Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jan 13, 2021
Date Accepted: Jan 12, 2022
Age- and sex-specific differences in multimorbidity patterns and temporal trends: A network-based analysis of 8.8 million hospital discharge records in Southwestern China
ABSTRACT
Background:
As multimorbidity is a global health challenge, a more global understanding of multimorbidity patterns and trends is needed; yet, majority studies often relied on self-reported conditions and have not simultaneously assessed the entire spectrum of chronic disease co-occurrence, especially in developing regions.
Objective:
This study aimed to provide a multidimensional approach to understand the full spectrum of chronic disease co-occurrence in the general inpatients in southwestern China, investigate multimorbidity patterns and temporal trends, and access their age and sex disparities.
Methods:
We conducted a retrospective cohort analysis based on 8.8 million hospital discharge records from 2015 to 2019, about 5 million individuals of all ages in a megacity in southwestern China. We examined all chronic diagnoses using the ICD-10 codes at three digits and focused on chronic disease with ≥1% prevalence for each age and gender strata, leading to a total of 149 and 145 chronic diseases in males and females. We constructed multimorbidity networks in the general population based on gender and age, using the Cosine index to measure chronic disease co-occurrence. Then divided networks into communities and assessed their temporal trends.
Results:
Interactions among chronic diseases were complex, with a more intensive connections in males and older inpatients. Nine chronic diseases were simultaneously classified as central diseases, hubs, and bursts in multimorbidity networks. Five of them were common to both genders, including hypertension, chronic ischemic heart disease, cerebral infarction, other cerebrovascular diseases, and atherosclerosis. The earliest leaps (≥ 6 degree leaps) among males was a disorder of glycoprotein metabolism that happened at 25-29 years, about 15 years earlier than that of females. The number of chronic diseases in the community increased over time, but the new entrants did not replace the community's core role.
Conclusions:
Our multimorbidity network analysis identifies specific differences in chronic diagnoses co-occurrence by gender and age, which could help clinical design interventions for inpatient multimorbidity.
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