Association rules analysis on patterns of multimorbidity in adults: based on the National Health and Nutrition Examination Surveys database

Zhang, Zheng; Xie, Yangli; Huang, Junlan; Sun, Xianding; Zhang, Ruobin; Chen, Lin

doi:10.1136/bmjopen-2022-063660

“…8,35,36 Association rule mining has been widely used in marketing and business analytics. Although some applications have been reported recently, [36][37][38][39] association rule mining is still relatively uncommon in clinical, epidemiology, and health outcomes research. To our knowledge, this is the first study to combine administrative claims analysis with association rule mining to evaluate the multimorbidity burdens in ASCVD.…”

Section: Journal Of Health Economics and Outcomes Researchmentioning

confidence: 99%

Multimorbidity in Atherosclerotic Cardiovascular Disease and Its Associations With Adverse Cardiovascular Events and Healthcare Costs: A Real-World Evidence Study

Dai,

Fernandes,

Sun

et al. 2024

Journal of Health Economics and Outcomes Research

0

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Background: Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of mortality and disability in the United States and worldwide. Objective: To assess the multimorbidity burden and its associations with adverse cardiovascular events (ACE) and healthcare costs among patients with ASCVD. Methods: This is a retrospective observational cohort study using Aetna claims database. Patients with ASCVD were identified during the study period (1/1/2018–10/31/2021). The earliest ASCVD diagnosis date was identified as the index date. Qualified patients were ≥18 years of age and had ≥12 months of health plan enrollment before and after the index date. Comorbid conditions were assessed using all data available within 12 months prior to and including the index date. Association rule mining was applied to identify comorbid condition combinations. ACEs and healthcare costs were assessed using all data within 12 months after the index date. Multivariable generalized linear models were performed to examine the associations between multimorbidity and ACEs and healthcare costs. Results: Of 223 923 patients with ASCVD (mean [SD] age, 73.6 [10.7] years; 42.2% female), 98.5% had ≥2, and 80.2% had ≥5 comorbid conditions. The most common comorbid condition dyad was hypertension-hyperlipidemia (78.7%). The most common triad was hypertension–hyperlipidemia–pain disorders (61.1%). The most common quartet was hypertension–hyperlipidemia–pain disorders–diabetes (30.2%). The most common quintet was hypertension–hyperlipidemia–pain disorders–diabetes–obesity (16%). The most common sextet was hypertension–hyperlipidemia–pain disorders–diabetes–obesity–osteoarthritis (7.6%). The mean [SD] number of comorbid conditions was 7.1 [3.2]. The multimorbidity burden tended to increase in older age groups and was comparatively higher in females and in those with higher social vulnerability. The increased number of comorbid conditions was significantly associated with increased ACEs and increased healthcare costs. Discussion: Extremely prevalent multimorbidity should be considered in the context of clinical decision-making to optimize secondary prevention of ASCVD. Conclusions: Multimorbidity was extremely prevalent among patients with ASCVD. Multimorbidity patterns varied considerably across ASCVD patients and by age, gender, and social vulnerability status. Multimorbidity was strongly associated with ACEs and healthcare costs.

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“…8,35,36 Association rule mining has been widely used in marketing and business analytics. Although some applications have been reported recently, [36][37][38][39] association rule mining is still relatively uncommon in clinical, epidemiology, and health outcomes research. To our knowledge, this is the first study to combine administrative claims analysis with association rule mining to evaluate the multimorbidity burdens in ASCVD.…”

Section: Journal Of Health Economics and Outcomes Researchmentioning

confidence: 99%

Multimorbidity in Atherosclerotic Cardiovascular Disease and Its Associations With Adverse Cardiovascular Events and Healthcare Costs: A Real-World Evidence Study

Dai,

Fernandes,

Sun

et al. 2024

JHEOR

1

0

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Background: Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of mortality and disability in the United States and worldwide. Objective: To assess the multimorbidity burden and its associations with adverse cardiovascular events (ACE) and healthcare costs among patients with ASCVD. Methods: This is a retrospective observational cohort study using Aetna claims database. Patients with ASCVD were identified during the study period (1/1/2018–10/31/2021). The earliest ASCVD diagnosis date was identified as the index date. Qualified patients were ≥18 years of age and had ≥12 months of health plan enrollment before and after the index date. Comorbid conditions were assessed using all data available within 12 months prior to and including the index date. Association rule mining was applied to identify comorbid condition combinations. ACEs and healthcare costs were assessed using all data within 12 months after the index date. Multivariable generalized linear models were performed to examine the associations between multimorbidity and ACEs and healthcare costs. Results: Of 223 923 patients with ASCVD (mean [SD] age, 73.6 [10.7] years; 42.2% female), 98.5% had ≥2, and 80.2% had ≥5 comorbid conditions. The most common comorbid condition dyad was hypertension-hyperlipidemia (78.7%). The most common triad was hypertension–hyperlipidemia–pain disorders (61.1%). The most common quartet was hypertension–hyperlipidemia–pain disorders–diabetes (30.2%). The most common quintet was hypertension–hyperlipidemia–pain disorders–diabetes–obesity (16%). The most common sextet was hypertension–hyperlipidemia–pain disorders–diabetes–obesity–osteoarthritis (7.6%). The mean [SD] number of comorbid conditions was 7.1 [3.2]. The multimorbidity burden tended to increase in older age groups and was comparatively higher in females and in those with higher social vulnerability. The increased number of comorbid conditions was significantly associated with increased ACEs and increased healthcare costs. Discussion: Extremely prevalent multimorbidity should be considered in the context of clinical decision-making to optimize secondary prevention of ASCVD. Conclusions: Multimorbidity was extremely prevalent among patients with ASCVD. Multimorbidity patterns varied considerably across ASCVD patients and by age, gender, and social vulnerability status. Multimorbidity was strongly associated with ACEs and healthcare costs.

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“…Relational association rules are an extension of ordinal association rules, which are a particular type of association rules that describe 111 numerical orderings between attributes that commonly occur over a dataset (Czibula, Marian and Czibula, 2014). This rule was also adopted in newer studies (Zheng et al, 2022).…”

Section: Discussionmentioning

confidence: 99%

Understanding Multimorbidity of Older Adults in Niger State North Central Nigeria.

Ahmed

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Background: Multimorbidity is defined as the co-occurrence of at least two chronic diseases in the same person. With advancing epidemiological and demographic transitions, the burden of multi-morbidity is expected to increase globally, and Nigeria is not an exemption. Overall objectives: The aim of the study was to develop a better understanding of multimorbidity among elderly Nigerians. Methods: A multi-methods (systematic literature review, quantitative and qualitative) survey was conducted. The systematic review was preceded by a designed priori protocol following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and the PRISMA Protocols statement. Data for the quantitative, and qualitative were administered on a cross-section of 734 and 12 multimorbid participants selected from 4 secondary hospitals and the communities respectively in Niger state over 5 months. SPSS and NVivo were used to analyze the quantitative and qualitative phases data respectively. Results: The prevalence of multimorbidity in Niger state north central Nigeria was 51.9% with multimorbidity prevalence ranging from 27% to 74% across Nigeria. Chronic disease conditions like hypertension, diabetes, and acid peptic diseases were the commonly occurring clusters of multimorbidity. A positive association between adverse childhood experiences (AECs) and multimorbidity was observed. The study also observed an association between adverse childhood experiences (ACEs) and behavioral risk factors. A Positive moderate association was observed between age and multimorbidity and a negative association was found between multimorbidity and levels of education and income. Using Donabedian’s model of healthcare quality revealed the process component of the model to be the primary component in determining the perceived quality of healthcare services among elderly multimorbid patients in Niger state north central Nigeria. Conclusion: There is a need to recognize ACEs and their consequences as a public health problem in Nigeria and commence the practice of public health surveillance to reduce the occurrence of ACEs and their effects. The prevention of multimorbidity should begin from childhood by preventing ACEs through the creation of a positive setting for both children and families and a system that supports healthy families. Additionally, identifying the common pattern of multimorbidity will provide insight to develop more integrative multidisciplinary preventive and better management approach for multimorbidity. Finally, access to and quality of health care can be improved by improving patient-physician relationships, reducing waiting times for seeing physicians and reducing financial cost of medical treatment. improving the These findings are important to better inform policymakers and related stakeholders, in order to ensure equitable access and improve the health outcomes of multimorbid patients and the overall population’s health. Although the result of this study has the potential to illuminate some of the weaknesses of the current multimorbidity care among the elderly, the sample selection is limited to 4 hospitals and some communities in Niger state, thus the findings cannot be generalized for the country. Nevertheless, the study can be replicated elsewhere in the country to increase its impact.

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Association rules analysis on patterns of multimorbidity in adults: based on the National Health and Nutrition Examination Surveys database

Cited by 5 publications

References 51 publications

Multimorbidity in Atherosclerotic Cardiovascular Disease and Its Associations With Adverse Cardiovascular Events and Healthcare Costs: A Real-World Evidence Study

Multimorbidity in Atherosclerotic Cardiovascular Disease and Its Associations With Adverse Cardiovascular Events and Healthcare Costs: A Real-World Evidence Study

Multimorbidity in Atherosclerotic Cardiovascular Disease and Its Associations With Adverse Cardiovascular Events and Healthcare Costs: A Real-World Evidence Study

Understanding Multimorbidity of Older Adults in Niger State North Central Nigeria.

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