Lifecourse determinants of the sequence of accrual of multiple long-term conditions

As with many countries we are facing challenges related to the growing number of people living with multiple long-term health conditions like diabetes, heart disease or dementia. All the way through peoples lives many things influence the chances of developing such conditions: things about people themselves, such as age and ethnicity, things that happen like infections or accidents, and behaviours like smoking and diet. Perhaps even more important, though hard to research, are broader issues throughout life such as the environment people grew up in, their education, work, income and so on. The uncomfortable truth is that people from more disadvantaged backgrounds are more likely to develop multiple conditions at an earlier age. There is also evidence that the order of developing conditions varies considerably and influences what then happens to people. This makes understanding these broader issues and how they affect that order vital to inform when and how we should intervene. To achieve this, we need to study exceptionally large numbers of people over their whole lifetime, but such datasets do not exist. Very large health datasets collected from NHS GPs are helpful but haven t been running long enough to track from birth to later life. They do include lots of information on long-term conditions but not much about broader issues. We have access to one such dataset of about 700,000 people which we can use to identify health conditions. We also have access to data from the 1970s birth cohort – a research study of about 17,000 people born in the same week of 1970 followed throughout their lives (currently 50 years old) who have provided detailed information about many broader issues every few years. The aim of this research is to safely and ethically establish the necessary environment, systems and methods to allow artificial intelligence techniques to connect birth cohort data with large GP datasets. This will allow us to connect information on the broader, lifecourse issues with the GP information on long-term conditions. Then we can: 1.Identify the kinds of people who develop combinations of burdensome long-term conditions by the time they are middle-aged. 2.Understand the order of developing long-term conditions through life and which ones develop first. 3.Work out how broader issues affect that order and the resulting combination of conditions. Technically this is exceedingly difficult to do. We have expert knowledge of Public Health, General Practice, Mathematics, Statistics and Computer Sciences, and two experienced Patient and Public co-investigators, who are involved throughout the study. Our future ambition is to apply the learning from this Award to other birth cohorts and larger routine datasets to accurately estimate the risk at different life stages and identify key time points for targeted public health interventions.