Exploring the co-occurrence patterns of multiple chronic diseases in the U.S. adult population using association rule discovery

There is an increasing prevalence of adults with multiple chronic conditions and the effective management of these conditions is complicated by the presence of significant comorbidities. The primary objective of this study was to explore the association patterns of multiple chronic conditions among U.S. adults and to examine to what extent these patterns vary by demographic characteristics and other risk factors.

We analyzed data from the nationally representative 2010 National Health Interview Survey (NHIS) using association rule mining. Based on the criteria of multiple chronic conditions used by CDC (Centers for Disease Control and Prevention), we selected nine chronic conditions including hypertension, heart disease, and diabetes using the responses of relevant survey items (e.g., Have you ever been told by a doctor or other health professional that you had hypertension?). We first applied association rule mining on these nine conditions to describe the overall prevalence and co-occurrence patterns of the conditions. We also compared each condition by limiting the number of the conditions that must appear on the antecedent part and the consequent part of the rules. To further explore how co-occurrence patterns are influenced by demographic and other characteristics, we examined several factors including age, gender, race, ethnicity, income, education, insurance, health status, residential area. We performed association analysis inside each of subgroups of the population by these factors and examine the differences in frequent association patterns using their support and confidence measures. Additionally, national estimates of corresponding subpopulations were derived using these association rules. The results of this study identified useful co-occurrence patterns of the chronic conditions and distinct subpopulations that were shaped by demographic and other risk factors. Developing a comprehensive understanding of these findings would help plan and implement successful public health programs and policies that are more responsive to the needs of U.S. adults.