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Multimorbidity Patterns in Elderly Primary Health Care Patients in a South Mediterranean European Region: A Cluster Analysis.

ABSTRACT: The purpose of this study was to identify clusters of diagnoses in elderly patients with multimorbidity, attended in primary care.Cross-sectional study.251 primary care centres in Catalonia, Spain.Individuals older than 64 years registered with participating practices.Multimorbidity, defined as the coexistence of 2 or more ICD-10 disease categories in the electronic health record. Using hierarchical cluster analysis, multimorbidity clusters were identified by sex and age group (65-79 and ?80 years).322,328 patients with multimorbidity were included in the analysis (mean age, 75.4 years [Standard deviation, SD: 7.4], 57.4% women; mean of 7.9 diagnoses [SD: 3.9]). For both men and women, the first cluster in both age groups included the same two diagnoses: Hypertensive diseases and Metabolic disorders. The second cluster contained three diagnoses of the musculoskeletal system in the 65- to 79-year-old group, and five diseases coincided in the ?80 age group: varicose veins of the lower limbs, senile cataract, dorsalgia, functional intestinal disorders and shoulder lesions. The greatest overlap (54.5%) between the three most common diagnoses was observed in women aged 65-79 years.This cluster analysis of elderly primary care patients with multimorbidity, revealed a single cluster of circulatory-metabolic diseases that were the most prevalent in both age groups and sex, and a cluster of second-most prevalent diagnoses that included musculoskeletal diseases. Clusters unknown to date have been identified. The clusters identified should be considered when developing clinical guidance for this population.

SUBMITTER: Foguet-Boreu Q

PROVIDER: S-EPMC4629893 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

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Multimorbidity Patterns in Elderly Primary Health Care Patients in a South Mediterranean European Region: A Cluster Analysis.

Foguet-Boreu Quintí Q Violán Concepción C Rodriguez-Blanco Teresa T Roso-Llorach Albert A Pons-Vigués Mariona M Pujol-Ribera Enriqueta E Cossio Gil Yolima Y Valderas Jose M JM

PloS one 20151102 11

<h4>Objective</h4>The purpose of this study was to identify clusters of diagnoses in elderly patients with multimorbidity, attended in primary care.<h4>Design</h4>Cross-sectional study.<h4>Setting</h4>251 primary care centres in Catalonia, Spain.<h4>Participants</h4>Individuals older than 64 years registered with participating practices.<h4>Main outcome measures</h4>Multimorbidity, defined as the coexistence of 2 or more ICD-10 disease categories in the electronic health record. Using hierarchic ...[more]

PMID: 26524599

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Project description:BackgroundMultimorbidity is the coexistence of more than two chronic diseases in the same individual; however, there is no consensus about the best definition. In addition, few studies have described the variability of multimorbidity patterns over time. The aim of this study was to identify multimorbidity patterns and their variability over a 6-year period in patients older than 65 years attended in primary health care.MethodsA cohort study with yearly cross-sectional analysis of electronic health records from 50 primary health care centres in Barcelona. Selected patients had multimorbidity and were 65 years of age or older in 2009. Diagnoses (International Classification of Primary Care, second edition) were extracted using O'Halloran criteria for chronic diseases. Multimorbidity patterns were identified using two steps: 1) multiple correspondence analysis and 2) k-means clustering. Analysis was stratified by sex and age group (65-79 and ≥80 years) at the beginning of the study period.ResultsAnalysis of 2009 electronic health records from 190,108 patients with multimorbidity (59.8% women) found a mean age of 71.8 for the 65-79 age group and 84.16 years for those over 80 (Standard Deviation [SD] 4.35 and 3.46, respectively); the median number of chronic diseases was seven (Interquartil range [IQR] 5-10). We obtained 6 clusters of multimorbidity patterns (1 nonspecific and 5 specifics) in each group, being the specific ones: Musculoskeletal, Endocrine-metabolic, Digestive/Digestive-respiratory, Neurological, and Cardiovascular patterns. A minimum of 42.5% of the sample remained in the same pattern at the end of the study, reflecting the stability of these patterns.ConclusionsThis study identified six multimorbidity patterns per each group, one nonnspecific pattern and five of them with a specific pattern related to an organic system. The multimorbidity patterns obtained had similar characteristics throughout the study period. These data are useful to improve clinical management of each specific subgroup of patients showing a particular multimorbidity pattern.

Project description:Patients with multimorbidity and complex health care needs are usually vulnerable elders with several concomitant advanced chronic diseases. Our research aim was to evaluate differences in patterns of multimorbidity by gender in this population and their possible prognostic implications, measured as in-hospital mortality, 1-month readmissions, and 1-year mortality. We focused on a cohort of elderly patients with well-established multimorbidity criteria admitted to a specific unit for chronic complex-care patients. Multimorbidity criteria, the Charlson, PROFUND and Barthel indexes, and the Pfeiffer test were collected prospectively during their stays. A total of 843 patients (49.2% men) were included, with a median age of 84 [interquartile range (IQR) 79-89] years. The women were older, with greater functional dependence [Barthel index: 40 (IQR:10-65) vs. 60 (IQR: 25-90)], showed more cognitive deterioration [Pfeiffer test: 5 (IQR:1-9) vs. 1 (0-6)], and had worse scores on the PROFUND index [15 (IQR:9-18) vs. 11.5 (IQR: 6-15)], all p <0.0001, while men had greater comorbidity measured with the Charlson index [5 (IQR: 3-7) vs. 4 (IQR: 3-6); p = 0.002]. In the multimorbidity criteria scale, heart failure, autoimmune diseases, dementia, and osteoarticular diseases were more frequent in women, while ischemic heart disease, chronic respiratory diseases, and neoplasms predominated in men. In the analysis of grouped patterns, neurological and osteoarticular diseases were more frequent in females, while respiratory and cancer predominated in males. We did not find gender differences for in-hospital mortality, 1-month readmissions, or 1-year mortality. In the multivariate analysis age, the Charlson, Barthel and PROFUND indexes, along with previous admissions, were independent predictors of 1-year mortality, while gender was non-significant. The Charlson and PROFUND indexes predicted mortality during follow-up more accurately in men than in women (AUC 0.70 vs. 0.57 and 0.74 vs. 0.62, respectively), with both p<0.001. In conclusion, our study shows differing patterns of multimorbidity by gender, with greater functional impairment in women and more comorbidity in men, although without differences in the prognosis. Moreover, some of these prognostic indicators had differing accuracy for the genders in predicting mortality.

Dataset Information

Multimorbidity Patterns in Elderly Primary Health Care Patients in a South Mediterranean European Region: A Cluster Analysis.

Publications

Multimorbidity Patterns in Elderly Primary Health Care Patients in a South Mediterranean European Region: A Cluster Analysis.

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