The diabetes mellitus multimorbidity network in people over 50 years: An analysis of Chinese data

Abstract Objective: To characterize the patients in the diabetes mellitus (DM) multimorbidity network in people over 50 years and explore the association between DM and other chronic non-communicable diseases (NCDs) and the variations in age and sex subgroups. Methods: Data on 75 NCDs were extracted from electronic medical record of 309,843 hospitalized patients older than 50-years-old who had at least one NCD. The association rules analysis was used as a novel cluster method. Result: The four NCDs that co-occurred with DM at the highest prevalence were hypertension (Hyp) (14.19%), dyslipidemia (Dys) (7.27%), cerebrovascular disease (CVD) (7.00%) and chronic liver disease (CLD) (6.15%). The most common triads were (Hyp, CVD, DM) (5.55%); (Hyp, Dys, DM) (4.80%); and (Hyp, coronary heart disease (CHD), DM) (4.44%). A total of 12 NCDs were closely related to DM ( >1.1) with (cholelithiasis (Cho), DM) as an unexpected combination. Coexistence of (Dys, DM) and (gout, DM) had the largest in male and female groups. The negative related cluster contained seven NCDs ( <0.9). There were nine NCDs included in the strong association rules. In males, the strongest rule was (peripheral vascular disease (PVD), Dys, DM), while (Hyp, Dys, CLD, DM) was the strongest in females. Most combinations were different by age and sex. In patients younger than 70 years, Hyp, CLD, and Dys were the most dominant NCDs in the DM multimorbidity network. In patients 70 years or older, chronic kidney disease (CKD), CVD, CHD, and heart disease (HD) frequently co-occurred with DM. Gout was more common in females. There were differences in the findings for Dys in male and female groups. Conclusion: Future primary healthcare policies for DM should be formulated based on age and sex. In patients younger than 70 years, more attention for hypertension, CLD, and Dyslipidemia is needed, while attention for CKD, CVD, CHD and HD is needed in patients older than 70 years. More attention should be paid to the prevention and treatment of the concurrence of gout and DM in females. Furthermore, there should be different recommendations in the guidelines for treatment of dyslipidemia in DM patients by sex.