One Patient, Many Diseases

10 January 2020

The word of the week is ‘multimorbidity’. It seems to lurk everywhere this week: in journal tables of contents and newspaper headings. It refers to people living with many health conditions. Doctors see it more and more often, which is partly because people live longer and partly because of unhealthy lifestyles. For example, a cluster of diseases around obesity: diabetes, hypertension and depression that often occur simultaneously would be termed multimorbidity.

‘Multimorbidity’ announced itself first on Monday morning in a table of contents from the Lancet Public Health. The paper showed that socioeconomic status affected the risk of multimorbidity, frailty, and disability.1 This finding was a result of analysis of the 24-year follow-up study of the Whitehall II cohort of British civil servants. Multimorbidity had the strongest association with mortality, meaning that people living with many health conditions were likely to die earlier than healthy people. The authors argued that it made multimorbidity a central target for improving population health.

Following that, on Tuesday morning, BMJ published a letter from the UK chief medical officers and others2 warning that multimorbidity was a new pattern of health and disease in the population, to which the medical profession had to respond. While it is customary to treat some clusters of conditions together, such as those around diabetes or HIV, this is not a common practice with other diseases. For example, mental and physical conditions are often treated separately. The letter called for the inclusion of the issue of multimorbidity in medical training and continuous professional development for specialists.

The fact that these days seemingly unrelated diseases occur simultaneously in so many people says something. There must be common genetic, behavioural, or environmental reasons for multimorbidity; and this gives clues to both treatment and prevention. Commendably, the editors of the above mentioned journal followed these clues and offered a public health prescription for the UK!3

Their prescription had only five words: tackle upstream determinants of health.

 

References:

  1. Dugravot A, Fayosse A, Dumurgier J, et al (2019) Social inequalities in multimorbidity, frailty, disability, and transitions to mortality: a 24-year follow-up of the Whitehall II cohort study. Lancet Public Heal 5:e42–e50. https://doi.org/10.1016/S2468-2667(19)30226-9
  2. Whitty CJM, MacEwen C, Goddard A, et al (2020) Rising to the challenge of multimorbidity. BMJ 368:. https://doi.org/10.1136/BMJ.L6964
  3. The Lancet Public Health TLP (2019) A public health prescription for the UK Government. Lancet Public Heal 5:e1. https://doi.org/10.1016/S2468-2667(19)30255-5

 

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