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Article: Comparing Multimorbidity Patterns Among Discharged Middle-Aged and Older Inpatients Between Hong Kong and Zurich: A Hierarchical Agglomerative Clustering Analysis of Routine Hospital Records

TitleComparing Multimorbidity Patterns Among Discharged Middle-Aged and Older Inpatients Between Hong Kong and Zurich: A Hierarchical Agglomerative Clustering Analysis of Routine Hospital Records
Authors
Keywordscomorbidity
machine learning
multiple chronic conditions
non-communicable disease
population aging
Issue Date2021
PublisherFrontiers. The Journal's web site is located at http://www.frontiersin.org/Medicine
Citation
Frontiers in Medicine, 2021, v. 8, p. article no. 651925 How to Cite?
AbstractBackground: Multimorbidity, defined as the co-occurrence of ≥2 chronic conditions, is clinically diverse. Such complexity hinders the development of integrated/collaborative care for multimorbid patients. In addition, the universality of multimorbidity patterns is unclear given scarce research comparing multimorbidity profiles across populations. This study aims to derive and compare multimorbidity profiles in Hong Kong (HK, PRC) and Zurich (ZH, Switzerland). Methods: Stratified by sites, hierarchical agglomerative clustering analysis (dissimilarity measured by Jaccard index) was conducted with the objective of grouping inpatients into clinically meaningful clusters based on age, sex, and 30 chronic conditions among 20,000 randomly selected discharged multimorbid inpatients (10,000 from each site) aged ≥ 45 years. The elbow point method based on average within-cluster dissimilarity, complemented with a qualitative clinical examination of disease prevalence, was used to determine the number of clusters. Results: Nine clusters were derived for each site. Both similarities and dissimilarities of multimorbidity patterns were observed. There was one stroke-oriented cluster (3.9% in HK; 6.5% in ZH) and one chronic kidney disease-oriented cluster (13.1% in HK; 11.5% ZH) in each site. Examples of site-specific multimorbidity patterns, on the other hand, included a myocardial infarction-oriented cluster in ZH (2.3%) and several clusters in HK with high prevalence of heart failure (>65%) and chronic pain (>20%). Conclusion: This is the first study using hierarchical agglomerative clustering analysis to profile multimorbid inpatients from two different populations to identify universalities and differences of multimorbidity patterns. Our findings may inform the coordination of integrated/collaborative healthcare services.
Persistent Identifierhttp://hdl.handle.net/10722/301281
ISSN

 

DC FieldValueLanguage
dc.contributor.authorLai, FTT-
dc.contributor.authorBeeler, PE-
dc.contributor.authorYip, BHK-
dc.contributor.authorCheetham, M-
dc.contributor.authorChau, PYK-
dc.contributor.authorChung, RY-
dc.contributor.authorWong, ELY-
dc.contributor.authorYeoh, EK-
dc.contributor.authorBattegay, E-
dc.contributor.authorWong, SYS-
dc.date.accessioned2021-07-27T08:08:48Z-
dc.date.available2021-07-27T08:08:48Z-
dc.date.issued2021-
dc.identifier.citationFrontiers in Medicine, 2021, v. 8, p. article no. 651925-
dc.identifier.issn2296-858X-
dc.identifier.urihttp://hdl.handle.net/10722/301281-
dc.description.abstractBackground: Multimorbidity, defined as the co-occurrence of ≥2 chronic conditions, is clinically diverse. Such complexity hinders the development of integrated/collaborative care for multimorbid patients. In addition, the universality of multimorbidity patterns is unclear given scarce research comparing multimorbidity profiles across populations. This study aims to derive and compare multimorbidity profiles in Hong Kong (HK, PRC) and Zurich (ZH, Switzerland). Methods: Stratified by sites, hierarchical agglomerative clustering analysis (dissimilarity measured by Jaccard index) was conducted with the objective of grouping inpatients into clinically meaningful clusters based on age, sex, and 30 chronic conditions among 20,000 randomly selected discharged multimorbid inpatients (10,000 from each site) aged ≥ 45 years. The elbow point method based on average within-cluster dissimilarity, complemented with a qualitative clinical examination of disease prevalence, was used to determine the number of clusters. Results: Nine clusters were derived for each site. Both similarities and dissimilarities of multimorbidity patterns were observed. There was one stroke-oriented cluster (3.9% in HK; 6.5% in ZH) and one chronic kidney disease-oriented cluster (13.1% in HK; 11.5% ZH) in each site. Examples of site-specific multimorbidity patterns, on the other hand, included a myocardial infarction-oriented cluster in ZH (2.3%) and several clusters in HK with high prevalence of heart failure (>65%) and chronic pain (>20%). Conclusion: This is the first study using hierarchical agglomerative clustering analysis to profile multimorbid inpatients from two different populations to identify universalities and differences of multimorbidity patterns. Our findings may inform the coordination of integrated/collaborative healthcare services.-
dc.languageeng-
dc.publisherFrontiers. The Journal's web site is located at http://www.frontiersin.org/Medicine-
dc.relation.ispartofFrontiers in Medicine-
dc.rightsThis Document is Protected by copyright and was first published by Frontiers. All rights reserved. It is reproduced with permission.-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectcomorbidity-
dc.subjectmachine learning-
dc.subjectmultiple chronic conditions-
dc.subjectnon-communicable disease-
dc.subjectpopulation aging-
dc.titleComparing Multimorbidity Patterns Among Discharged Middle-Aged and Older Inpatients Between Hong Kong and Zurich: A Hierarchical Agglomerative Clustering Analysis of Routine Hospital Records-
dc.typeArticle-
dc.identifier.emailLai, FTT: fttlai@hku.hk-
dc.identifier.authorityLai, FTT=rp02802-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.3389/fmed.2021.651925-
dc.identifier.hkuros323781-
dc.identifier.volume8-
dc.identifier.spagearticle no. 651925-
dc.identifier.epagearticle no. 651925-
dc.publisher.placeSwitzerland-

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