Background
Methods
Design, setting, and study population
Coding and selection of diseases
Variables
Statistical analysis
Descriptive analysis
Multiple correspondence analysis
k-means clustering
Multimorbidity patterns
Results
Patients included in the analysis in 2009, N = 190,108 | ||||
Women | Men | |||
65–79 years | ≥80 years | 65–79 years | ≥80 years | |
Total, n(%) | 80,208 (42.2) | 33,442 (17.6) | 59,331 (31.2) | 17,127 (9.0) |
Number of diagnoses*, n(%) | ||||
2 | 4249 (5.3) | 1595 (4.8) | 3770 (6.4) | 782 (4.6) |
[3–5] | 22,491 (28.1) | 8688 (26.0) | 19,429 (32.7) | 4534 (26.5) |
[6–9] | 32,663 (40.7) | 13,732 (41.0) | 23,846 (40.2) | 7252 (42.3) |
≥ 10 | 20,805 (25.9) | 9427 (28.2) | 12,286 (20.7) | 4559 (26.6) |
Median number of diagnoses (IQR)** | 7 (5–10) | 7 (5–10) | 6 (4–9) | 7 (5–10) |
Number of diagnoses included in cluster analysis*** | 83 | 85 | 84 | 85 |
Patients included in the analysis in 2014, N = 166,095 | ||||
Women | Men | |||
70–79 years | ≥80 years | 70–79 years | ≥80 years | |
Total n(%) | 51,835 (31.2) | 49,940 (30.1) | 38,127 (22.9) | 26,193 (15.8) |
Number of diagnoses*, n(%) | ||||
2 | 3220 (6.2) | 2026 (4.1) | 2811 (7.4) | 1125 (4.3) |
[3–5] | 16,662 (32.1) | 12,144 (24.3) | 13,879 (36.4) | 6818 (26.0) |
[6–9] | 21,334 (41.2) | 21,316 (42.7) | 15,119 (39.6) | 11,333 (43.3) |
≥ 10 | 10,619 (20.5) | 14,454 (28.9) | 6318 (16.6) | 6917 (26.4) |
Median number of diagnoses (IQR)** | 6 (4–9) | 7 (5–10) | 6 (4–8) | 7 (5–10) |
Number of diagnoses included in cluster analysis*** | 80 | 84 | 80 | 82 |
Chronic diseases prevalence
K-means clustering
Multimorbidity patterns
Neuropsychiatric pattern | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Number of persons in the cluster | n = 8242 | n = 7493 | n = 6770 | n = 6042 | n = 5360 | n = 4688 | |||||||
Persons stable in the pattern. n(%) | 8242a (100) | 7210a (87.5) | 6297a (76.4) | 5386a (65.4) | 4536a (55.0) | 3503a (42.5) | |||||||
ICPC2 | Diagnoses | Prevb (%) | O/E rc | Prevb (%) | O/E rc | Prevb (%) | O/E rc | Prevb (%) | O/E rc | Prevb (%) | O/E rc | Prevb (%) | O/E rc |
K86 | Hypertension, uncomplicated | 70.4 | 1.02 | 69.8 | 1.02 | 68.7 | 1.01 | 68.6 | 1.03 | 68.6 | 1.04 | 70.8 | 1.09 |
T93 | Lipid disorder | 67.6 | 1.17 | 68.4 | 1.18 | 68.1 | 1.17 | 67.9 | 1.16 | 68.4 | 1.17 | 70.6 | 1.21 |
P76 | Depressive disorder | 53.5 | 1.96 | 53.7 | 1.97 | 53.1 | 1.95 | 53.4 | 1.97 | 51.3 | 1.90 | 49.2 | 1.86 |
L95 | Osteoporosis | 39.5 | 1.21 | 39.9 | 1.22 | 40.0 | 1.23 | 39.3 | 1.22 | 39.2 | 1.24 | 39.2 | 1.27 |
P70 | Dementia | 32.4 |
5.98
| 30.8 |
6.31
| 30.1 |
6.79
| 27.9 |
7.05
| 25.4 |
7.33
| 21.0 |
6.94
|
L91 | Osteoarthritis. other | 31.8 | 1.18 | 31.1 | 1.16 | 30.1 | 1.13 | 30.4 | 1.16 | 29.5 | 1.14 | 29.3 | 1.15 |
T90 | Diabetes. non-insulin dependent | 31.0 | 1.38 | 30.9 | 1.40 | 30.6 | 1.40 | 32.8 | 1.52 | 33.7 | 1.60 | 37.4 | 1.81 |
F92 | Cataract | 29.4 | 1.15 | 29.2 | 1.16 | 29.1 | 1.18 | 29.2 | 1.22 | 28.2 | 1.23 | 26.4 | 1.22 |
K90 | Stroke/cerebrovascular accident | 23.5 |
4.81
| 23.1 |
4.94
| 22.4 |
5.02
| 21.5 |
5.11
| 20.2 |
5.08
| 16.9 |
4.50
|
P71 | Organic psychosis, other | 16.0 |
5.72
| 16.2 |
6.06
| 16.0 |
6.25
| 15.8 |
6.46
| 15.5 |
6.61
| 14.6 |
6.66
|
K76 | Ischaemic heart disease without angina | 13.9 |
4.27
| 13.9 |
4.47
| 13.6 |
4.57
| 14.2 |
5.04
| 15.4 |
5.68
| 17.9 |
7.00
|
K91 | Cerebrovascular disease | 12.9 |
6.05
| 12.5 |
6.11
| 12.4 |
6.23
| 12.4 |
6.33
| 12.4 |
6.55
| 11.5 |
6.36
|
N87 | Parkinsonism | 12.8 |
6.62
| 11.9 |
6.51
| 12.2 |
7.00
| 11.6 |
7.12
| 11.7 |
7.47
| 11.1 |
7.72
|
N99 | Neurological disease, other | 11.6 |
4.63
| 11.9 |
4.85
| 11.8 |
4.88
| 11.8 |
5.00
| 11.0 |
4.78
| 10.7 |
4.86
|
K92 | Atherosclerosis/ peripheral vascular disease | 9.6 |
3.08
| 9.6 |
3.17
| 9.6 |
3.30
| 9.6 |
3.45
| 9.4 |
3.47
| 11.4 |
4.36
|
K89 | Transient cerebral ischaemia | 9.3 |
3.67
| 9.1 |
3.74
| 8.6 |
3.69
| 8.7 |
3.90
| 8.0 |
3.77
| 6.9 |
3.45
|
K74 | Ischaemic heart disease with angina | 8.7 |
3.84
| 8.9 |
3.97
| 8.6 |
4.03
| 9.0 |
4.48
| 9.1 |
4.81
| 11.4 |
6.54
|
K75 | Acute myocardial infarction | 7.9 |
4.79
| 8.0 |
5.11
| 7.7 |
5.16
| 7.8 |
5.60
| 8.7 |
6.53
| 9.6 |
7.61
|
N88 | Epilepsy | 6.4 |
5.83
| 6.5 |
6.08
| 6.9 |
6.45
| 6.6 |
6.27
| 6.4 |
6.28
| – |
–
|
B81 | Anaemia. Vit B12/folate deficiency | 4.0 |
2.83
| 3.7 |
2.74
| 3.6 |
2.78
| 3.5 |
2.86
| 3.5 |
3.09
| 2.9 |
2.80
|
F83 | Retinopathy | – | – | 5.5 |
2.12
| 5.9 |
2.32
| 7.2 |
2.87
| 7.2 |
2.96
| 9.8 |
4.13
|
N94 | Peripheral neuritis/neuropathy | – | – | – | – | – | – | 5.3 |
2.15
| 5.5 |
2.28
| 7.0 |
2.98
|
T82 | Obesity | – | – | – | – | – | – | 21.1 | 0.72 | 21.8 | 0.74 | 23.0 | 0.79 |
B82 | Anaemia. other/unspecified | – | – | – | – | – | – | – | – | 13.1 |
2.09
| 13.9 |
2.46
|
F84 | Macular degeneration | – | – | – | – | – | – | – | – | – | – | 3.2 |
2.24
|
Neuropsychiatric pattern | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Number of persons in the cluster | n = 5956 | n = 5644 | n = 5080 | n = 4483 | n = 3819 | n = 3274 | |||||||
Patients stable in the pattern, n(%) | 5956a (100) | 5013a (84.2) | 4205a (70.6) | 3757a (63.1) | 3214a (54.0) | 2741a (46.0) | |||||||
ICPC2 | Diagnosis | Prevb (%) | O/E rc | Prevb (%) | O/E rc | Prevb (%) | O/E rc | Prevb (%) | O/E rc | Prevb (%) | O/E rc | Prevb (%) | O/E rc |
K86 | Hypertension, uncomplicated | 67.3 | 0.99 | 70.0 | 1.03 | 71.0 | 1.05 | 68.9 | 1.02 | 68.1 | 1.02 | 66.2 | 0.99 |
T93 | Lipid disorder | 54.5 | 1.10 | 58.6 | 1.17 | 60.6 | 1.20 | 59.9 | 1.18 | 60.3 | 1.18 | 58.7 | 1.15 |
Y85 | Benign prostatic hypertrophy | 45.7 | 1.10 | 43.9 | 1.05 | 42.4 | 1.01 | 42.4 | 1.02 | 42.9 | 1.03 | 44.5 | 1.08 |
T90 | Diabetes, non-insulin dependent | 37.8 | 1.23 | 42.5 | 1.39 | 45.5 | 1.49 | 43.2 | 1.43 | 42.1 | 1.40 | 38.2 | 1.28 |
K90 | Stroke/cerebrovascular accident | 34.9 |
4.31
| 35.4 |
4.56
| 35.5 |
4.73
| 35.0 |
4.86
| 35.3 |
5.11
| 35.5 |
5.34
|
P76 | Depressive disorder | 34.1 |
3.11
| 32.1 |
2.95
| 30.4 |
2.83
| 31.4 |
2.94
| 31.9 |
3.04
| 32.3 |
3.19
|
P70 | Dementia | 28.2 |
6.56
| 24.3 |
6.24
| 22.2 |
6.32
| 22.2 |
6.84
| 21.5 |
7.52
| 21.7 |
8.73
|
F92 | Cataract | 23.8 | 1.11 | 24.1 | 1.14 | 24.3 | 1.16 | 23.4 | 1.14 | 23.7 | 1.20 | 21.2 | 1.13 |
K76 | Ischaemic heart disease without angina | 21.5 |
2.12
| 24.0 |
2.42
| 24.4 |
2.52
| 24.4 |
2.57
| 22.5 |
2.44
| 20.0 |
2.23
|
K92 | Atherosclerosis/peripheral vascular disease | 19.6 |
2.16
| 23.4 |
2.63
| 25.2 |
2.92
| 23.7 |
2.83
| 22.6 |
2.78
| 20.3 |
2.60
|
K91 | Cerebrovascular disease | 19.4 |
5.84
| 20.1 |
6.08
| 20.9 |
6.46
| 20.8 |
6.57
| 21.4 |
6.90
| 21.2 |
7.07
|
N87 | Parkinsonism | 17.3 |
6.74
| 15.0 |
6.14
| 13.6 |
5.88
| 13.6 |
6.12
| 13.9 |
6.66
| 14.2 |
7.10
|
K75 | Acute myocardial infarction | 13.5 |
2.06
| 15.8 |
2.47
| 15.6 |
2.50
| 15.8 |
2.62
| 14.9 |
2.52
| 12.8 |
2.28
|
N99 | Neurological disease, other | 13.5 |
5.08
| 13.0 |
4.96
| 12.8 |
4.98
| 13.3 |
5.24
| 13.9 |
5.65
| 14.7 |
6.22
|
P71 | Organic psychosis, other | 13.5 |
6.13
| 12.3 |
5.77
| 11.7 |
5.66
| 11.4 |
5.76
| 12.0 |
6.35
| 12.6 |
6.99
|
K89 | Transient cerebral ischaemia | 11.1 |
3.58
| 10.6 |
3.52
| 10.3 |
3.54
| 9.8 |
3.50
| 9.7 |
3.63
| 9.0 |
3.62
|
K74 | Ischaemic heart disease with angina | 10.3 |
2.35
| 11.1 |
2.58
| 11.3 |
2.71
| 11.9 |
2.93
| 11.1 |
2.79
| 9.7 |
2.50
|
N88 | Epilepsy | 8.2 |
6.13
| 7.4 |
5.61
| 7.1 |
5.43
| 7.8 |
6.06
| 8.5 |
6.69
| 9.1 |
7.33
|
A04 | Weakness/tiredness. General | 6.4 |
2.63
| 6.1 |
2.50
| 6.0 |
2.53
| 5.7 |
2.51
| 5.9 |
2.83
| 5.7 |
3.13
|
B81 | Anaemia. Vit B12/folate deficiency | 4.0 |
2.63
| 3.9 |
2.65
| 3.9 |
2.79
| 3.1 |
2.39
| 2.8 |
2.20
| 2.6 |
2.12
|
B82 | Anaemia. other/unspecified | – | – | 14.5 |
2.01
| 14.8 |
2.13
| 13.7 |
2.08
| – | – | – | – |
F83 | Retinopathy | – | – | 6.5 |
2.13
| 7.4 |
2.45
| 6.6 |
2.17
| 6.4 |
2.09
| – | – |
N94 | Peripheral neuritis/neuropathy | – | – | 6.2 |
2.07
| 6.5 |
2.22
| 6.6 |
2.25
| 6.5 |
2.28
| 5.7 |
2.07
|
U99 | Urinary disease. Other | – | – | 20.4 | 1.22 | 20.3 | 1.24 | – | – | – | – | – | – |