Title: Time to break the chains: advancing bio-social understanding of multimorbidity
Funder: Economic and Social Research Council

Abstract: Two short articles for broader audience in the Conversation and one blog post for The Centre for Humanities and Social Science of Health, Medicine and Technology (UoL). Organizing a community event in Sefton area of Merseyside. A short animated film will be used to portray unequal health trajectories of Sefton residents in a visual form and to appeal to broader types of participants. Local and national media will be invited, a blog posted on the Conversation and reported on the NWC ARC's social media (blog, twitter). Building a local network of Multimorbidity representatives to raise the impact Building an academic collaboration in the theme of biosocial pathways to multimorbidity, presenting a talk at two international conferences. I will also continue to develop contacts and collaboration locally and regionally, mainly through The ARC NWC and its Community Research and Engagement Network. Submitting a funding application for a Postdoctoral Fellowship with Welcome trust (January 2021). Conducting a new analysis that will extend my PhD life course model of multimorbidity by integrating biomarkers collected in the English Longitudinal Study of Ageing. Alignment with the Industrial Strategy My project meets the criteria of one of the Grand Challenge: Ageing Society. It will address two aspects: 1. Healthy Ageing 2. From data to early diagnosis and precision medicine Two thirds of adults aged over 65 are expected to be living with multimorbidity by 2035 (Kingston et al. 2018). 17% would be living with 4 or more diseases, double the number in 2015. Multimorbidity is associated with reduced quality of life and higher health care needs. Over the period of the next 5 years, the NHS Long Term Plan expects that rising multimorbidity will drive health care costs up by 14% and £4bn. Although multimorbidity is such an obstacle for healthy ageing, no studies have explored biomarkers of multimorbidity and their predictive potential for early diagnosis. I will develop a biosocial life course model of multimorbidity that could be used for the prevention of multimorbidity. Detecting early markers of multimorbidity would identify which groups of people are at risk, providing vital information on who needs to be targeted for intervention. Being able to target groups for intervention more efficiently would result in higher chances of successful intervention and could lead to potentially large health care savings. Secondly, postponing or eliminating the onset of multimorbidity by increasing knowledge about its accumulation over the life course and more effective patient self-management is another way in which the project can contribute to healthier ageing and cost-saving in health care. This will be achieved by training a group of Multimorbidity Representatives in the Sefton area of Merseyside, known for high health inequalities, organising a community event with the launch of an animated documentary to increase health literacy among non-professional public. The impact of my research can be scaled up to national policy level. The House of Lords' Science and Technology Committee launched an inquiry to determine whether the Grand Challenge to increase Healthy Ageing is achievable and which approaches may be most successful. Dr. Lauren Walker, a researcher in multimorbidity and polypharmacy from UoL, provided evidence to the Committee in March 2020. She is keen on collaborating with me to raise the profile of multimorbidity nationally. The study will use Advanced Quantitative Methods: 1. The integration and analysis of complex biological data in social and behavioural perspective of health and illness, using the concepts of Allostatic Load and Complex Multimorbidity 2. Longitudinal analysis of multimorbidity using a Structural Equation Model and growth mixture modelling. Both approaches are considered best practices in the field but have not yet fully spread in population health and health sociology.

Lay abstract: The current COVID-19 pandemic highlights in a dramatic way the essential link between human biology and its physical and social environment. The pandemic has thrown multimorbidity into the spotlight as underlying chronic conditions seem to be critical markers of vulnerability and intensive care needs. This project sets out to explore and explain how multimorbidity, the presence of two or more chronic conditions in a person, is a result of bio-social trajectories over the life course, by visiting some of the best researchers in the field and learning new skills; analyzing bio-social linkages on my PhD data; publishing for academic and non-academic target groups; organizing an inter-disciplinary conference at University of Liverpool and a public engagement event with discussions and a short film screening. My PhD research showed that the burden of multimorbidity in the English ageing population is associated with socio-economic, psycho-social and lifestyle circumstances. Developing multimorbidity is not the result of either biological ageing or a consequence of unhealthy lifestyle choices. In general, ageing individuals from better-off backgrounds are healthier than their peers who are worse-off. The first aim of the proposed project is enriching the current debate on multimorbidity with social science perspectives by organising the conference What's the point of Multimorbidity? Biosocial and critical understanding of the concept in July 2021 at UoL. By bringing together medical scientists and clinicians, social scientists, policy makers, patients and members of the public, I want to raise awareness of the social determinants of and inequalities in multimorbidity, and discuss ways forward. This will raise the profile of multimorbidity research and enhance the impact of my past and current research findings. Using a visual approach to communicate the topic, an animated film about ageing lives with multimorbidity will be produced and presented to the community. To effectively engage the public and to formalize regional focus on social aspects of multimorbidity, I will collaborate with the North West Coast Applied Research Collaboration. This network will be translated into my further career plans and funding application to Welcome Trust in January 2021. The second aim of the project is to better predict an early risk of developing multiple health conditions, as this contribution to knowledge can help prevent or delay the accumulation of multimorbidity in later life. Biological markers, often based on physical capacity or blood concentrations of certain molecules, could provide an early and more advanced insight into the onset of multiple chronic conditions. This analysis would extend my PhD life course model of multimorbidity by integrating biomarkers collected in the English Longitudinal Study of Ageing, using advanced features of Structural Equation Modelling. If society wishes to prevent the development of multimorbidity, we need to improve our knowledge of the chains of risk leading from the childhood circumstances to the actual manifestation of multimorbidity. Detecting early signs, measured directly in our bodies as biomarkers, could help identify a window of opportunity to break the chains of risk before multimorbidity develops. These issues have not been explored yet and they present an exciting extension of my PhD.

Research activity codes: 2.6 RESOURCES AND INFRASTRUCTURE (AETIOLOGY);4.1 DISCOVERY AND PRECLINICAL TESTING OF MARKERS AND TECHNOLOGIES
Health categories: GENERIC HEALTH RELEVANCE