Multimorbidity Patterns in Primary Care: Interactions among Chronic Diseases Using Factor Analysis

Abstract

ObjectivesThe primary objective of this study was to identify the existence of chronic disease multimorbidity patterns in the primary care population, describing their clinical components and analysing how these patterns change and evolve over time both in women and men. The secondary objective of this study was to generate evidence regarding the pathophysiological processes underlying multimorbidity and to understand the interactions and synergies among the various diseases.MethodsThis observational, retrospective, multicentre study utilised information from the electronic medical records of 19 primary care centres from 2008. To identify multimorbidity patterns, an exploratory factor analysis was carried out based on the tetra-choric correlations between the diagnostic information of 275,682 patients who were over 14 years of age. The analysis was stratified by age group and sex.ResultsMultimorbidity was found in all age groups, and its prevalence ranged from 13% in the 15 to 44 year age group to 67% in those 65 years of age or older. Goodness-of-fit indicators revealed sample values between 0.50 and 0.71. We identified five patterns of multimorbidity: cardio-metabolic, psychiatric-substance abuse, mechanical-obesity-thyroidal, psychogeriatric and depressive. Some of these patterns were found to evolve with age, and there were differences between men and women.ConclusionsNon-random associations between chronic diseases result in clinically consistent multimorbidity patterns affecting a significant proportion of the population. Underlying pathophysiological phenomena were observed upon which action can be taken both from a clinical, individual-level perspective and from a public health or population-level perspective.

Morbilidad y consumo de fármacos. Comparación de resultados entre la Encuesta Nacional de Salud y los registros electrónicos

“…Así, por ejemplo, hay trabajos 28-30 que han descrito posibles variaciones en la declaración de enfermedades en las encuestas de salud en patologías asintomáticas o con síntomas inespecíficos, aunque se considera que la limitación de la pregunta al año previo puede controlar en parte los sesgos de memoria. En relación al uso de EDC, ha sido previamente empleado sobre todo para el estudio de la multimorbilidad 31,32 , debido a que facilita el manejo y la interpretación clínica de los resultados, al colapsar las diferentes formas de codificación de diagnósticos similares en grupos mutuamente excluyentes.…”

Multimorbidity in Older Patients with Cardiovascular Disease

“…Prados-Torres et al used exploratory factor analysis to identify five patterns of multimorbidity among primary care patients in Spain [23]: cardiometabolic, mechanical, psychogeriatric, depressive, and psychiatric-substance abuse. Each pattern consisted of several chronic conditions that tended to occur together and the authors assigned a name to each cluster based on the types of conditions present.…”

Multimorbidity, polypharmacy, referrals, and adverse drug events: are we doing things well?

“…2 Although it particularly affects the older population, this problem is also present at other stages of life, including childhood. 3 Recent studies have revealed the existence of patterns of multimorbidity that consist of systematically associated clinical conditions.…”

“…3 Recent studies have revealed the existence of patterns of multimorbidity that consist of systematically associated clinical conditions. 2 Such patterns evolve and worsen over the course of a patient's life, and reflect clinical situations that cut across individual medical specialties established by healthcare systems. 2 The consequences of this complex reality for a healthcare system in which the majority of illnesses are chronic and affect the older and frailer portion of the population include polypharmacy (that is, the simultaneous and prolonged prescription of multiple medications to a single individual), 4 and repeated referrals for specialised care.…”

“…2 Such patterns evolve and worsen over the course of a patient's life, and reflect clinical situations that cut across individual medical specialties established by healthcare systems. 2 The consequences of this complex reality for a healthcare system in which the majority of illnesses are chronic and affect the older and frailer portion of the population include polypharmacy (that is, the simultaneous and prolonged prescription of multiple medications to a single individual), 4 and repeated referrals for specialised care. 5 These 'natural' consequences may have associated risks that are often unanticipated and insufficiently analysed, and ultimately compromise the health of the patient.…”