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.

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.
 
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