i) reduces quality of life, (ii) complicates decision-making and (iii) incurs major health service costs.
Atopic allergic diseases, such as asthma and eczema, are amongst the commonest long-term conditions (1 in 5 children, up to 10% of adults), and are associated with adverse effects on quality of life and costs to individuals and health services. Our previous work (and that of others) has shown complex patterns of allergic disease comorbidity and increased risk of non-allergic comorbidity, including cardiovascular disease, fractures and mental health issues, supporting multimorbidity being an important, but poorly described concept, for these diseases. Multimorbidity may result from common biological mechanisms or treatment side-effects.
There is a need to better understand allergic and non-allergic disease comorbidities co-existing in clusters with allergic disease to help identify opportunities to prevent multimorbidity or reduce its impact.
Our objectives in the consolidator phase are to:
1. Identify clusters and trajectories to known and previously unidentified multimorbidity in people with allergic disorders using the Clinical Practice Research Datalink.
2. Engage a critical mass of inter-disciplinary expertise, including clinicians, data scientists, and patients to enhance the collaborative phase.
The Consolidator phase will provide the foundation for the Collaborative phase that will:
3. Investigate mechanisms driving associations between common allergic conditions and multimorbidity using classical statistical approaches and artificial intelligence and address determinants of multimorbidity in people with allergic diseases including environmental (e.g., pollution), lifestyle (e.g. smoking) and social factors (e.g. deprivation), and medications (e.g. corticosteroids).
4. Identify modifiable risk factors and "at-risk" subgroups.
Atopic allergic diseases, such as asthma and eczema, are amongst the commonest long-term conditions (1 in 5 children, up to 10% of adults), and are associated with adverse effects on quality of life and costs to individuals and health services. Our previous work (and that of others) has shown complex patterns of allergic disease comorbidity and increased risk of non-allergic comorbidity, including cardiovascular disease, fractures and mental health issues, supporting multimorbidity being an important, but poorly described concept, for these diseases. Multimorbidity may result from common biological mechanisms or treatment side-effects.
There is a need to better understand allergic and non-allergic disease comorbidities co-existing in clusters with allergic disease to help identify opportunities to prevent multimorbidity or reduce its impact.
Our objectives in the consolidator phase are to:
1. Identify clusters and trajectories to known and previously unidentified multimorbidity in people with allergic disorders using the Clinical Practice Research Datalink.
2. Engage a critical mass of inter-disciplinary expertise, including clinicians, data scientists, and patients to enhance the collaborative phase.
The Consolidator phase will provide the foundation for the Collaborative phase that will:
3. Investigate mechanisms driving associations between common allergic conditions and multimorbidity using classical statistical approaches and artificial intelligence and address determinants of multimorbidity in people with allergic diseases including environmental (e.g., pollution), lifestyle (e.g. smoking) and social factors (e.g. deprivation), and medications (e.g. corticosteroids).
4. Identify modifiable risk factors and "at-risk" subgroups.
Publications
Mulick AR
(2022)
Novel multimorbidity clusters in people with eczema and asthma: a population-based cluster analysis.
in Scientific reports
Mahil SK
(2020)
Global reporting of cases of COVID-19 in psoriasis and atopic dermatitis: an opportunity to inform care during a pandemic.
in The British journal of dermatology
Matthewman J
(2022)
Atopic Eczema-Associated Fracture Risk and Oral Corticosteroids: A Population-Based Cohort Study.
in The journal of allergy and clinical immunology. In practice
Kern C
(2021)
Association of Atopic Dermatitis and Mental Health Outcomes Across Childhood: A Longitudinal Cohort Study.
in JAMA dermatology
Matthewman J
(2023)
Anxiety and Depression in People with Eczema or Psoriasis: A Comparison of Associations in UK Biobank and Linked Primary Care Data.
in Clinical epidemiology
Magyari A
(2022)
Adult atopic eczema and the risk of dementia: A population-based cohort study.
in Journal of the American Academy of Dermatology
Description | Medical Advisory Board of the National Eczema Society |
Geographic Reach | National |
Policy Influence Type | Participation in a guidance/advisory committee |
Impact | Contribution to the development of public guidance and statements, e.g. the recent statement about Topical Corticosteroid withdrawal in atopic eczema. |
URL | https://eczema.org/ |
Description | Health Data Research UK renewal |
Amount | £70,000,000 (GBP) |
Organisation | Medical Research Council (MRC) |
Sector | Public |
Country | United Kingdom |
Start | 03/2023 |
End | 03/2028 |
Description | Immune Mediated Inflammatory Disease (IMID) Taskforce |
Organisation | King's College London |
Department | St. John's Institute of Dermatology |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | I established and led this taskforce with partners from across the UK using OpenSAFELY to assess COVID-19 in people with IMID diseases |
Collaborator Contribution | Indepth and varied contributions to protocol writing, code lists, analyses and write up. |
Impact | https://www.medrxiv.org/content/10.1101/2021.09.03.21262888v1 |
Start Year | 2021 |
Description | New collaboration with colleagues at Oxford University |
Organisation | University of Oxford |
Department | Nuffield Department of Population Health |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | Arising out of our ongoing research focused on metal health outcomes, we have developed a new collaboration focused on use of accelerometry data in UK Biobank data. |
Collaborator Contribution | Dr Aiden Doherty is advising us on the better use of accelerometry data to assess physical activity and sleep. |
Impact | Funding proposals submitted to support further activities in this collaboration and outcomes are awaited. |
Start Year | 2022 |
Description | Psoprotect |
Organisation | King's College London |
Department | St. John's Institute of Dermatology |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | I joined a team at the start of the pandemic to assess the risks of COVID-19 in people with psoriasis based on developing two new registries: one for patients and another for healthcare workers, https://psoprotect.org/partners/. |
Collaborator Contribution | There are now 1525 reports from physicians globally; these data have been used to understand outcomes and to inform policy. |
Impact | Factors associated with adverse COVID-19 outcomes - insights from a global registry-based study. J Allergy Clin Immunology; https://www.jacionline.org/article/S0091-6749(20)31413-5/fulltext Risk mitigating behaviours in people with inflammatory skin and joint disease during the COVID-19 pandemic differ by treatment type: a cross-sectional patient survey. Br J Dermatol; https://onlinelibrary.wiley.com/doi/10.1111/bjd.19755 Describing the burden of the COVID-19 pandemic in people with psoriasis: findings from a global cross-sectional study. J Eur Acad Dermatol Venereol; https://onlinelibrary.wiley.com/doi/10.1111/jdv.17450 Association Between Tumor Necrosis Factor Inhibitors and the Risk of Hospitalization or Death Among Patients With Immune-Mediated Inflammatory Disease and COVID-19. JAMA Network Open; https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2785080 Global reporting of cases of COVID-19 in psoriasis and atopic dermatitis: an opportunity to inform care during a pandemic. Br J Dermatol; https://onlinelibrary.wiley.com/doi/10.1111/bjd.19161 |
Start Year | 2020 |
Description | Towards Prevention and Better management of Multimorbidity In Common Allergic Conditions Research Collaborative |
Organisation | University of Glasgow |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | We have partnered with colleagues from the University of Glasgow to develop the collaborative stage of this proposal. |
Collaborator Contribution | Professor Olivia Wu and Dr Claudia Geue have joined our collaborative bringing expertise in health economics and qualitative research. |
Impact | None yet, proposal submitted for collaborative funding. |
Start Year | 2021 |
Description | Innovation and sustainability in dermatology |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | Talk about innovative engagement in research with huge interest in how this can help eczema research and clinical practice. |
Year(s) Of Engagement Activity | 2023 |
URL | https://www.stjohnsdermacademy.com/event-oct2021-june2023 |
Description | Invited Parkes-Weber lecture Royal College of Physicians for Medical Dermatology meeting in 2023 |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | Talk to dermatologists and dermatology trainees. Engaged audience |
Year(s) Of Engagement Activity | 2023 |
Description | Invited talk at a seminar organised by the Association of Physicians of Great Britain and Ireland, "Inflammation crossing the disciplines" |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Special seminar at the Association of Physicians of Great Britain and Ireland, "Inflammation crossing the disciplines" being held in May 2022 |
Year(s) Of Engagement Activity | 2022 |
Description | National Eczema Society public talk |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Public/other audiences |
Results and Impact | The National Eczema Society organised an in person half day event in Guildford attended by members of the public, live streamed and with available recordings on their website with huge public interest in the topic. |
Year(s) Of Engagement Activity | 2023 |
URL | https://eczema.org/blog/talk-does-eczema-have-an-impact-on-other-health-conditions/ |
Description | National Tour of hospitals with sculpture about eczema |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Patients, carers and/or patient groups |
Results and Impact | Our eczema sculpture (https://www.lshtm.ac.uk/aboutus/public-engagement/stories-engagement/colouring-adult-eczema-getting-under-skin) is now going on a National tour of hospitals. It is currently in Derby Royal Hospital, having previously been at Guy's hospital for a four month period, where it was viewed by patients, carers, members of the public and staff including health professionals. |
Year(s) Of Engagement Activity | 2023 |
URL | https://www.lshtm.ac.uk/aboutus/public-engagement/stories-engagement/colouring-adult-eczema-getting-... |
Description | Presentation of research at the Association of Physicians of Great Britain and Ireland |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | APAM conference is in April 2023. Expected fruitful discussions and future collaborations. |
Year(s) Of Engagement Activity | 2023 |
Description | Public engagement series of workshops |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Patients, carers and/or patient groups |
Results and Impact | PPI discussions to inform studies of mental health outcomes and multimorbidity in patients with skin and allergic diseases. Discussions focused around research questions and study design, but will later focus on analyses and interpretation. |
Year(s) Of Engagement Activity | 2021 |
URL | https://www.peopleinresearch.org/wp-content/uploads/2020/12/PPI-people-in-research-v4-2.pdf |
Description | Talk at the British Association of Dermatologists Annual conference 2023 |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | Annual British Association of Dermatologists conference plenary talk with a lot of questions and interest. |
Year(s) Of Engagement Activity | 2023 |
URL | https://badannualmeeting.co.uk/wp-content/uploads/2023/06/BAD-FINAL-PROGRAMME-2023.pdf |
Description | Video about Colouring Adult Eczema |
Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Public/other audiences |
Results and Impact | This video is designed to communicate about the "Colouring Adult Eczema" project to a wide range of audiences to increase awareness about adult eczema. |
Year(s) Of Engagement Activity | 2022 |
URL | https://vimeo.com/773679146 |