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Five-year trajectories of multimorbidity patterns in an elderly Mediterranean population using Hidden Markov Models
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Five-year trajectories of multimorbidity patterns in an elderly Mediterranean population using Hidden Markov Models
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Five-year trajectories of multimorbidity patterns in an elderly Mediterranean population using Hidden Markov Models
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Journal Article
Five-year trajectories of multimorbidity patterns in an elderly Mediterranean population using Hidden Markov Models
2020
Overview
This study aimed to analyse the trajectories and mortality of multimorbidity patterns in patients aged 65 to 99 years in Catalonia (Spain). Five year (2012–2016) data of 916,619 participants from a primary care, population-based electronic health record database (Information System for Research in Primary Care, SIDIAP) were included in this retrospective cohort study. Individual longitudinal trajectories were modelled with a Hidden Markov Model across multimorbidity patterns. We computed the mortality hazard using Cox regression models to estimate survival in multimorbidity patterns. Ten multimorbidity patterns were originally identified and two more states (death and drop-outs) were subsequently added. At baseline, the most frequent cluster was the
Non-Specific Pattern
(42%), and the least frequent the
Multisystem Pattern
(1.6%)
.
Most participants stayed in the same cluster over the 5 year follow-up period, from 92.1% in the
Nervous, Musculoskeletal
pattern to 59.2% in the
Cardio-Circulatory and Renal
pattern. The highest mortality rates were observed for patterns that included cardio-circulatory diseases:
Cardio-Circulatory and Renal
(37.1%);
Nervous, Digestive and Circulatory
(31.8%); and
Cardio-Circulatory, Mental, Respiratory and Genitourinary
(28.8%). This study demonstrates the feasibility of characterizing multimorbidity patterns along time. Multimorbidity trajectories were generally stable, although changes in specific multimorbidity patterns were observed. The Hidden Markov Model is useful for modelling transitions across multimorbidity patterns and mortality risk. Our findings suggest that health interventions targeting specific multimorbidity patterns may reduce mortality in patients with multimorbidity.
