Understanding patterns and identifying common clusters of chronic diseases may help policymakers, researchers, and clinicians to understand the needs of the care process better and potentially save both provider and patient time and cost. However, only limited research has been conducted in this area, and ambiguity remains as those limited previous studies used different approaches to identify common clusters and findings may vary with approaches. This study estimates the prevalence of common chronic diseases and examines co-occurrence of diseases using four approaches: (i) identification of the most occurring pairs and triplets of comorbid diseases; performing (ii) cluster analysis of diseases, (iii) principal component analysis, and (iv) latent class analysis. Data were collected using a questionnaire mailed to a cross-sectional sample of senior Australians, with 4574 responses. Eighty-two percent of respondents reported having at least one chronic disease and over 52% reported having at least two chronic diseases. Respondents suffering from any chronic diseases had an average of 2.4 comorbid diseases. Three defined groups of chronic diseases were identified: (i) asthma, bronchitis, arthritis, osteoporosis and depression; (ii) high blood pressure and diabetes; and (iii) cancer, with heart disease and stroke either making a separate group or “attaching” themselves to different groups in different analyses. The groups were largely consistent across the approaches. Stability and sensitivity analyses also supported the consistency of the groups. The consistency of the findings suggests there is co-occurrence of diseases beyond chance, and patterns of co-occurrence are important for clinicians, patients, policymakers and researchers. Further studies are needed to provide a strong evidence base to identify comorbid groups which would benefit from appropriate guidelines for the care and management of patients with particular disease clusters.
References
[1]
Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M (2009) Defining comorbidity: implications for understanding health and health services. Annals of family medicine 7: 357–363.
[2]
Kirchberger I, Meisinger C, Heier M, Zimmermann AK, Thorand B, et al. (2012) Patterns of multimorbidity in the aged population. Results from the KORA-Age study. PloS one 7: e30556.
[3]
McCarron M, Swinburne J, Burke E, McGlinchey E, Carroll R, et al. (2013) Patterns of multimorbidity in an older population of persons with an intellectual disability: results from the intellectual disability supplement to the Irish longitudinal study on aging (IDS-TILDA). Research in developmental disabilities 34: 521–527.
[4]
Starfield B (2006) Threads and yarns: weaving the tapestry of comorbidity. Annals of family medicine 4: 101–103.
[5]
Taylor AW, Price K, Gill TK, Adams R, Pilkington R, et al. (2010) Multimorbidity - not just an older person's issue. Results from an Australian biomedical study. BMC public health 10: 718.
[6]
McRae I, Yen L, Jeon YH, Herath PM, Essue B (2012) Multimorbidity is associated with higher out-of-pocket spending: a study of older Australians with multiple chronic conditions. Australian journal of primary health
[7]
Jowsey T, McRae IS, Valderas JM, Dugdale P, Phillips R, et al. (2013) Time's Up. Descriptive Epidemiology of Multi-Morbidity and Time Spent on Health Related Activity by Older Australians: A Time Use Survey. PloS one 8: e59379.
[8]
McCormick WC, Boling PA (2005) Multimorbidity and a comprehensive Medicare care-coordination benefit. Journal of the American Geriatrics Society 53: 2227–2228.
[9]
Holden L, Scuffham PA, Hilton MF, Muspratt A, Ng SK, et al. (2011) Patterns of multimorbidity in working Australians. Population health metrics 9: 15.
[10]
Caughey GE, Vitry AI, Gilbert AL, Roughead EE (2008) Prevalence of comorbidity of chronic diseases in Australia. BMC public health 8: 221.
[11]
Cornell JE, Pugh JA, Williams JW, Kazis L, Lee AF, et al. (2007) Multimorbidity clusters: clustering binary data from multimorbidity clusters:clustering binary data from a large administrative medical database. Applied Multivariate Research 12: 163–182.
[12]
Garcia-Olmos L, Salvador CH, Alberquilla A, Lora D, Carmona M, et al. (2012) Comorbidity patterns in patients with chronic diseases in general practice. PloS one 7: e32141.
[13]
Schafer I, von Leitner EC, Schon G, Koller D, Hansen H, et al. (2010) Multimorbidity patterns in the elderly: a new approach of disease clustering identifies complex interrelations between chronic conditions. PloS one 5: e15941.
[14]
Steinman MA, Lee SJ, John Boscardin W, Miao Y, Fung KZ, et al. (2012) Patterns of multimorbidity in elderly veterans. Journal of the American Geriatrics Society 60: 1872–1880.
[15]
Prados-Torres A, Poblador-Plou B, Calderon-Larranaga A, Gimeno-Feliu LA, Gonzalez-Rubio F, et al. (2012) Multimorbidity patterns in primary care: interactions among chronic diseases using factor analysis. PloS one 7: e32190.
[16]
Knox SA, Harrison CM, Britt HC, Henderson JV (2008) Estimating prevalence of common chronic morbidities in Australia. The Medical journal of Australia 189: 66–70.
[17]
Britt HC, Harrison CM, Miller GC, Knox SA (2008) Prevalence and patterns of multimorbidity in Australia. The Medical journal of Australia 189: 72–77.
[18]
Vu T, Finch CF, Day L (2011) Patterns of comorbidity in community-dwelling older people hospitalised for fall-related injury: a cluster analysis. BMC Geriatr 11: 45.
[19]
Guralnik JM (1996) Assessing the impact of comorbidity in the older population. Annals of epidemiology 6: 376–380.
[20]
Formiga F, Ferrer A, Sanz H, Marengoni A, Alburquerque J, et al. (2013) Patterns of comorbidity and multimorbidity in the oldest old: the Octabaix study. European journal of internal medicine 24: 40–44.
[21]
Australian Bureau of Statistics (2009) National health survey: summary of results, 2007–2008 (reissue), Cat. no. 4364.0. Canberra: Australian Bureau of Statistics.
[22]
Everitt BS, Landau S, Leese M (2001) Cluster analysis (4th ed.). New York: Oxford University Press.
[23]
Kaufman L, Rousseeuw PJ (2005) Finding groups in data. An introduction to cluster analysis. Hoboken, NJ: Wiley.
[24]
Calinski T, Harabasz J (1974) A dendrite method for cluster analysis. Communications in Statistics 3: 1–27.
[25]
Kubinger K (2003) On artificial results due to using factor analysis for dichotomous variables. Psychology Science 45: 106–110.
[26]
Lanza ST, Collins LM, Lemmon DR, Schafer JL (2007) PROC LCA: A SAS Procedure for Latent Class Analysis. Struct Equ Modeling 14: 671–694.
[27]
Fortin M, Hudon C, Haggerty J, Akker M, Almirall J (2010) Prevalence estimates of multimorbidity: a comparative study of two sources. BMC health services research 10: 111.
[28]
Fortin M, Dubois MF, Hudon C, Soubhi H, Almirall J (2007) Multimorbidity and quality of life: a closer look. Health and quality of life outcomes 5: 52.
[29]
Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, et al. (2011) Aging with multimorbidity: a systematic review of the literature. Ageing research reviews 10: 430–439.
[30]
Wolff JL, Starfield B, Anderson G (2002) Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Archives of internal medicine 162: 2269–2276.
[31]
Long AN, Dagogo-Jack S (2011) Comorbidities of diabetes and hypertension: mechanisms and approach to target organ protection. Journal of clinical hypertension 13: 244–251.
[32]
Dickens C, Creed F (2001) The burden of depression in patients with rheumatoid arthritis. Rheumatology 40: 1327–1330.
[33]
Eyre H, Kahn R, Robertson RM (2004) Preventing cancer, cardiovascular disease, and diabetes: a common agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association. Diabetes Care 27: 1812–1824.
[34]
Aspin C, Jowsey T, Glasgow N, Dugdale P, Nolte E, et al. (2010) Health policy responses to rising rates of multi-morbid chronic illness in Australia and New Zealand. Aust N Z J Public Health 34: 386–393.
[35]
Huntley AL, Johnson R, Purdy S, Valderas JM, Salisbury C (2012) Measures of multimorbidity and morbidity burden for use in primary care and community settings: a systematic review and guide. Annals of family medicine 10: 134–141.