The Multimorbidity Working Group

It has been estimated that the prevalence of multimorbidity, which is defined as the occurrence of two or more chronic diseases in an individual, may range from 20–40% in middle age to 80% in older adults. This is attributable largely to increases in life expectancy and progress in early detection of diseases and in treatment. As a result, people live longer with multiple diseases, as indicated by the Global Burden of Disease project (Forouzanfar et al., 2016). With an ageing European population, the need for population-based health research on multimorbidity has become a public health priority. In this context, there is a need to better understand the determinants and the mechanisms of multimorbidity.

 The Multimorbidity Working Group aims to develop a research programme that expands current knowledge on the etiology of single morbid conditions to acquire novel scientific evidence on the determinants of multimorbidity, by exploiting the existing infrastructure of a prospective investigation and a network of scientists. Within EPIC, the occurrence of incident events of type 2 diabetes and cardiovascular diseases (CVD) were validated and harmonized within the EPIC InterAct project (Langenberg et al., 2011) and the EPIC-CVD project (Danesh et al., 2007), respectively, and cancer onset and mortality are routinely collected by EPIC participating centres. Other incident conditions were the object of research activities in EPIC, including Parkinson disease (Peters et al., 2020) and rheumatoid arthritis.

 To harmonize the follow-up time for the three conditions, incident cases of cancer and CVD ascertained after 31 December 2007 were censored. In EPIC-CVD centres with a censor date earlier than 31 December 2007, incident cases of cancer and type 2 diabetes were censored at that date. The Working Group is currently investigating how key risk factors for the incidence of a single adverse event, such as cancer, are related to clustering of noncommunicable diseases within individuals. These risk factors include, but are not limited to, obesity, tobacco use, physical inactivity, harmful alcohol use, and unhealthy diets (Freisling et al, 2020).

Other important research areas of the Working Group are to investigate how cardiometabolic comorbidities, before cancer, affect cancer risk, stage at diagnosis, and survival in patients with cancer (Kohls et al., 2022). Cardiometabolic comorbidities may also modify or mediate associations between established cancer risk factors, such as obesity, and risk of cancer and survival after cancer.

 Funding for these activities was obtained from the French National Cancer Institute (INCa) and the World Cancer Research Fund International (WCRF); other funding opportunities are continuously sought.

 

Selected publications

  1. Forouzanfar MH, Afshin A, Alexander LT, Biryukov S, Brauer M, Cercy K, et al.; GBD 2015 Risk Factors Collaborators (2016). Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 388(10053):1659–724. https://doi.org/10.1016/S0140-6736(16)31679-8 PMID:27733284
  2. Langenberg C, Sharp S, Forouhi NG, Franks PW, Schulze MB, Kerrison N, et al.; InterAct Consortium (2011). Design and cohort description of the InterAct Project: an examination of the interaction of genetic and lifestyle factors on the incidence of type 2 diabetes in the EPIC Study. Diabetologia. 54(9):2272–82. https://doi.org/10.1007/s00125-011-2182-9 PMID:21717116
  3. Danesh J, Saracci R, Berglund G, Feskens E, Overvad K, Panico S, et al.; EPIC-Heart (2007). EPIC-Heart: the cardiovascular component of a prospective study of nutritional, lifestyle and biological factors in 520,000 middle-aged participants from 10 European countries. Eur J Epidemiol. 22(2):129–41. https://doi.org/10.1007/s10654-006-9096-8 PMID:17295097
  4. Peters S, Gallo V, Vineis P, Middleton LT, Forsgren L, Sacerdote C, et al. (2020). Alcohol consumption and risk of Parkinson’s disease: data from a large prospective European cohort. Mov Disord. 35(7):1258–63. https://doi.org/10.1002/mds.28039 PMID:32357270
  5. Freisling H, Viallon V, Lennon H, Bagnardi V, Ricci C, Butterworth AS, et al. (2020). Lifestyle factors and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study. BMC Med. 18(1):5. https://doi.org/10.1186/s12916-019-1474-7 PMID:31918762
  6. Kohls M, Freisling H, Charvat H, Soerjomataram I, Viallon V, Davila-Batista V, et al. (2022). Impact of cumulative body mass index and cardiometabolic diseases on survival among patients with colorectal and breast cancer: a multi-centre cohort study. BMC Cancer. 22(1):546. https://doi.org/10.1186/s12885-022-09589-y PMID:35568802

 

Contact details/Working Group leaders

Pietro Ferrari, PhD
Nutrition and Metabolism Branch (NME)
International Agency for Research on Cancer (IARC/WHO)
25 avenue Tony Garnier
CS 90627
69366 LYON CEDEX 07
France
FerrariP@iarc.who.int

Heinz Freisling, PhD
Nutrition and Metabolism Branch (NME)
International Agency for Research on Cancer (IARC/WHO)
25 avenue Tony Garnier
CS 90627
69366 LYON CEDEX 07
France
FreislingH@iarc.who.int