浙江大学学报（医学版）2025，Vol.54Issue(4)：423-433,11.DOI:10.3724/zdxbyxb-2025-0054
不同年龄住院患者的共病模式及其费用单中心实证分析
Multimorbidity patterns and associated hospitalization costs among different age groups of patients in a single medical center
摘要
Abstract
Objective:To analyze the multimorbidity patterns and core diseases among hospitalized patients in different age groups and to explore the impacts of multimorbidity patterns on hospitalization costs.Methods:Electronic medical records of adult inpatients(aged ≥18 years)from Ningbo Medical Center Lihuili Hospital between January 1,2018,and June 30,2023 were collected.The multimorbidity status involving 53 specific diseases was analyzed across different age groups.Association rule mining was used to identify common multimorbidity patterns.Complex network analysis was used to identify core diseases within the multimorbidity networks.Generalized estimating equations(GEE)were used to analyze the impact of different multimorbidity patterns on hospitalization costs.Results:The prevalence of multimorbidity among the 359 402 adult inpatients was 38.51％,with higher rates observed in males(43.60％)and elderly patients(58.29％).Association rule mining identified 15 common multimorbidity patterns,which exhibited differences across age groups.The most prevalent multimorbidity pattern overall was"diabetes→hypertension"(support=7.04％,confidence=62.17％,lift=2.17).In the young adult group,the most prevalent pattern was"dyslipidemia→chronic liver disease"(support=1.19％,confidence=53.17％,lift=6.04).In the middle-aged group,it was"diabetes→hypertension"(support=4.84％,confidence=50.28％,lift=2.15).In the elderly group,it was"coronary heart disease,diabetes→hypertension"(support=2.38％,confidence=77.43％,lift=1.63).Complex network analysis revealed that the core diseases within multimorbidity networks differed across age groups.The core disease identified in the young adult group was chronic liver disease(degree centrality=50,betweenness centrality=0.055,closeness centrality=0.963).Core diseases in the middle-aged group included hypertension,chronic liver disease,and diabetes(all with degree centrality=52,betweenness centrality=0.022,closeness centrality=1.000).Core diseases in the elderly group comprised hypertension,diabetes,malignant tumors,chronic liver disease,thyroid disease,anemia,and arrhythmia(all with degree centrality=52,betweenness centrality=0.009,closeness centrality=1.000).Generalized estimating equations analysis indicated that,most multimorbidity patterns were significantly associated with increased hospitalization costs.However,the magnitude of cost increase varied across different multimorbidity patterns.Specifically,hospitalization costs for patients with patterns such as"heart failure→hypertension","stroke→hypertension","malignant tumor,diabetes→hypertension","stroke,diabetes→hypertension",and"diabetes,heart failure→hypertension"were more than double those of patients without any target diseases.Conclusions:Multimorbidity patterns and core diseases among hospitalized patients differ significantly across age groups,and different patterns exert varying impacts on hospitalization costs.These findings underscore the necessity for age-stratified and multimorbidity pattern specific management strategies.关键词
共病/住院费用/住院患者/关联规则/复杂网络分析/广义估计方程/单中心研究Key words
Multimorbidity/Hospitalization costs/Inpatients/Association rules/Complex network analysis/Generalized estimating equations/Single-center study分类
医药卫生引用本文复制引用
李涛,徐小林,程杨杨,林开..不同年龄住院患者的共病模式及其费用单中心实证分析[J].浙江大学学报（医学版）,2025,54(4):423-433,11.基金项目
国家自然科学基金(72474197) The study was supported by National Natural Science Foundation of China(72474197) （72474197）
