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. 2021 Sep 1;18(17):9216.
doi: 10.3390/ijerph18179216.

Combined Multimorbidity and Polypharmacy Patterns in the Elderly: A Cross-Sectional Study in Primary Health Care

Grant Stafford  1   2 , Noemí Villén  3   4 , Albert Roso-Llorach  2   4   5 , Amelia Troncoso-Mariño  3   6 , Mònica Monteagudo  2   5 , Concepción Violán  5   7
Affiliations

Combined Multimorbidity and Polypharmacy Patterns in the Elderly: A Cross-Sectional Study in Primary Health Care

Grant Stafford et al. Int J Environ Res Public Health. .

Abstract

(1) Background: The acquisition of multiple chronic diseases, known as multimorbidity, is common in the elderly population, and it is often treated with the simultaneous consumption of several prescription drugs, known as polypharmacy. These two concepts are inherently related and cause an undue burden on the individual. The aim of this study was to identify combined multimorbidity and polypharmacy patterns for the elderly population in Catalonia. (2) Methods: A cross-sectional study using electronic health records from 2012 was conducted. A mapping process was performed linking chronic disease categories to the drug categories indicated for their treatment. A soft clustering technique was then carried out on the final mapped categories. (3) Results: 916,619 individuals were included, with 93.1% meeting the authors' criteria for multimorbidity and 49.9% for polypharmacy. A seven-cluster solution was identified: one non-specific (Cluster 1) and six specific, corresponding to diabetes (Cluster 2), neurological and musculoskeletal, female dominant (Clusters 3 and 4) and cardiovascular, cerebrovascular and renal diseases (Clusters 5 and 6), and multi-system diseases (Cluster 7). (4) Conclusions: This study utilized a mapping process combined with a soft clustering technique to determine combined patterns of multimorbidity and polypharmacy in the elderly population, identifying overrepresentation in six of the seven clusters with chronic disease and chronic disease-drug categories. These results could be applied to clinical practice guidelines in order to better attend to patient needs. This study can serve as the foundation for future longitudinal regarding relationships between multimorbidity and polypharmacy.

Keywords: chronic disease; clustering; combined patterns; elderly; machine learning; multimorbidity; polypharmacy; primary healthcare.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Estimated population study according to selection criteria.
Figure 2
Figure 2
Number of significant chronic disease or chronic disease-drug categories after mapping.
Figure 3
Figure 3
Multimorbid and polymedicated individuals in the study aged 65–99 years (n = 916,619, Catalonia, 2012).
See this image and copyright information in PMC

References

    1. The World Bank Life Expectancy at Birth, Total (Years) [(accessed on 10 March 2021)]; Available online: https://data.worldbank.org/indicator/SP.DYN.LE00.IN.
    1. Partridge L., Deelen J., Slagboom P.E. Facing up to the global challenges of ageing. Nature. 2018;561:45–56. doi: 10.1038/s41586-018-0457-8. - DOI - PubMed
    1. Murray C.J.L., Barber R.M., Foreman K.J., Ozgoren A.A., Abd-Allah F., Abera S.F., Aboyans V., Abraham J.P., Abubakar I., Abu-Raddad L.J., et al. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: Quantifying the epidemiological transition. Lancet. 2015;386:2145–2191. doi: 10.1016/S0140-6736(15)61340-X. - DOI - PMC - PubMed
    1. Strom B.L., Kimmel S.E., Hennessy S., editors. Pharmacoepidemiology. 5th ed. John Wiley & Sons; Hoboken, NJ, USA: 2011. Basic principles of clinical pharmacology relevant to pharmacoepidemiologic studies; pp. 23–37.
    1. MacMahon S., Calverley P., Chaturvedi N., Chen Z., Corner L., Davies M., Ezzati M., Guthrie B., Hanson K., Jha V., et al. Multimorbidity: A Priority for Global Health Research. The Academy of Medical Sciences; London, UK: 2018. p. 6.

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