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Original article Multimorbidity patterns by health-related quality of life status in older adults: An association rules and network analysis utilizing Korean National Health and Nutrition Examination Survey
Thi-Ngoc Tran1orcid , Sanghee Lee1orcid , Chang-Mo Oh2orcid , Hyunsoon Cho3,4orcid
Epidemiol Health 2022;e2022113
DOI: https://doi.org/10.4178/epih.e2022113 [Accepted]
Published online: November 29, 2022
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1Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea
2Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
3Department of Cancer AI and Digital Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea
4Integrated Biostatistics Branch, Division of Cancer Data Science, Research Institute, National Cancer Center, Goyang, Republic of Korea
Corresponding author:  Hyunsoon Cho,
Email: hscho@ncc.re.kr
Received: 19 July 2022   • Revised: 28 November 2022   • Accepted: 29 November 2022

Objectives
Improved life expectancy has increased the prevalence of older adults living with multimorbidity, which likely deteriorates their health-related quality of life (HRQoL). However, less is known about patterns and the relationships of multimorbidity by HRQoL status in older adults.
Methods
Individuals aged 65 or older from the Korean National Health and Nutrition Examination Survey V-VII (2010-2018) were analyzed. HRQoL was assessed by the EQ-5D questionnaire and categorized into three groups: poor, normal, and good. The impact of multimorbidity on HRQoL was evaluated using logistic regression. The patterns and inter-relationships between multimorbidities, stratified by the HRQoL groups, were analyzed using the association rule and network analysis approach.
Results
Multimorbidity status was significantly associated with poor HRQoL (3 or more diseases vs. none: aOR = 2.70, 95% CI, 2.10–3.46). Hypertension, arthritis, hyperlipidemia, and diabetes were the most prevalent diseases across all HRQoL groups. The complex interrelationships of morbidities, higher prevalence, and node strengths in all diseases were observed in the poor HRQoL group, particularly arthritis, depression, and stroke, compared to other groups (1.5~3 times higher, all p-values <.05). Apart from hypertension, arthritis and hyperlipidemia had a higher prevalence and stronger connections with other diseases in women, whereas diabetes and stroke in men with poor HRQoL.
Conclusions
Our study revealed that multimorbidity patterns were complicatedly inter-correlated disease networks in the poor HRQoL group and diversed by sex. These findings enhance the understanding of multimorbidity connections and help inform health care needs for older adults, especially those with poor HRQoL.


Epidemiol Health : Epidemiology and Health