Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Mar 22, 2022
Date Accepted: Sep 10, 2022
Associations of Multimorbidity: A Comprehensive Analysis of Three Hundred Thousand Hospitalized Middle-Aged and Older Adults in China
ABSTRACT
Background:
It is necessary to understand the multimorbidity patterns to inform clinical practice guidelines and management of multiple diseases in China.
Objective:
This study is aimed to determine the associations between multiple chronic conditions through comprehensive analysis, and preliminarily explore the frequently occurring management strategies for the middle-aged and elderly population.
Methods:
The data of patients aged over 50 with at least one chronic condition were extracted from the homepages of hospitalized medical records in Shenzhen, China from 2017 to 2018. Association Rule Mining, chi-square test and decision tree analysis were combined to identify associations between multiple chronic conditions.
Results:
The data of 306264 hospitalized cases were obtained, of which 86.3% suffered at least two kinds of chronic diseases, and the proportion of multimorbidity increased with age. A total of 4489 multimorbidity patterns were identified. The top three multimorbidity patterns were Hypertension & Cerebrovascular disease, followed by the Hypertension & Senile cataract and the Spine disease & Heart disease. The top 10 association rules according to lifts showed that among patients aged 50-64, lipoprotein metabolism disorder occurred in 7 rules in males and 10 rules in females. The combination of osteoporosis and malignant tumor had the strongest association in males (lift = 6.60). Among patients aged 65 or over, there were strong associations between cerebrovascular disease, heart disease, lipoprotein metabolism disorder and peripheral vascular disease. The strongest associations were observed between senile cataract and glaucoma in males (lift = 6.65) and in females (lift = 4.93). In particular, the four association rules including osteoporosis and malignant tumor were only observed in males, while the association between anemia, gout and chronic kidney disease (lift=3.00) were only observed in females.
Conclusions:
The common multimorbidity patterns of middle-aged and elderly people were identified, and the particular associations of conditions occurred more frequently than expected by random chance, which provided evidence for potential mechanism and risk factors for specific combinations and encourage healthcare providers to develop comprehensive prevention and intervention plans according to gender and age.
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