Multimorbidity Patterns Of Chronic Diseases In The Hospitalized Elderly

Objectives: To describe patterns and association of multimorbidity in the hospitalized elderly,and provide evidences for management strategies of multimorbidity in clinical.Methods: The study enrolled consecutive patients aged 65 years or older(N=26100),whom admitted to the Department of Internal Medicine at the First Affiliated Hospital of Soochow University from December 2011 to December 2016.The information of the patient's disease was based on hospital discharge diagnoses.According to the previous studies,13 common chronic diseases were used for analysis.Patterns of multimorbidity were evaluated using three analytical approaches: conditional count(observed and expected rates,logistic regression models),cluster analysis and factor analyses.Results: The prevalence of multimorbidity was 55.7% in the hospitalized elderly.The most common chronic diseases were hypertension(52.3%),cancer(27.1%),diabetes mellitus(22.2%),coronary heart disease(18.2%)and cerebrovascular disease(15.2%).The number of comorbid conditions varied from an average of 2.8 to 4.1.The top five multimorbidity were heart failure(97.3%),benign prostatic hyperplasia(95.5%),atrial fibrillation(94.0%),chronic kidney disease(93.2%),and coronary heart disease(91.8%).The chronic disease pairs with the strongest associations by conditional count were coronary heart disease and heart failure(OR 8.02;95%CI 7.29-8.83),atrial fibrillation and heart failure(OR 7.26;95%CI 6.52-8.09).The cluster analyses and factor analyses revealed five patterns: the first pattern included the coronary heart disease,heart failure,and atrial fibrillation;the second pattern included the hypertension,diabetes mellitus,and cerebrovascular;the third pattern included the chronic obstructive pulmonary disease and benign prostatic hyperplasia;the fourth pattern included the chronic kidney disease and arthritis;the fifth pattern included the gastrointestinal disease and liver disease.Cancer were a separate group in cluster analysis,and ‘‘attaching'' themselves to hypertension,diabetes mellitus and cerebrovascular pattern in factor analyses.Conclusions: The large majority of elderly populations subjects had multimorbidity.The comorbid conditions of each chronic disease was very universally.The three analytical approaches revealed five patterns and confirm the non-random co-occurrence of certain diseases in the elderly.