Abstract
In the present study, we aimed to identify multimorbidity patterns in a Japanese population and investigate whether these patterns have differing effects on polypharmacy and dosage frequency. Data was collected on 17 chronic health conditions via nationwide cross-sectional survey of 3,256 adult Japanese residents. Factor analysis was performed to identify multimorbidity patterns, and associations were determined with excessive polypharmacy [concurrent use of ≥ 10 prescription or over-the-counter (OTC) medications] and higher dosage frequency ( ≥ 3 doses per day). Secondary outcomes were the number of concurrent prescription medications and the number of concurrent OTC medications. We used a generalized linear model to adjust for individual sociodemographic characteristics. Five multimorbidity patterns were identified: cardiovascular/renal/metabolic, neuropsychiatric, skeletal/articular/digestive, respiratory/dermal, and malignant/digestive/urologic. Among these patterns, malignant/digestive/urologic and cardiovascular/renal/metabolic patterns showed the strongest associations with excessive polypharmacy and the number of concurrent OTC medications. Malignant/digestive/urologic, respiratory/dermal, and skeletal/articular/digestive patterns were also associated with higher dosage frequency. Multimorbidity patterns have differing effects on excessive polypharmacy and dosage frequency. Malignant/digestive/urologic pattern may be at higher risk of impaired medication safety and increased treatment burden, than other patterns. Continued study is warranted to determine how to incorporate multimorbidity patterns into risk assessments of polypharmacy and overall treatment burden.
Highlights
Multimorbidity, which is defined as the co-occurrence of multiple chronic or acute diseases and medical conditions in an individual, is increasingly becoming a major concern in primary care[1]
Excessive polypharmacy was found in 101 patients (6.8%), and higher dosage frequency was found in 351 patients (23.7%) among outpatients
In a representative sample of Japanese adults, aged 18–84 years, our study identified five multimorbidity patterns with differing associations with both excessive polypharmacy and dosage frequency in outpatients
Summary
Multimorbidity, which is defined as the co-occurrence of multiple chronic or acute diseases and medical conditions in an individual, is increasingly becoming a major concern in primary care[1]. A number of studies have investigated the associations of one-dimensional index of multimorbidity (i.e., the total number of chronic health conditions) with polypharmacy and dosage frequency[12,13], the question of whether nonrandom cluster patterns of chronic health conditions have differing effects on these outcomes remains unanswered. Such a one-dimensional index may be too crude to fully elucidate the effects of multimorbidity on medication usage in real world practice. We aimed to identify multimorbidity patterns in a Japanese population, and determine the extent to which multimorbidity patterns have differing effects on polypharmacy and dosage frequency
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