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

Enrica Menditto,Francisca González Rubio,Valentina Orlando,Alexandra Prados Torres,Beatriz Poblador Plou,Mercedes Aza Pascual-Salcedo,Aida Moreno Juste,Antonio Gimeno Miguel,Miguel Angel Medina

doi:10.1371/journal.pone.0210701

Abstract

ObjectivesThe 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.MethodsThis 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.ResultsSix 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.ConclusionsThe 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.

Highlights

Optimization of drug prescribing is emerging as a mandatory element for healthcare systems [1]
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

Summary

Introduction

Optimization of drug prescribing is emerging as a mandatory element for healthcare systems [1]. Patients are prescribed several drugs following multiple disease-specific guidelines [2]. Several studies have shown that inappropriate polypharmacy increases the risk of unnecessary drug use, potential drug-drug and drug-disease interactions, and adverse drug reactions (ADRs) [3,4,5]. Polypharmacy is often due to the so-called ‘prescribing cascade’, which involves the clinician’s failure to recognize a new medical event as an ADR. In such cases, an additional drug is prescribed to treat the adverse reaction leading to side effects instead of withdrawing or changing the responsible drug, creating a vicious circle and adding further risks to multimorbid patients [6,7]

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