Multimorbidity patterns in primary care: interactions among chronic diseases using factor analysis.
Multimorbidity patterns in primary care: interactions among chronic diseases using factor analysis.
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DOI：
10.1371/journal.pone.0032190
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Alcalá-Nalvaiz JT
中科院分区：
文献类型：
--
作者：
Prados-Torres A;Poblador-Plou B;Calderón-Larrañaga A;Gimeno-Feliu LA;González-Rubio F;Poncel-Falcó A;Sicras-Mainar A;Alcalá-Nalvaiz JT
本研究的主要目的是确定初级保健人群中存在的慢性病多病模式，描述其临床组成部分，并分析这些模式在女性和男性中如何随时间变化和演变。本研究的次要目的是为多发病的病理生理过程提供证据，并了解各种疾病之间的相互作用和协同作用。这项观察性、回顾性、多中心研究利用了2008年以来19个初级保健中心的电子病历信息。为了确定多发病模式，我们对275,682例14岁以上患者的诊断信息进行了探索性因素分析。分析按年龄组和性别分层。在所有年龄组中均发现多重发病，其患病率从15至44岁年龄组的13%到65岁及以上年龄组的67%不等。拟合优度指标显示样本值在0.50和0.71之间。我们确定了五种多病模式：心脏代谢，精神药物滥用，机械肥胖-甲状腺，心理老年和抑郁症。研究发现，其中一些模式会随着年龄的增长而进化，男女之间也存在差异。慢性疾病之间的非随机关联导致临床一致的多病模式，影响很大一部分人口。观察到潜在的病理生理现象，可以从临床、个人层面和公共卫生或人口层面的角度采取行动。
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. 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. 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. 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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