Patterns of multimorbidity and polypharmacy in young and adult population: Systematic associations among chronic diseases and drugs using factor analysis

• Published in: PloS one 2019-02, Vol.14 (2), p.e0210701
• Main Authors: Menditto, Enrica, Gimeno Miguel, Antonio, Moreno Juste, Aida, Poblador Plou, Beatriz, Aza Pascual-Salcedo, Mercedes, Orlando, Valentina, González Rubio, Francisca, Prados Torres, Alexandra
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Adults; Age; Age Factors; Alcohol; Analysis; Biocompatibility; Biology and Life Sciences; Biomedical materials; Cascades; Child; Child, Preschool; Chronic Disease - drug therapy; Chronic Disease - epidemiology; Chronic diseases; Chronic illnesses; Comorbidity; Cross-Sectional Studies; Demographics; Diseases; Drug interactions; Drug Prescriptions - statistics & numerical data; Drugs; Elderly; Epidemiology; Factor analysis; Factor Analysis, Statistical; Female; Geriatrics; Health aspects; Health risks; Health sciences; Health services; Hospitals; Humans; Infant; Infant, Newborn; Male; Medical electronics; Medical personnel; Medical societies; Medicine and Health Sciences; Mental disorders; Mental health; Middle Aged; Multimorbidity; Older people; Online health care information services; Pain; Patients; Pharmacists; Pharmacoeconomics; Pharmacy; Physicians; Polypharmacy; Population; Population studies; Prescription drugs; Prescription writing; Primary care; Public health; Respiration; Sex; Sex Factors; Spain - epidemiology; Studies; Thyroid gland; Vitamin deficiency; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0210701

The objective was to identify the systematic associations among chronic diseases and drugs in the form of patterns and to describe and clinically interpret the constituted patterns with a focus on exploring the existence of potential drug-drug and drug-disease interactions and prescribing cascades. This observational, cross-sectional study used the demographic and clinical information from electronic medical databases and the pharmacy billing records of all users of the public health system of the Spanish region of Aragon in 2015. An exploratory factor analysis was conducted based on the tetra-choric correlations among the diagnoses of chronic diseases and the dispensed drugs in 887,572 patients aged ≤65 years. The analysis was stratified by age and sex. To name the constituted patterns, assess their clinical nature, and identify potential interactions among diseases and drugs, the associations found in each pattern were independently reviewed by two pharmacists and two doctors and tested against the literature and the information reported in the technical medicinal forms. Six multimorbidity-polypharmacy patterns were found in this large-scale population study, named as respiratory, mental health, cardiometabolic, endocrinological, osteometabolic, and mechanical-pain. The nature of the patterns in terms of diseases and drugs differed by sex and age and became more complex as age advanced. The six clinically sound multimorbidity-polypharmacy patterns described in this non-elderly population confirmed the existence of systematic associations among chronic diseases and medications, and revealed some unexpected associations suggesting the prescribing cascade phenomenon as a potential underlying factor. These findings may help to broaden the focus and orient the early identification of potential interactions when caring for multimorbid patients at high risk of adverse health outcomes due to polypharmacy.