Patterns of multimorbidity and polypharmacy in young and adult population: Systematic associations among chronic diseases and drugs using factor analysis

Abstract

ObjectivesThe objective was to identify the systematic associations among chronic diseases and drugs in the form of patterns and to describe and clinically interpret the constituted patterns with a focus on exploring the existence of potential drug-drug and drug-disease interactions and prescribing cascades.MethodsThis observational, cross-sectional study used the demographic and clinical information from electronic medical databases and the pharmacy billing records of all users of the public health system of the Spanish region of Aragon in 2015. An exploratory factor analysis was conducted based on the tetra-choric correlations among the diagnoses of chronic diseases and the dispensed drugs in 887,572 patients aged ≤65 years. The analysis was stratified by age and sex. To name the constituted patterns, assess their clinical nature, and identify potential interactions among diseases and drugs, the associations found in each pattern were independently reviewed by two pharmacists and two doctors and tested against the literature and the information reported in the technical medicinal forms.ResultsSix multimorbidity-polypharmacy patterns were found in this large-scale population study, named as respiratory, mental health, cardiometabolic, endocrinological, osteometabolic, and mechanical-pain. The nature of the patterns in terms of diseases and drugs differed by sex and age and became more complex as age advanced.ConclusionsThe six clinically sound multimorbidity-polypharmacy patterns described in this non-elderly population confirmed the existence of systematic associations among chronic diseases and medications, and revealed some unexpected associations suggesting the prescribing cascade phenomenon as a potential underlying factor. These findings may help to broaden the focus and orient the early identification of potential interactions when caring for multimorbid patients at high risk of adverse health outcomes due to polypharmacy.

Polypharmacy in a semirural community in Chile: Results from Maule Cohort

“…Polypharmacy is most commonly defined as the concomitant use of five or more medications . Polypharmacy has been associated with medication errors, drug‐drug interactions, drug‐disease interactions, increased health‐service utilization, and adverse drug reactions . Most studies analyzing polypharmacy and its risk factors are based on elderly populations .…”

“…[1][2][3] Polypharmacy has been associated with medication errors, drug-drug interactions, drug-disease interactions, increased health-service utilization, and adverse drug reactions. [2][3][4][5][6][7] Most studies analyzing polypharmacy and its risk factors are based on elderly populations. 1,8,9 However, polypharmacy in younger populations is a growing public health concern.…”

Comparing potential drug-drug interactions in veterinary medications using two electronic databases

“…Multiple-drug prescriptions for the treatment of diseases and complications usually occurs in humans and animals [1,2]. One category of adverse drug reactions (ADRs) is de ned as drug-drug interactions (DDIs), in which one drug interferes with another.…”

Ser ou estar doente? Impacto da dor, da multimorbidade e da complexidade farmacoterápica na qualidade de vida e percepção da doença em pessoas acompanhadas em ambulatório de Clínica Médica

“…Os diagnósticos na multimorbidade podem vir em grupos, mais que em pares, o que pode ocorrer por diferentes motivos, como doenças com fatores fisiopatológicos comuns, doenças que acontecem como complicações de outras, intercorrências agudas em pacientes com doenças crônicas e doenças concomitantes sem relação causal entre elas (Sinnige, 2015). Grandes grupos de doenças agregadas em pacientes com multimorbidade podem ser, por exemplo, respiratório, doença mental, cardiometabólico, endocrinológico, osteometabólico e dor mecânica (Menditto, 2019). Outros autores consideram como grupos principais doenças cardiovasculares; doenças relacionadas à senescência e doenças metabólicas; doenças relacionadas ao consumo de álcool e tabaco; condições relacionadas a dor e sistema musculoesquelético e doenças psíquicas (Déruaz-Luyet, 2017).…”

“…Outros autores consideram como grupos principais doenças cardiovasculares; doenças relacionadas à senescência e doenças metabólicas; doenças relacionadas ao consumo de álcool e tabaco; condições relacionadas a dor e sistema musculoesquelético e doenças psíquicas (Déruaz-Luyet, 2017). Há diferença na composição dos agregados de acordo com o sexo e idade dos indivíduos (Menditto, 2019). Na atenção primária, entre pessoas de 18 a 29 anos, as díades mais comuns foram doença ulcerosa péptica com artrite, lombalgia, tuberculose ou doença pulmonar crônica.…”