Multiple Long-Term Conditions

Multimorbidity or the coexistence of two or more health conditions in an individual has been overlooked as an important cause of early death and disability. The focus of most epidemiological, mechanistic, and therapeutic research has been on single diseases (whether non-communicable or communicable) or a few groups of diseases known to be causally related (e.g. hypercholesterolaemia, atherosclerosis, coronary heart disease). However, there has been little attention to other disease clusters, such as those involving common communicable diseases (e.g. influenza), common chronic physical conditions (e.g. hypertension) and common mental illnesses (e.g. depression).

Why this Research is Needed

The focus of most health and medical research and clinical care provision is on single conditions and not the clusters in which many exist. Understanding which conditions cluster and why has important implications for disease prevention, treatment, and management.

Theme Aims
  • Aim one: to identify clusters of diseases responsible for the greatest burden of premature death and disability.
  • Aim two: to elucidate the biological mechanisms responsible for the most common clusters of diseases.
  • Aim three: to determine whether treatment of specific diseases is affected by the presence of other diseases in multimorbid condition clusters.
Upcoming /Ongoing Projects within the Theme

We are using advanced statistical and machine learning methodologies to identify common condition clusters in several large UK datasets. We are also examining the impact of common disease clusters in key population subgroups, characterising temporal trends in the incidence and prevalence of these clusters, and identifying interactions between conditions and the impact of these interactions on the development of other conditions, disability, and death.

We are also using data from observational genetic and multi-omics studies, as well as data from experimental studies, to study the molecular signatures associated with common condition clusters to identify associations likely to be causally relevant to multiple conditions. This will aid in the identification of novel therapeutic targets relevant to those with multimorbidity.

Patient and Public Involvement, Engagement and Participation

 Public and patient involvement is at the heart of our research. We have community members on our executive advisory board and a community engagement advisory group to guide us in our research design, conduct, and dissemination. We will be carrying out a large community consultation survey as part of our research program to better understand the healthcare consumer of those with multimorbidity and local priorities for diagnosis, treatment, and care provision to better equip our team to ask the right research questions and focus on the areas that matter most to those affected by multimorbidity.

Equality, Diversity and Inclusion

 We are committed to ensuring equality, diversity, and inclusion within our research design and conduct. We have achieved gender equity in our core research and advisory groups and are committed to disaggregating all data that we generate and analyse by sex wherever it is possible to do so. All research meetings for our theme are held in a hybrid online/in-person format to accommodate the diverse physical needs of our research and community advisory group members.


Key Individuals
  • Professor Ioanna Tzoulaki
    Professor Ioanna Tzoulaki
    Theme Lead, MLTC
  • Professor Otavio Berwanger
    Professor Otavio Berwanger
    Theme Lead, MLTC
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