A conceptual framework for characterising lifecourse determinants of multiple long-term condition multimorbidity

Area of Science:

• Public Health
• Epidemiology
• Lifecourse Research

Background:

• Early-life experiences (preconception to age 18) significantly impact the risk of developing multiple long-term conditions (multimorbidity).
• A comprehensive understanding of these early-life determinants and their interrelationships is crucial for effective multimorbidity research and prevention.
• Existing research and policy often overlook crucial factors highlighted by public involvement.

Purpose of the Study:

• To develop a conceptual framework for characterizing population-level domains of early-life determinants of future multimorbidity.
• To provide a conceptual framing for future research on multimorbidity etiology and prevention.
• To integrate public perspectives into understanding early-life influences on long-term health.

Main Methods:

• The study was conducted as part of the Multidisciplinary Ecosystem to study Lifecourse Determinants and Prevention of Early-onset Burdensome Multimorbidity (MELD-B) initiative.
• A review of existing research evidence and policy informed the conceptualization of determinant domains.
• Co-production with public involvement through two workshops shaped the framework.

Main Results:

• Key early-life risk factor domains identified include adverse childhood experiences, socioeconomic status, social and physical environment, and education.
• Policy recommendations predominantly focus on individual-level factors, contrasting with broader determinants highlighted in research.
• Public contributors emphasized domains such as religion, spirituality, health screening, and diet, which were underrepresented in existing evidence and policy.

Conclusions:

• The co-produced conceptual framework can guide future research using diverse data sources to identify at-risk populations.
• This framework supports the development of targeted public health policies for preventing early-onset multimorbidity.
• Integrating public insights enriches the understanding of early-life determinants for effective health interventions.