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Multicenter Study
. 2012;7(2):e32190.
doi: 10.1371/journal.pone.0032190. Epub 2012 Feb 29.

Multimorbidity patterns in primary care: interactions among chronic diseases using factor analysis

Alexandra Prados-Torres  1 , Beatriz Poblador-Plou, Amaia Calderón-Larrañaga, Luis Andrés Gimeno-Feliu, Francisca González-Rubio, Antonio Poncel-Falcó, Antoni Sicras-Mainar, José Tomás Alcalá-Nalvaiz
Affiliations
Multicenter Study

Multimorbidity patterns in primary care: interactions among chronic diseases using factor analysis

Alexandra Prados-Torres et al. PLoS One. 2012.

Abstract

Objectives: The 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.

Methods: This 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.

Results: Multimorbidity 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.

Conclusions: Non-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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Population pyramid, year 2008.
Figure 2
Figure 2. Scree plot for men in the 15 to 44 age range.
Figure 3
Figure 3. Scree plot for men in the 45 to 64 age range.
Figure 4
Figure 4. Scree plot for men older than 65 years of age.
Figure 5
Figure 5. Scree plot for women in the 15 to 44 age range.
Figure 6
Figure 6. Scree plot for women in the 45 to 64 age range.
Figure 7
Figure 7. Scree plot for women older than 65 years of age.
See this image and copyright information in PMC

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