Identifying multimorbidity patterns of non-communicable diseases in paediatric inpatients: a cross-sectional study in Shanghai, China

Abstract

ObjectivesTo enhance the understanding of non-communicable disease (NCD) multimorbidity in children who are inpatients by delineating the characteristics of and identifying patterns among paediatric inpatients with multimorbidity in China.DesignCross-sectional study.SettingPaediatric wards (n=17) in Pudong New Area, Shanghai, China.ParticipantsA total of 193 432 paediatric inpatients in the electronic health record systems of 17 hospitals from 2011 to 2016 participated in the study, and 91 004 children with NCDs were extracted and classified based on International Classification of Diseases, 10th version codes.Main outcome measuresNumber of the NCDs and multimorbidity patterns of the paediatric inpatients.ResultsIn total, 47.05% (95% CI 46.83 to 47.27) of the paediatric inpatients had one or more chronic diseases, and 16.30% (95% CI 16.14 to 16.46) had multimorbidity. Congenital anomalies accounted for 19.43% (95% CI 19.25 to 19.61) of the principal diagnoses among the paediatric inpatients. Five common multimorbidity patterns were identified: a neurological-respiratory cluster, a neurological-respiratory-ear cluster, a cardiovascular-circulatory cluster, a genitourinary cluster (boy group) and a musculoskeletal-connective cluster (10–18 years age group).ConclusionsMultimorbidity in paediatric inpatients suggests that decisions about reasonable allocation of paediatric inpatient resources should be fully considered. Multimorbidity patterns in paediatric inpatients revealed that prevention, including innovative treatments targeting children, should be further studied.

Social determinants of multimorbidity patterns: A systematic review

“…A broad set studies detected a stronger association of mental and musculoskeletal multimorbidity with female sex, including neurological diseases ( 64 , 130 ), musculoskeletal and osteoarticular ( 42 , 64 , 67 , 71 , 93 , 102 , 126 , 130 , 131 ); and common mental disorders ( 42 , 132 ), like anxiety ( 44 , 67 , 86 , 93 , 114 ) depression ( 43 , 67 , 86 , 93 , 114 , 119 ), dementia ( 85 ) and emotional disorders ( 47 ). While cardiometabolic patterns ( 53 , 71 , 73 , 78 , 82 , 90 , 94 , 114 , 123 ), musculoskeletal ( 53 , 96 ), digestive and genitourinary patterns ( 99 , 110 , 124 , 131 ) were more frequent in men. As expected, a positive association between multimorbidity and age was found ( 67 , 74 , 105 , 110 , 132 , 133 ).…”

“…From a sociodemographic point of view, our study reveals important differences in the multimorbidity patterns of men and women, which, according to the results described, seem to be linked to avoidable social inequalities that can be linked to the social and economic conditions of these groups. Thus, while musculoskeletal ( 42 , 64 , 67 , 71 , 93 , 102 , 126 , 130 , 131 ) and mental patterns ( 43 , 67 , 86 , 93 , 114 , 119 ) are more typical of women, cardiovascular patterns are more prevalent in men ( 24 , 53 , 71 , 73 , 78 , 82 , 90 , 94 , 123 ), which leads us to believe that behind these results there are also important differences in the individual behaviors and lifestyles of these groups (e.g., considering the differences among married and individuals living alone) ( 55 , 60 , 66 , 70 , 72 , 78 , 97 ). Likewise, in the case of age, the present results show that multimorbidity is not only a matter of older people (although it is more visible in these age groups) ( 89 , 104 , 105 , 137 ) since certain types of multimorbidity are also observed in young and middle age people, such as mental and allergy multimorbidity patterns ( 42 , 95 ).…”