Biological and functional multimorbidity—from mechanisms to management

• Published in: Nature medicine Vol. 29; no. 7; pp. 1649 - 1657
• Main Authors: Langenberg, Claudia, Hingorani, Aroon D., Whitty, Christopher J. M.
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01.07.2023; Nature Publishing Group
• Subjects: 692/308/409; 692/308/575; Biomedical and Life Sciences; Biomedicine; Cancer Research; Clinical trials; Comorbidity; Delivery of Health Care; Education; Education, Medical; Ethnicity; Health care; Health services; Horizontal integration; Humans; Infectious Diseases; Medical research; Metabolic Diseases; Molecular Medicine; Multimorbidity; Neurosciences; Patients; Review Article
• ISSN: 1078-8956; 1546-170X; 1546-170X
• DOI: 10.1038/s41591-023-02420-6

Globally, the number of people with multiple co-occurring diseases will increase substantially over the coming decades, with important consequences for patients, carers, healthcare systems and society. Addressing this challenge requires a shift in the prevailing clinical, educational and scientific thinking and organization—with a strong emphasis on the maintenance of generalist skills to balance the specialization trends of medical education and research. Multimorbidity is not a single entity but differs quantitively and qualitatively across life stages, ethnicities, sexes, socioeconomic groups and geographies. Data-driven science that quantifies the impact of disease co-occurrence—beyond the small number of currently well-studied long-term conditions (such as cardiometabolic diseases)—can help illuminate the pathological diversity of multimorbidity and identify common, mechanistically related, and prognostically relevant clusters. Broader access to data opportunities across modalities and disciplines will catalyze vertical and horizontal integration of multimorbidity research, to enable reconfiguring of medical services, clinical trials, guidelines and research in a way that accounts for the complexity of multimorbidity—and provides efficient, joined-up services for patients. Multimorbidity is increasing globally, and addressing it requires a shift in the prevailing clinical, educational and scientific thinking. This Review discusses emerging mechanisms, research challenges and the implications for patients and healthcare systems.