Multimorbidity Patterns in Elderly Primary Health Care Patients in a South Mediterranean European Region: A Cluster Analysis

PLoS One. 2015 Nov 2;10(11):e0141155. doi: 10.1371/journal.pone.0141155. eCollection 2015.


Objective: The purpose of this study was to identify clusters of diagnoses in elderly patients with multimorbidity, attended in primary care.

Design: Cross-sectional study.

Setting: 251 primary care centres in Catalonia, Spain.

Participants: Individuals older than 64 years registered with participating practices.

Main outcome measures: Multimorbidity, defined as the coexistence of 2 or more ICD-10 disease categories in the electronic health record. Using hierarchical cluster analysis, multimorbidity clusters were identified by sex and age group (65-79 and ≥80 years).

Results: 322,328 patients with multimorbidity were included in the analysis (mean age, 75.4 years [Standard deviation, SD: 7.4], 57.4% women; mean of 7.9 diagnoses [SD: 3.9]). For both men and women, the first cluster in both age groups included the same two diagnoses: Hypertensive diseases and Metabolic disorders. The second cluster contained three diagnoses of the musculoskeletal system in the 65- to 79-year-old group, and five diseases coincided in the ≥80 age group: varicose veins of the lower limbs, senile cataract, dorsalgia, functional intestinal disorders and shoulder lesions. The greatest overlap (54.5%) between the three most common diagnoses was observed in women aged 65-79 years.

Conclusion: This cluster analysis of elderly primary care patients with multimorbidity, revealed a single cluster of circulatory-metabolic diseases that were the most prevalent in both age groups and sex, and a cluster of second-most prevalent diagnoses that included musculoskeletal diseases. Clusters unknown to date have been identified. The clusters identified should be considered when developing clinical guidance for this population.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Cardiovascular Diseases / epidemiology*
  • Cluster Analysis
  • Comorbidity
  • Cross-Sectional Studies
  • Electronic Health Records
  • Female
  • Humans
  • Hypertension / epidemiology*
  • Male
  • Mental Disorders / epidemiology*
  • Metabolic Diseases / epidemiology*
  • Musculoskeletal Diseases / epidemiology*
  • Primary Health Care
  • Spain / epidemiology