Programa de Máster en Salud Pública, Universitat Pompeu Fabra, 08003 Barcelona, Spain.
Unitat Transversal de Recerca (UTR), Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain.
Int J Environ Res Public Health. 2021 Sep 1;18(17):9216. doi: 10.3390/ijerph18179216.
(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.
(1)背景:多种慢性疾病的合并发生,即共病,在老年人群中很常见,通常需要同时使用几种处方药进行治疗,即多药治疗。这两个概念是内在相关的,会给个体带来不必要的负担。本研究旨在确定加泰罗尼亚老年人群的共病和多药治疗合并模式。(2)方法:使用 2012 年的电子健康记录进行了一项横断面研究。通过将慢性疾病类别与用于治疗这些疾病的药物类别进行映射,进行了一个映射过程。然后对最终映射的类别进行软聚类技术分析。(3)结果:共纳入 916619 人,93.1%的人符合作者共病标准,49.9%的人符合多药治疗标准。确定了一个七聚类解决方案:一个非特异性(聚类 1)和六个特异性,对应于糖尿病(聚类 2)、神经和肌肉骨骼、女性为主(聚类 3 和 4)以及心血管、脑血管和肾脏疾病(聚类 5 和 6)和多系统疾病(聚类 7)。(4)结论:本研究使用了映射过程和软聚类技术来确定老年人群中共病和多药治疗的合并模式,在六个聚类中发现了慢性疾病和慢性疾病-药物类别的过度表现。这些结果可应用于临床实践指南,以更好地满足患者的需求。本研究可以为未来关于共病和多药治疗之间关系的纵向研究奠定基础。