A scoping review finds a growing trend in studies validating multimorbidity patterns and identifies five broad types of validation methods

Journal of Clinical Epidemiology - Tập 165 - Trang 111214 - 2024
Thamer Ba Dhafari1, Alexander Pate1, Narges Azadbakht1, Rowena Bailey2, James Rafferty2, Farideh Jalali-najafabadi3, Glen P. Martin1, Abdelaali Hassaine1, Ashley Akbari2, Jane Lyons2, Alan Watkins2, Ronan A. Lyons2, Niels Peek1,4
1Division of Informatics, Imaging & Data Sciences, School of Health Sciences, The University of Manchester, M13 9PL Manchester, UK
2Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Singleton Park, SA2 8PP Swansea, UK
3Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, M13 9PL Manchester, UK
4NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK

Tài liệu tham khảo

2018 Barnett, 2012, Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study, Lancet, 380, 37, 10.1016/S0140-6736(12)60240-2 Garin, 2016, Global multimorbidity patterns: a cross-sectional, population-based, multi-country study, J Gerontol A Biol Sci Med Sci, 71, 205, 10.1093/gerona/glv128 Whitty, 2020, Map clusters of diseases to tackle multimorbidity, Nature, 579, 494, 10.1038/d41586-020-00837-4 Buja, 2018, Multimorbidity patterns in high-need, high-cost elderly patients, PLoS One, 13, 1, 10.1371/journal.pone.0208875 Hassaine, 2020, Learning multimorbidity patterns from electronic health records using Non-negative Matrix Factorisation, J Biomed Inform, 112, 10.1016/j.jbi.2020.103606 Zhu, 2020, Characteristics, service use and mortality of clusters of multimorbid patients in England: a population-based study, BMC Med, 18, 1, 10.1186/s12916-020-01543-8 Zemedikun, 2018, Patterns of multimorbidity in middle-aged and older adults: an analysis of the UK biobank data, Mayo Clin Proc, 93, 857, 10.1016/j.mayocp.2018.02.012 Ng, 2018, Patterns of multimorbid health conditions: a systematic review of analytical methods and comparison analysis, Int J Epidemiol, 47, 1687, 10.1093/ije/dyy134 Busija, 2019, Do replicable profiles of multimorbidity exist? Systematic review and synthesis, Eur J Epidemiol, 34, 1025, 10.1007/s10654-019-00568-5 Martin, 2020, Toward a framework for the design, implementation, and reporting of methodology scoping reviews, J Clin Epidemiol, 127, 191, 10.1016/j.jclinepi.2020.07.014 Cezard, 2021, Studying trajectories of multimorbidity: a systematic scoping review of longitudinal approaches and evidence, BMJ Open, 11, 10.1136/bmjopen-2020-048485 Johnston, 2019, Defining and measuring multimorbidity: a systematic review of systematic reviews, Eur J Public Health, 29, 182, 10.1093/eurpub/cky098 Clay, 2018, Associations of multimorbid medical conditions and health-related quality of life among older african American men, J Gerontol B Psychol Sci Soc Sci, 73, 258, 10.1093/geronb/gbx090 Kalgotra, 2017, Examining health disparities by gender: a multimorbidity network analysis of electronic medical record, Int J Med Inf, 108, 22, 10.1016/j.ijmedinf.2017.09.014 Teh, 2018, Patterns of multi-morbidity and prediction of hospitalisation and all-cause mortality in advanced age, Age Ageing, 47, 261, 10.1093/ageing/afx184 Nichols, 2022, In simulated data and health records, latent class analysis was the optimum multimorbidity clustering algorithm, J Clin Epidemiol, 152, 164, 10.1016/j.jclinepi.2022.10.011 Akugizibwe, 2020, Multimorbidity patterns and unplanned hospitalisation in a cohort of older adults, J Clin Med, 9, 1, 10.3390/jcm9124001 Álvarez-Gálvez, 2022, Social inequalities in multimorbidity patterns in Europe: a multilevel latent class analysis using the European Social Survey (ESS), SSM Popul Health, 20 Amirzada, 2023, Multimorbidity patterns in the German general population aged 40 years and over, Arch Gerontol Geriatr, 114, 10.1016/j.archger.2023.105067 Aoki, 2018, Multimorbidity patterns in relation to polypharmacy and dosage frequency: a nationwide, cross-sectional study in a Japanese population, Sci Rep, 8, 4, 10.1038/s41598-018-21917-6 Aoki, 2021, Effect of multimorbidity patterns on the decline in health-related quality of life: a nationwide prospective cohort study in Japan, BMJ Open, 11, 10.1136/bmjopen-2020-047812 Bekić, 2021, Clusters of physical frailty and cognitive impairment and their associated comorbidities in older primary care patients, Healthcare (Switzerland), 9 Bendayan, 2021, Multimorbidity patterns and memory trajectories in older adults: evidence from the English longitudinal study of aging, J Gerontol A Biol Sci Med Sci, 76, 867, 10.1093/gerona/glab009 Calvin, 2022, Association of multimorbidity, disease clusters, and modification by genetic factors with risk of dementia, JAMA Netw Open, 5, 10.1001/jamanetworkopen.2022.32124 Carrasco-Ribelles, 2023, Contribution of frailty to multimorbidity patterns and trajectories: longitudinal dynamic cohort study of aging people, JMIR Public Health Surveill, 9, 10.2196/45848 Carretero-Bravo, 2022, Multimorbidity patterns and their association with social determinants, mental and physical health during the COVID-19 pandemic, Int J Environ Res Public Health, 19, 10.3390/ijerph192416839 Chen, 2022, Patterns and determinants of multimorbidity in older adults: study in health-ecological perspective, Int J Environ Res Public Health, 19, 10.3390/ijerph192416756 Corsonello, 2022, Prognostic interplay of functional status and multimorbidity among older patients discharged from hospital, J Am Med Dir Assoc, 23, 499, 10.1016/j.jamda.2021.07.012 Craig, 2021, Social determinants of multimorbidity in Jamaica: application of latent class analysis in a cross-sectional study, BMC Public Health, 21, 10.1186/s12889-021-11225-6 Craig, 2023, Multimorbidity patterns and health-related quality of life in Jamaican adults: a cross sectional study exploring potential pathways, Front Med, 10, 10.3389/fmed.2023.1094280 Damiano, 2022, Frailty, multimorbidity patterns and mortality in institutionalized older adults in Italy, Aging Clin Exp Res, 34, 3123, 10.1007/s40520-022-02269-8 De Carvalho, 2018, Lifestyle factors and high body mass index are associated with different multimorbidity clusters in the Brazilian population, PLoS One, 13, 1, 10.1371/journal.pone.0207649 Eton, 2022, Longitudinal trajectories of treatment burden: a prospective survey study of adults living with multiple chronic conditions in the midwestern United States, J Comorb Multimorb, 12, 10.1177/26335565221081291 Eyowas, 2022, Magnitude, pattern and correlates of multimorbidity among patients attending chronic outpatient medical care in Bahir Dar, northwest Ethiopia: the application of latent class analysis model, PLoS One, 17, 10.1371/journal.pone.0267208 Fan, 2022, Multimorbidity patterns and association with mortality in 0.5 million Chinese adults, Chin Med J (Engl), 135, 648, 10.1097/CM9.0000000000001985 Fehlberg, 2023, Health behaviors and multimorbidity associated with bruxism: population-based study, Oral Dis, 29, 245, 10.1111/odi.13928 Gates, 2018, Multimorbidity patterns and associations with functional limitations among an aging population in prison, Arch Gerontol Geriatr, 77, 115, 10.1016/j.archger.2018.03.012 Grande, 2021, Multimorbidity burden and dementia risk in older adults: the role of inflammation and genetics, Alzheimer's Dementia, 17, 768, 10.1002/alz.12237 Grant, 2020, Use of latent class analysis and k-means clustering to identify complex patient profiles, JAMA Netw Open, 3, 1, 10.1001/jamanetworkopen.2020.29068 Gu, 2018, Multimorbidity and health-related quality of life among the community-dwelling elderly: a longitudinal study, Arch Gerontol Geriatr, 74, 133, 10.1016/j.archger.2017.10.019 Han, 2022, The 10-year multimorbidity trajectory and mortality risk in older people with long-term care needs, Arch Gerontol Geriatr, 103, 10.1016/j.archger.2022.104775 Ho, 2022, Multimorbidity patterns and their relationships with incident disability and frailty among older adults in Taiwan: a 16-year, population-based cohort study, Arch Gerontol Geriatr, 101, 10.1016/j.archger.2022.104688 Ho, 2022, Trends of multimorbidity patterns over 16 Years in older Taiwanese people and their relationship to mortality, Int J Environ Res Public Health, 19, 10.3390/ijerph19063317 Ho, 2023, Association between multimorbidity patterns and incident depression among older adults in Taiwan: the role of social participation, BMC Geriatr, 23, 10.1186/s12877-023-03868-4 Honda, 2022, Multimorbidity patterns and the relation to self-rated health among older Japanese people: a nationwide cross-sectional study, BMJ Open, 12, 10.1136/bmjopen-2022-063729 Hsieh, 2023, Multimorbid patterns and cognitive performance in the presence of informative dropout among community-dwelling Taiwanese older adults, Innov Aging, 7, 10.1093/geroni/igad012 Hu, 2022, A longitudinal analysis of PM2.5 exposure and multimorbidity clusters and accumulation among adults aged 45-85 in China, PLOS Global Public Health, 2, 10.1371/journal.pgph.0000520 Hunter, 2021, Prevalence and patterns of multimorbidity in Australian baby boomers: the Busselton healthy ageing study, BMC Public Health, 21, 1539, 10.1186/s12889-021-11578-y Jacob, 2020, Burden and patterns of multimorbidity: impact on disablement in older adults, Am J Phys Med Rehabil, 99, 359, 10.1097/PHM.0000000000001388 Khondoker, 2023, Multimorbidity pattern and risk of dementia in later life: an 11-year follow-up study using a large community cohort and linked electronic health records, J Epidemiol Community Health, 77, 285, 10.1136/jech-2022-220034 Khorrami, 2020, The patterns of non-communicable disease multimorbidity in Iran: a multilevel analysis, Sci Rep, 10, 1, 10.1038/s41598-020-59668-y Li, 2022, Exploring the relationship between depression and different multimorbidity patterns among older people covered by long-term care insurance in Shanghai, China, Psychogeriatrics, 22, 99, 10.1111/psyg.12783 Liu, 2022, The differential impact of multimorbidity patterns and subsequent accumulation on longitudinal trajectories of physical function decline in a population-based cohort of older people, J Gerontol A Biol Sci Med Sci, 77, 1629, 10.1093/gerona/glab384 Lu, 2021, Multimorbidity patterns in old adults and their associated multi-layered factors: a cross-sectional study, BMC Geriatr, 21, 372, 10.1186/s12877-021-02292-w Luo, 2023, Associations between multimorbidity and frailty transitions among older Americans, J Cachexia Sarcopenia Muscle, 14, 1075, 10.1002/jcsm.13197 de Macedo Stumpf, 2023, Cross-sectional associations between body mass index, waist circumference, and multimorbidity: pró-Saúde study, PeerJ, 11 Marengoni, 2021, Patterns of multimorbidity and risk of disability in community-dwelling older persons, Aging Clin Exp Res, 33, 457, 10.1007/s40520-020-01773-z Marengoni, 2021, Multimorbidity patterns and 6-year risk of institutionalization in older persons: the role of social formal and informal care, J Am Med Dir Assoc, 22, 2184, 10.1016/j.jamda.2020.12.040 Møller, 2020, Patterns of multimorbidity and demographic profile of latent classes in a Danish population-A register-based study, PLoS One, 15, e0237375, 10.1371/journal.pone.0237375 Nguyen, 2019, Multimorbidity patterns, frailty, and survival in community-dwelling older adults, J Gerontol A Biol Sci Med Sci, 74, 1265, 10.1093/gerona/gly205 Nguyen, 2020, Factors associated with multimorbidity patterns in older adults in england: findings from the English longitudinal study of aging (ELSA), J Aging Health, 32, 1120, 10.1177/0898264319891026 Nunes, 2017, Contextual and individual inequalities of multimorbidity in Brazilian adults: a cross-sectional national-based study, BMJ Open, 7, e015885, 10.1136/bmjopen-2017-015885 Park, 2019, Use of latent class analysis to identify multimorbidity patterns and associated factors in Korean adults aged 50 years and older, PLoS One, 14, 1, 10.1371/journal.pone.0216259 Pati, 2022, Emerging multimorbidity patterns and their links with selected health outcomes in a working-age population group, J Prev Med Hyg, 63, E152 Puri, 2022, Identifying non-communicable disease multimorbidity patterns and associated factors: a latent class analysis approach, BMJ Open, 12, e053981, 10.1136/bmjopen-2021-053981 Rodrigues, 2022, Multimorbidity patterns and hospitalisation occurrence in adults and older adults aged 50 years or over, Sci Rep, 12, 11643, 10.1038/s41598-022-15723-4 Ronaldson, 2021, Associations between physical multimorbidity patterns and common mental health disorders in middle-aged adults: a prospective analysis using data from the UK Biobank, Lancet Reg Health Eur, 8 Ronaldson, 2022, Associations between air pollution and multimorbidity in the UK Biobank: a cross-sectional study, Front Public Health, 10, 10.3389/fpubh.2022.1035415 Ronaldson, 2023, Physical multimorbidity, depressive symptoms, and social participation in adults over 50 years of age: findings from the English Longitudinal Study of Ageing, Aging Ment Health, 27, 43, 10.1080/13607863.2021.2017847 Restocchi, 2022, Multimorbidity profiles and stochastic block modeling improve ICU patient clustering, 925 Shang, 2022, Association of a wide range of individual chronic diseases and their multimorbidity with brain volumes in the UK Biobank: A cross-sectional study, EClinicalMedicine, 47, 10.1016/j.eclinm.2022.101413 Shi, 2022, Association between multimorbidity trajectories and incident disability among mid to older age adults: China Health and Retirement Longitudinal Study, BMC Geriatr, 22, 741, 10.1186/s12877-022-03421-9 Sturmer, 2022, Dietary pattern as a predictor of multimorbidity patterns: a population-based cross-sectional study with women, Clin Nutr ESPEN, 51, 452, 10.1016/j.clnesp.2022.06.105 Subedi, 2022, Comorbidity profiles of patients experiencing homelessness: a latent class analysis, PLoS One, 17, e0268841, 10.1371/journal.pone.0268841 Tazzeo, 2021, Multimorbidity patterns and risk of frailty in older community-dwelling adults: a population-based cohort study, Age Ageing, 50, 2183, 10.1093/ageing/afab138 Valletta, 2023, Multimorbidity patterns and 18-year transitions from normal cognition to dementia and death: a population-based study, J Intern Med, 294, 326, 10.1111/joim.13683 Vetrano, 2022, Multimorbidity patterns and 5-year mortality in institutionalized older adults, J Am Med Dir Assoc, 23, 1389, 10.1016/j.jamda.2022.01.067 Wang, 2019, Multilevel analysis of the patterns of physical-mental multimorbidity in general population of são paulo metropolitan area, Brazil, Sci Rep, 9, 2390, 10.1038/s41598-019-39326-8 Wang, 2021, Association between multimorbidity patterns and disability among older people covered by long-term care insurance in Shanghai, China, BMC Public Health, 21, 1 Wang, 2022, The effect of dual sensory impairment and multimorbidity patterns on functional impairment: a longitudinal cohort of middle-aged and older adults in China, Front Aging Neurosci, 14 Wartelle, 2022, Multimorbidity clustering of the emergency department patient flow: impact analysis of new unscheduled care clinics, PLoS One, 17, e0262914, 10.1371/journal.pone.0262914 Yan, 2022, Patterns of multimorbidity in association with falls among the middle-aged and older adults: results from the China Health and Retirement Longitudinal Study, BMC Public Health, 22, 1814, 10.1186/s12889-022-14124-6 Yao, 2020, Prevalence and patterns of multimorbidity in a nationally representative sample of older Chinese: results from the China health and retirement longitudinal study, J Gerontol A Biol Sci Med Sci, 75, 1974, 10.1093/gerona/glz185 Yao, 2020, Associations between multimorbidity and physical performance in older Chinese adults, Int J Environ Res Public Health, 17, 1, 10.3390/ijerph17124546 Yao, 2022, Multimorbidity measures differentially predicted mortality among older Chinese adults, J Clin Epidemiol, 146, 97, 10.1016/j.jclinepi.2022.03.002 Zhai, 2023, Association between multimorbidity patterns and catastrophic health expenditure among Chinese older adults living alone, Arch Gerontol Geriatr, 106, 104892, 10.1016/j.archger.2022.104892 Zhang, 2022, Multimorbidity patterns and associated factors in older Chinese: results from the China health and retirement longitudinal study, BMC Geriatr, 22, 470, 10.1186/s12877-022-03154-9 Zhao, 2023, Association between multimorbidity patterns and healthcare costs among middle-aged and older adults in China, Arch Gerontol Geriatr, 109, 104959, 10.1016/j.archger.2023.104959 Zheng, 2020, Patterns of chronic conditions and their association with visual impairment and health care use, JAMA Ophthalmol, 138, 387, 10.1001/jamaophthalmol.2020.0052 Zheng, 2020, Chronic condition patterns in the US population and their association with health related quality of life, Prev Med, 136, 10.1016/j.ypmed.2020.106102 Diane Zheng, 2021, Multimorbidity patterns and their relationship to mortality in the US older adult population, PLoS One, 16, 1 Zhong, 2022, Gender and socioeconomic differences in the prevalence and patterns of multimorbidity among middle-aged and older adults in China, Int J Environ Res Public Health, 19, 16956, 10.3390/ijerph192416956 Zhong, 2023, Prevalence, patterns of multimorbidity and associations with health care utilization among middle-aged and older people in China, BMC Public Health, 23, 537, 10.1186/s12889-023-15412-5 Zhou, 2022, Association of multimorbidity patterns with incident disability and recovery of independence among middle-aged and older adults, Age Ageing, 51, 177, 10.1093/ageing/afac177 Zou, 2022, Association of multimorbidity of non-communicable diseases with mortality: a 10-year prospective study of 0.5 million Chinese adults, Public Health, 205, 63, 10.1016/j.puhe.2022.01.021 Gonsoulin, 2017, A health profile of senior-aged women veterans: a latent class analysis of condition clusters, Innov Aging, 1, 1, 10.1093/geroni/igx024 Roso-Llorach, 2018, Comparative analysis of methods for identifying multimorbidity patterns: a study of ‘real-world’ data, BMJ Open, 8, 1, 10.1136/bmjopen-2017-018986 Baré, 2021, Multimorbidity patterns of chronic conditions and geriatric syndromes in older patients from the MoPIM multicentre cohort study, BMJ Open, 11, e049334, 10.1136/bmjopen-2021-049334 Prasad, 2022, Data-driven patient stratification of UK Biobank cohort suggests five endotypes of multimorbidity, Brief Bioinform, 23, 10.1093/bib/bbac410 Siah, 2022, Multimorbidity and mortality: a data science perspective, J Comorb Multimorb, 12, 10.1177/26335565221105431 Arshadipour, 2022, Impact of prenatal and childhood adversity effects around World War II on multimorbidity: results from the KORA-Age study, BMC Geriatr, 22, 115, 10.1186/s12877-022-02793-2 Robertson, 2022, Identifying multimorbidity clusters in an unselected population of hospitalised patients, Sci Rep, 12, 5134, 10.1038/s41598-022-08690-3 Guisado-Clavero, 2018, Multimorbidity patterns in the elderly: a prospective cohort study with cluster analysis, BMC Geriatr, 18, 1, 10.1186/s12877-018-0705-7 Machón, 2020, Multimorbidity and functional status in older people: a cluster analysis, Eur Geriatr Med, 11, 321, 10.1007/s41999-020-00291-5 Madlock-Brown, 2021, Increases in multimorbidity with weight class in the United States, Clinical Obesity, 11, 1, 10.1111/cob.12436 Violán, 2018, Multimorbidity patterns with K-means nonhierarchical cluster analysis, BMC Fam Pract, 19, 1, 10.1186/s12875-018-0790-x Alvarez-Galvez, 2022, Discovery and classification of complex multimorbidity patterns: unravelling chronicity networks and their social profiles, Sci Rep, 12, 20004, 10.1038/s41598-022-23617-8 Marengoni, 2021, Multimorbidity patterns and 6-year risk of institutionalization in older persons: the role of social formal and informal care, J Am Med Dir Assoc, 22, 2184, 10.1016/j.jamda.2020.12.040 Vetrano, 2020, Twelve-year clinical trajectories of multimorbidity in a population of older adults, Nat Commun, 11, 3223, 10.1038/s41467-020-16780-x Menditto, 2019, Patterns of multimorbidity and polypharmacy in young and adult population: systematic associations among chronic diseases and drugs using factor analysis, PLoS One, 14, 1, 10.1371/journal.pone.0210701 Violán, 2020, Five-year trajectories of multimorbidity patterns in an elderly Mediterranean population using Hidden Markov Models, Sci Rep, 10, 10.1038/s41598-020-73231-9 Ioakeim-Skoufa, 2022, Multimorbidity clusters in the oldest old: results from the EpiChron cohort, Int J Environ Res Public Health, 19, 10180, 10.3390/ijerph191610180 Martínez-Velilla, 2022, Specific multimorbidity patterns modify the impact of an exercise intervention in older hospitalized adults, J Comorb Multimorb, 12, 10.1177/26335565221145461 Roso-Llorach, 2022 Díaz-Santiago, 2020, Phenotype-genotype comorbidity analysis of patients with rare disorders provides insight into their pathological and molecular bases, PLoS Genet, 16, 10.1371/journal.pgen.1009054 Olaya, 2017, Latent class analysis of multimorbidity patterns and associated outcomes in Spanish older adults: a prospective cohort study, BMC Geriatr, 17, 1, 10.1186/s12877-017-0586-1 Shi, 2021, Development of multimorbidity over time: an analysis of Belgium primary care data using Markov chains and weighted association rule mining, J Gerontol A Biol Sci Med Sci, 76, 1234, 10.1093/gerona/glaa278 Violán, 2019, Soft clustering using real-world data for the identification of multimorbidity patterns in an elderly population: cross-sectional study in a Mediterranean population, BMJ Open, 9, 1, 10.1136/bmjopen-2019-029594 Stafford, 2021, Combined multimorbidity and polypharmacy patterns in the elderly: a cross-sectional study in primary health care, Int J Environ Res Public Health, 18, 10.3390/ijerph18179216 Craig, 2020, Prevalence and patterns of multimorbidity in the Jamaican population: a comparative analysis of latent variable models, PLoS One, 15, 1, 10.1371/journal.pone.0236034 Fränti, 2022, Clustering diagnoses from 58 million patient visits in Finland between 2015 and 2018, JMIR Med Inform, 10, e35422, 10.2196/35422 Monchka, 2022, The effect of disease co-occurrence measurement on multimorbidity networks: a population-based study, BMC Med Res Methodol, 22, 165, 10.1186/s12874-022-01607-8 Guo, 2019, Analysis of disease comorbidity patterns in a large-scale China population, BMC Med Genom, 12, 177, 10.1186/s12920-019-0629-x Giannoula, 2021, A system-level analysis of patient disease trajectories based on clinical, phenotypic and molecular similarities, Bioinformatics, 37, 1435, 10.1093/bioinformatics/btaa964 Lin, 1991, Divergence measures based on the Shannon entropy, IEEE Trans Inf Theor, 37, 145, 10.1109/18.61115 Altman, 1990 Hennig, 2007, Cluster-wise assessment of cluster stability, Comput Stat Data Anal, 52, 258, 10.1016/j.csda.2006.11.025 Jensen, 2014, Temporal disease trajectories condensed from population-wide registry data covering 6.2 million patients, Nat Commun, 5, 10.1038/ncomms5022 Beam, 2019, Clinical concept embeddings learned from massive sources of multimodal medical data, 2020, 295 Su, 2021, Clinical subphenotypes in COVID-19: derivation, validation, prediction, temporal patterns, and interaction with social determinants of health, NPJ Digit Med, 4, 110, 10.1038/s41746-021-00481-w Rodríguez, 2021, Deploying unsupervised clustering analysis to derive clinical phenotypes and risk factors associated with mortality risk in 2022 critically ill patients with COVID-19 in Spain, Crit Care, 25, 63, 10.1186/s13054-021-03487-8 Horne, 2020, Challenges of clustering multimodal clinical data: review of applications in asthma subtyping, JMIR Med Inform, 8, 10.2196/16452 Liu, 2022, Multimorbidity patterns and the disablement process among public long-term care insurance claimants in the city of yiwu (zhejiang province, China), Int J Environ Res Public Health, 19, 645, 10.3390/ijerph19020645 Friedman, 2006