The largest study to date to analyse millions of both genetic and patient records on the long-term health conditions of later life has identified opportunities for new ways to prevent and treat multiple overlapping conditions.
Currently, nine million people in the UK live with two or more long-term conditions at the same time – known as multimorbidity. Their treatment accounts for half of the NHS budget.
Led by the University of Exeter, supported by NIHR PenARC and NIHR Exeter Biomedical Research Centre, and funded by the Medical Research Council and the National Institute for Health Research, the GEMINI study looked at both genetics and clinical information from more than three million people in the UK and Spain.
Published today in eBioMedicine research has identified genetic overlaps in 72 long-term health conditions associated with ageing, to identify where specific genes are linked to two or more conditions. With more than 2,500 combinations of conditions analysed, the programme aims to unlock cases where a drug or prevention strategies can prevent or delay the onset of multimorbidity. It also revealed genetic connections that explain why certain conditions may be more likely to co-occur in the same patient.
The research comes after the Government’s Chief Scientific Advisor Professor Chris Whitty highlighted improving the treatment of people with one or more long term conditions – known as multimorbidity – as a key priority for research.
Dr Joao Delgado, at the University of Exeter Medical School led the research. He said:
“Overlapping long-term conditions have a huge impact on the lives of millions of people and are difficult and costly to treat. For the first time, we’ve combined analysis of both genetics and clinical records on a massive scale, in a new and robust approach to identify where genes play a critical role in more than one condition. We’re now working to drill down into specifics combination of conditions, and expect to reveal drugs or lifestyle changes that already work for treating existing conditions that can be repurposed to prevent multimorbidity, with promising results. For example, we identified the role of treatable conditions, such as B12 deficiency and iron deficiency anaemia in the development of multimorbidity. This will lead to a more personalised approach to prevention and treatment in multimorbidity.”
Co–author Professor Jane Masoli, of the University of Exeter Medical School, said:
“A known problem in treating overlapping health conditions is that clinical services and guidelines largely address single disease groups and not the bigger picture. Studying multiple conditions is really complex and until now research has also focussed on one condition at a time. This research, provides a platform for researching what causes overlapping health conditions, and will have major benefits for rapidly progressing medical understanding to ultimately improve people’s lives. Treating people in a more personalised way, as a whole person rather than by single disease, is likely to deliver better quality for people living with multiple conditions, and reduce the burden on health services.”
Kate Boddy, PenARC Research Fellow, said:
“Involving patients, carers and the public in this kind of research is far less common than in clinical research. GEMINI researchers, however, recognise how vital it is that patients and carers are equal partners in the research process. That’s why GEMINI has two public participant co-investigators, Mary Mancini and Leon Farmer, who attend all the ‘lab’ meetings and co-authored this paper.
“We also held Patient and Public Involvement and Engagement (PPIE) workshops to decide key aspects of the scientific process as the research progressed. For this paper the selection of Long Term Conditions (LTCs) for analysis was a fundamental step in the research. We held a workshop with patients and carers affected by LTCs to identify conditions of key importance to patients that researchers might have missed.
“The initial list was based on conditions found in data sources available to researchers. The workshop added 28 to the list, clear evidence of how PPIE is a key part of GEMINI and has directly shaped this research.”
The paper is entitled ‘A systematic analysis of the contribution of genetics to multimorbidity and comparisons with primary care data’, and is published in eBioMedicine.