{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T07:16:16Z","timestamp":1775805376330,"version":"3.50.1"},"reference-count":64,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2024,12,19]],"date-time":"2024-12-19T00:00:00Z","timestamp":1734566400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100004423","name":"World Health Organization","doi-asserted-by":"publisher","award":["grants 2021\/1189041, 2022\/1249357"],"award-info":[{"award-number":["grants 2021\/1189041, 2022\/1249357"]}],"id":[{"id":"10.13039\/100004423","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100018939","name":"World Diabetes Foundation","doi-asserted-by":"publisher","award":["grant WDF15-1224"],"award-info":[{"award-number":["grant WDF15-1224"]}],"id":[{"id":"10.13039\/501100018939","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome","doi-asserted-by":"publisher","award":["074833\/Z\/04\/Z, 093541\/Z\/10\/Z, 103994\/Z\/14\/Z, 107435\/Z\/15\/Z, 205177\/Z\/16\/Z, 214185\/Z\/18\/Z, 218743\/Z\/19\/Z"],"award-info":[{"award-number":["074833\/Z\/04\/Z, 093541\/Z\/10\/Z, 103994\/Z\/14\/Z, 107435\/Z\/15\/Z, 205177\/Z\/16\/Z, 214185\/Z\/18\/Z, 218743\/Z\/19\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"name":"UKRI MRC","award":["grants MR\/P008984\/1, MR\/P024408\/1, MR\/P02386X\/1, MR\/X004163\/1, MR\/X020851\/1"],"award-info":[{"award-number":["grants MR\/P008984\/1, MR\/P024408\/1, MR\/P02386X\/1, MR\/X004163\/1, MR\/X020851\/1"]}]},{"name":"UKRI EPSRC","award":["grant EP\/V043102\/1"],"award-info":[{"award-number":["grant EP\/V043102\/1"]}]},{"name":"UKRI BBSRC","award":["grant BB\/T009004\/1"],"award-info":[{"award-number":["grant BB\/T009004\/1"]}]},{"DOI":"10.13039\/501100001711","name":"Swiss National Science Foundation","doi-asserted-by":"publisher","award":["grant 40P740-160366"],"award-info":[{"award-number":["grant 40P740-160366"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"publisher"}]},{"name":"NSW Health, Cardiovascular Elite Postdoctoral Researcher Grants","award":["grant H23\/37663"],"award-info":[{"award-number":["grant H23\/37663"]}]},{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["grant 1U19MH098780"],"award-info":[{"award-number":["grant 1U19MH098780"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["grant K23DK135798"],"award-info":[{"award-number":["grant K23DK135798"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung and Blood Institute","doi-asserted-by":"crossref","award":["grants HHSN268200900033C, 5U01HL114180, 1UM1HL134590"],"award-info":[{"award-number":["grants HHSN268200900033C, 5U01HL114180, 1UM1HL134590"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["grant 2022566"],"award-info":[{"award-number":["grant 2022566"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003593","name":"National Council for Scientific and Technological Development","doi-asserted-by":"publisher","award":["CNPq Brasil, grant 408523\/2023-9"],"award-info":[{"award-number":["CNPq Brasil, grant 408523\/2023-9"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["grant 1P20CA217231"],"award-info":[{"award-number":["grant 1P20CA217231"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011110","name":"Inter-American Institute for Global Change Research","doi-asserted-by":"publisher","award":["grant CRN3036"],"award-info":[{"award-number":["grant CRN3036"]}],"id":[{"id":"10.13039\/501100011110","id-type":"DOI","asserted-by":"publisher"}]},{"name":"International Development Research Center Canada","award":["grant 106887, 108167"],"award-info":[{"award-number":["grant 106887, 108167"]}]},{"DOI":"10.13039\/501100004828","name":"Grand Challenges Canada","doi-asserted-by":"publisher","award":["grant GMH-POC-0335-04"],"award-info":[{"award-number":["grant GMH-POC-0335-04"]}],"id":[{"id":"10.13039\/501100004828","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","award":["grants R21TW009982, D71TW010877, R21TW011740, K01TW011478"],"award-info":[{"award-number":["grants R21TW009982, D71TW010877, R21TW011740, K01TW011478"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]},{"name":"DFID\/MRC\/Wellcome Global Health Trials","award":["grant MR\/M007405\/1"],"award-info":[{"award-number":["grant MR\/M007405\/1"]}]},{"name":"FONDECYT via CIENCIACTIVA\/CONCYTEC, British Council, British Embassy and the Newton-Paulet Fund","award":["grants 223-2018, 224-2018"],"award-info":[{"award-number":["grants 223-2018, 224-2018"]}]},{"DOI":"10.13039\/100015283","name":"Bloomberg Philanthropies","doi-asserted-by":"publisher","award":["46129"],"award-info":[{"award-number":["46129"]}],"id":[{"id":"10.13039\/100015283","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007855","name":"Alliance for Health Policy and Systems Research","doi-asserted-by":"publisher","award":["grants 2009\/32034, 2012\/253750"],"award-info":[{"award-number":["grants 2009\/32034, 2012\/253750"]}],"id":[{"id":"10.13039\/100007855","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Institute for Health and Care Research (NIHR), Three Schools Mental Health Programme","award":["MHF012"],"award-info":[{"award-number":["MHF012"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Multimorbidity data typically are analyzed by tallying disease counts, an approach that overlooks nuanced relationships among conditions. We identified clusters of multimorbidity and subpopulations with varying risks and examined their association with all-cause mortality using a data-driven approach. We analyzed 8-year follow-up data of people aged 35\u00a0years or older who were part of the CRONICAS Cohort Study, a multisite cohort from Peru. First, we used Partitioning Around Medoids and multidimensional scaling to identify multimorbidity clusters. We then estimated the association between multimorbidity clusters and all-cause mortality. Second, we identified subpopulations using finite mixture modeling. Our analysis revealed three clusters of chronic conditions: respiratory (cluster 1: bronchitis, chronic obstructive pulmonary disease, and asthma); lifestyle, hypertension, depression, and diabetes (cluster 2); and circulatory (cluster 3: heart disease, stroke, and peripheral artery disease). Although only the cluster comprising circulatory diseases showed a significant association with all-cause mortality in the overall population, we identified two latent subpopulations (named I and II) exhibiting differential mortality risks associated with specific multimorbidity clusters. These findings underscore the importance of considering multimorbidity clusters and sociodemographic characteristics in understanding mortality risks. They also highlight the need for tailored interventions to address the unique needs of different subpopulations living with multimorbidity to reduce mortality risks effectively.<\/jats:p>","DOI":"10.1093\/aje\/kwae466","type":"journal-article","created":{"date-parts":[[2024,12,17]],"date-time":"2024-12-17T23:28:03Z","timestamp":1734478083000},"page":"901-911","source":"Crossref","is-referenced-by-count":1,"title":["Multimorbidity patterns, sociodemographic characteristics, and mortality: Data science insights from low-resource settings"],"prefix":"10.1093","volume":"195","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6169-8049","authenticated-orcid":false,"given":"Juan Carlos","family":"Bazo-Alvarez","sequence":"first","affiliation":[{"name":"CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia , Miraflores, Lima 15074,","place":["Peru"]},{"name":"Research Department of Primary Care and Population Health, University College London , London WC1E 6BT ,","place":["United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8609-0312","authenticated-orcid":false,"given":"Darwin","family":"Del Castillo","sequence":"additional","affiliation":[{"name":"CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia , Miraflores, Lima 15074,","place":["Peru"]},{"name":"Department of Global Health, University of Washington , Seattle, WA 98105 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6384-6957","authenticated-orcid":false,"given":"Luis","family":"Piza","sequence":"additional","affiliation":[{"name":"CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia , Miraflores, Lima 15074,","place":["Peru"]},{"name":"Facultad de Medicina \u201cAlberto Hurtado,\u201d Universidad Peruana Cayetano Heredia , San Mart\u00edn de Porres, Lima 15102 ,","place":["Peru"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6834-1376","authenticated-orcid":false,"given":"Antonio","family":"Bernab\u00e9-Ortiz","sequence":"additional","affiliation":[{"name":"CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia , Miraflores, Lima 15074,","place":["Peru"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2090-1856","authenticated-orcid":false,"given":"Rodrigo M","family":"Carrillo-Larco","sequence":"additional","affiliation":[{"name":"CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia , Miraflores, Lima 15074,","place":["Peru"]},{"name":"Hubert Department of Global Health, Rollins School of Public Health, Emory University , Atlanta, GA 30322 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9168-6022","authenticated-orcid":false,"given":"Liam","family":"Smeeth","sequence":"additional","affiliation":[{"name":"Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine , London WC1E 7HT,","place":["United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3704-9217","authenticated-orcid":false,"given":"Robert H","family":"Gilman","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD 21205 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1106-8812","authenticated-orcid":false,"given":"William","family":"Checkley","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine , Baltimore, MD 21205,","place":["United States"]},{"name":"Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University , Baltimore, MD 21205,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4738-5468","authenticated-orcid":false,"given":"J Jaime","family":"Miranda","sequence":"additional","affiliation":[{"name":"CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia , Miraflores, Lima 15074,","place":["Peru"]},{"name":"Facultad de Medicina \u201cAlberto Hurtado,\u201d Universidad Peruana Cayetano Heredia , San Mart\u00edn de Porres, Lima 15102 ,","place":["Peru"]},{"name":"Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine , London WC1E 7HT,","place":["United Kingdom"]},{"name":"Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney , Camperdown , NSW 2006,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,12,19]]},"reference":[{"issue":"1","key":"2026041002362593600_ref1","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1038\/s41572-022-00376-4","article-title":"Multimorbidity","volume":"8","author":"Skou","year":"2022","journal-title":"Nat Rev Dis Primers"},{"key":"2026041002362593600_ref2","doi-asserted-by":"publisher","first-page":"26335565221106070","DOI":"10.1177\/26335565221106074","article-title":"Multimorbidity matters in low and middle-income countries","volume":"12","author":"Basto-Abreu","year":"2022","journal-title":"J Multimorb Comorb"},{"issue":"1","key":"2026041002362593600_ref3","doi-asserted-by":"publisher","first-page":"45","DOI":"10.5334\/gh.835","article-title":"Multimorbidity: not just for the West","volume":"15","author":"Banerjee","year":"2020","journal-title":"Glob Heart"},{"key":"2026041002362593600_ref4","volume-title":"Multimorbidity: a priority for global health research","author":"Academy of Medical Sciences","year":"2018"},{"issue":"8","key":"2026041002362593600_ref5","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0238091","article-title":"Multimorbidity, polypharmacy, and COVID-19 infection within the UK Biobank cohort","volume":"15","author":"McQueenie","year":"2020","journal-title":"PLoS One"},{"issue":"7821","key":"2026041002362593600_ref6","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1038\/s41586-020-2521-4","article-title":"Factors associated with COVID-19-related death using OpenSAFELY","volume":"584","author":"Williamson","year":"2020","journal-title":"Nature"},{"key":"2026041002362593600_ref7","doi-asserted-by":"publisher","DOI":"10.1016\/j.amsu.2021.102204","article-title":"Global prevalence and determinants of mortality among patients with COVID-19: A systematic review and meta-analysis","volume":"64","author":"Abate","year":"2021","journal-title":"Ann Med Surg (Lond)"},{"key":"2026041002362593600_ref8","doi-asserted-by":"publisher","first-page":"2235042X2096191","DOI":"10.1177\/2235042X20961919","article-title":"Multimorbidity of chronic non-communicable diseases in low- and middle-income countries: a scoping review","volume":"10","author":"Abebe","year":"2020","journal-title":"J Comorb"},{"issue":"12","key":"2026041002362593600_ref9","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0295958","article-title":"Latent class analyses of multimorbidity and all-cause mortality: a prospective study in Chilean adults","volume":"18","author":"Nazar","year":"2023","journal-title":"PLoS One"},{"key":"2026041002362593600_ref10","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1016\/j.archger.2016.07.008","article-title":"Multimorbidity and mortality in older adults: a systematic review and meta-analysis","volume":"67","author":"Nunes","year":"2016","journal-title":"Arch Gerontol Geriatr"},{"issue":"1","key":"2026041002362593600_ref11","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1186\/s12916-015-0402-8","article-title":"The impact of multimorbidity on adult physical and mental health in low- and middle-income countries: what does the Study on Global Ageing and Adult Health (SAGE) reveal?","volume":"13","author":"Arokiasamy","year":"2015","journal-title":"BMC Med"},{"issue":"7800","key":"2026041002362593600_ref12","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1038\/d41586-020-00837-4","article-title":"Map clusters of diseases to tackle multimorbidity","volume":"579","author":"Whitty","year":"2020","journal-title":"Nature"},{"issue":"1","key":"2026041002362593600_ref13","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-049133","article-title":"Multimorbidity of non-communicable diseases in low-income and middle-income countries: a systematic review and meta-analysis","volume":"12","author":"Asogwa","year":"2022","journal-title":"BMJ Open"},{"issue":"1","key":"2026041002362593600_ref14","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1186\/s12879-015-0750-1","article-title":"Patterns of HIV, TB, and non-communicable disease multi-morbidity in peri-urban South Africa- a cross sectional study","volume":"15","author":"Oni","year":"2015","journal-title":"BMC Infect Dis"},{"issue":"6","key":"2026041002362593600_ref15","doi-asserted-by":"publisher","first-page":"716","DOI":"10.1159\/000529406","article-title":"Multimorbidity patterns in older adults: the role of social variables and lifestyle behaviors","volume":"69","author":"Caballero","year":"2023","journal-title":"Gerontology"},{"key":"2026041002362593600_ref16","doi-asserted-by":"publisher","first-page":"1081518","DOI":"10.3389\/fpubh.2023.1081518","article-title":"Social determinants of multimorbidity patterns: a systematic review","volume":"11","author":"\u00c1lvarez-G\u00e1lvez","year":"2023","journal-title":"Front Public Health"},{"key":"2026041002362593600_ref17","doi-asserted-by":"publisher","first-page":"26335565231223350","DOI":"10.1177\/26335565231223350","article-title":"Patterns of multimorbidity in primary care electronic health records: a systematic review","volume":"14","author":"Beridze","year":"2024","journal-title":"J Multimorb Comorb"},{"issue":"9836","key":"2026041002362593600_ref18","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/S0140-6736(12)60240-2","article-title":"Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study","volume":"380","author":"Barnett","year":"2012","journal-title":"Lancet"},{"issue":"10258","key":"2026041002362593600_ref19","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.1016\/S0140-6736(20)30925-9","article-title":"Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u20132019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"396","author":"Vos","year":"2020","journal-title":"Lancet"},{"key":"2026041002362593600_ref20","doi-asserted-by":"publisher","first-page":"2235042X19875297","DOI":"10.1177\/2235042X19875297","article-title":"Multimorbidity at sea level and high-altitude urban and rural settings: the CRONICAS Cohort Study","volume":"9","author":"Miranda","year":"2019","journal-title":"J Comorb"},{"issue":"2","key":"2026041002362593600_ref21","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1111\/1753-6405.12762","article-title":"Socioeconomic status and multimorbidity: a systematic review and meta-analysis","volume":"42","author":"Pathirana","year":"2018","journal-title":"Aust N Z J Public Health"},{"issue":"1","key":"2026041002362593600_ref22","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2011-000610","article-title":"Addressing geographical variation in the progression of non-communicable diseases in Peru: the CRONICAS cohort study protocol","volume":"2","author":"Miranda","year":"2012","journal-title":"BMJ Open"},{"issue":"19","key":"2026041002362593600_ref23","doi-asserted-by":"publisher","first-page":"2486","DOI":"10.1001\/jama.285.19.2486","article-title":"Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)","volume":"285","author":"National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)","year":"2001","journal-title":"JAMA"},{"issue":"1","key":"2026041002362593600_ref24","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/j.gheart.2015.12.005","article-title":"The relationship between socioeconomic status and CV risk factors: the CRONICAS Cohort Study of Peruvian Adults","volume":"11","author":"Quispe","year":"2016","journal-title":"Glob Heart"},{"issue":"3","key":"2026041002362593600_ref25","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1002\/(SICI)1099-1255(199705)12:3&lt;313::AID-JAE440&gt;3.0.CO;2-G","article-title":"Demand for medical care by the elderly: a finite mixture approach","volume":"12","author":"Deb","year":"1997","journal-title":"J Appl Economet"},{"key":"2026041002362593600_ref26","volume-title":"FMM: Stata module to estimate finite mixture models","author":"Deb","year":"2012"},{"issue":"4","key":"2026041002362593600_ref27","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1007\/s10852-005-9022-1","article-title":"Clustering rules: a comparison of partitioning and hierarchical clustering algorithms","volume":"5","author":"Reynolds","year":"2006","journal-title":"J Math Model Algorithms"},{"key":"2026041002362593600_ref28","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1007\/978-3-030-32047-8_16","volume-title":"Similarity Search and Applications","author":"Schubert","year":"2019"},{"key":"2026041002362593600_ref29","doi-asserted-by":"publisher","DOI":"10.1016\/j.is.2021.101804","article-title":"Fast and eager k-Medoids clustering: O(k) runtime improvement of the PAM, CLARA, and CLARANS algorithms","author":"Schubert","year":"2021"},{"key":"2026041002362593600_ref30","doi-asserted-by":"crossref","DOI":"10.1201\/9780367801700","volume-title":"Multidimensional Scaling","author":"Cox","year":"2000"},{"issue":"1","key":"2026041002362593600_ref31","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1146\/annurev-statistics-031017-100325","article-title":"Finite mixture models","volume":"6","author":"McLachlan","year":"2019","journal-title":"Annu Rev Stat Appl"},{"issue":"5","key":"2026041002362593600_ref32","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1093\/fampra\/cmr018","article-title":"Multimorbidity, service organization and clinical decision making in primary care: a qualitative study","volume":"28","author":"Bower","year":"2011","journal-title":"Fam Pract"},{"issue":"576","key":"2026041002362593600_ref33","doi-asserted-by":"publisher","first-page":"285","DOI":"10.3399\/bjgp10X514756","article-title":"GPs' and pharmacists' experiences of managing multimorbidity: a 'Pandora's box","volume":"60","author":"Smith","year":"2010","journal-title":"Br J Gen Pract"},{"issue":"10134","key":"2026041002362593600_ref34","doi-asserted-by":"publisher","first-page":"2047","DOI":"10.1016\/S0140-6736(18)30323-4","article-title":"Action to address the household economic burden of non-communicable diseases","volume":"391","author":"Jan","year":"2018","journal-title":"Lancet"},{"issue":"6","key":"2026041002362593600_ref35","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2020-002820","article-title":"Report of the WHO independent high-level commission on NCDs: where is the focus on addressing inequalities?","volume":"5","author":"Perone","year":"2020","journal-title":"BMJ Glob Health"},{"key":"2026041002362593600_ref36","doi-asserted-by":"publisher","DOI":"10.26633\/RPSP.2019.8","article-title":"Primary care and multimorbidity in six Latin American and Caribbean countries","volume":"43","author":"Macinko","journal-title":"Rev Panam Salud Publica"},{"issue":"5","key":"2026041002362593600_ref37","doi-asserted-by":"publisher","first-page":"1687","DOI":"10.1093\/ije\/dyy134","article-title":"Patterns of multimorbid health conditions: a systematic review of analytical methods and comparison analysis","volume":"47","author":"Ng","year":"2018","journal-title":"Int J Epidemiol"},{"issue":"8","key":"2026041002362593600_ref38","doi-asserted-by":"publisher","first-page":"e587","DOI":"10.1016\/S2468-2667(21)00107-9","article-title":"Examining variation in the measurement of multimorbidity in research: a systematic review of 566 studies","volume":"6","author":"Ho","year":"2021","journal-title":"Lancet Public Health"},{"key":"2026041002362593600_ref39","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m160","article-title":"Measuring multimorbidity beyond counting diseases: systematic review of community and population studies and guide to index choice","volume":"368:m160","author":"Stirland","year":"2020","journal-title":"BMJ"},{"key":"2026041002362593600_ref40","doi-asserted-by":"publisher","first-page":"2235042X19870934","DOI":"10.1177\/2235042X19870934","article-title":"Prevalence of multimorbidity in community settings: a systematic review and meta-analysis of observational studies","volume":"9","author":"Nguyen","year":"2019","journal-title":"J Comorb"},{"issue":"1","key":"2026041002362593600_ref41","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1093\/eurpub\/cky098","article-title":"Defining and measuring multimorbidity: a systematic review of systematic reviews","volume":"29","author":"Johnston","year":"2019","journal-title":"Eur J Public Health"},{"issue":"2","key":"2026041002362593600_ref42","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1093\/fampra\/cms060","article-title":"Comparing measures of multimorbidity to predict outcomes in primary care: a cross sectional study","volume":"30","author":"Brilleman","year":"2013","journal-title":"Fam Pract"},{"issue":"8","key":"2026041002362593600_ref43","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-046749","article-title":"Complex multimorbidity and mortality in Japan: a prospective propensity-matched cohort study","volume":"11","author":"Kato","year":"2021","journal-title":"BMJ Open"},{"issue":"11","key":"2026041002362593600_ref44","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-048485","article-title":"Studying trajectories of multimorbidity: a systematic scoping review of longitudinal approaches and evidence","volume":"11","author":"Cezard","year":"2021","journal-title":"BMJ Open"},{"key":"2026041002362593600_ref45","doi-asserted-by":"publisher","first-page":"26335565221105430","DOI":"10.1177\/26335565221105431","article-title":"Multimorbidity and mortality: a data science perspective","volume":"12","author":"Siah","year":"2022","journal-title":"J Multimorb Comorb"},{"issue":"1","key":"2026041002362593600_ref46","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1186\/s12916-020-01543-8","article-title":"Characteristics, service use and mortality of clusters of multimorbid patients in England: a population-based study","volume":"18","author":"Zhu","year":"2020","journal-title":"BMC Med"},{"issue":"6","key":"2026041002362593600_ref47","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1097\/CM9.0000000000001985","article-title":"Multimorbidity patterns and association with mortality in 0.5 million Chinese adults","volume":"135","author":"Fan","year":"2022","journal-title":"Chin Med J (Engl)"},{"key":"2026041002362593600_ref48","doi-asserted-by":"publisher","first-page":"6621785","DOI":"10.1155\/2021\/6621785","article-title":"A systematic review of the patterns of associative multimorbidity in Asia","volume":"2021","author":"Rajoo","year":"2021","journal-title":"Biomed Res Int"},{"issue":"9603","key":"2026041002362593600_ref49","doi-asserted-by":"publisher","first-page":"1929","DOI":"10.1016\/S0140-6736(07)61696-1","article-title":"The burden and costs of chronic diseases in low-income and middle-income countries","volume":"370","author":"Abegunde","year":"2007","journal-title":"Lancet"},{"issue":"9867","key":"2026041002362593600_ref50","doi-asserted-by":"publisher","first-page":"690","DOI":"10.1016\/S0140-6736(13)60063-X","article-title":"Improving responsiveness of health systems to non-communicable diseases","volume":"381","author":"Atun","year":"2013","journal-title":"Lancet"},{"issue":"5","key":"2026041002362593600_ref51","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1136\/thoraxjnl-2013-204460","article-title":"Chronic obstructive pulmonary disease mortality and prevalence: the associations with smoking and poverty\u2014a BOLD analysis","volume":"69","author":"Burney","year":"2014","journal-title":"Thorax"},{"issue":"22","key":"2026041002362593600_ref52","doi-asserted-by":"publisher","first-page":"2746","DOI":"10.1161\/hc4601.099487","article-title":"Global burden of cardiovascular diseases","volume":"104","author":"Yusuf","year":"2001","journal-title":"Circulation"},{"issue":"10","key":"2026041002362593600_ref53","doi-asserted-by":"publisher","first-page":"1225","DOI":"10.1111\/j.1365-3156.2008.02116.x","article-title":"Non-communicable diseases in low- and middle-income countries: context, determinants and health policy","volume":"13","author":"Miranda","year":"2008","journal-title":"Trop Med Int Health"},{"issue":"582","key":"2026041002362593600_ref54","doi-asserted-by":"publisher","first-page":"e12","DOI":"10.3399\/bjgp11X548929","article-title":"Epidemiology and impact of multimorbidity in primary care: a retrospective cohort study","volume":"61","author":"Salisbury","year":"2011","journal-title":"Br J Gen Pract"},{"issue":"7","key":"2026041002362593600_ref55","doi-asserted-by":"publisher","first-page":"680","DOI":"10.1016\/S0895-4356(00)00368-1","article-title":"Prevalence of morbidity and multimorbidity in elderly male populations and their impact on 10-year all-cause mortality: the FINE study (Finland, Italy, Netherlands, elderly)","volume":"54","author":"Menotti","year":"2001","journal-title":"J Clin Epidemiol"},{"issue":"Suppl 3","key":"2026041002362593600_ref56","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1007\/s11606-007-0322-1","article-title":"Multiple chronic conditions: prevalence, health consequences, and implications for quality, care management, and costs","volume":"22","author":"Vogeli","year":"2007","journal-title":"J Gen Intern Med"},{"issue":"4","key":"2026041002362593600_ref57","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1177\/1077558711399580","article-title":"Review: health care utilization and costs of elderly persons with multiple chronic conditions","volume":"68","author":"Lehnert","year":"2011","journal-title":"Med Care Res Rev"},{"issue":"7419","key":"2026041002362593600_ref58","doi-asserted-by":"publisher","first-page":"837","DOI":"10.1136\/bmj.327.7419.837","article-title":"Managing multiple morbidity in mid-life: a qualitative study of attitudes to drug use","volume":"327","author":"Townsend","year":"2003","journal-title":"BMJ"},{"issue":"10","key":"2026041002362593600_ref59","doi-asserted-by":"publisher","first-page":"1041","DOI":"10.1016\/j.jclinepi.2012.05.005","article-title":"Cumulative complexity: a functional, patient-centered model of patient complexity can improve research and practice","volume":"65","author":"Shippee","year":"2012","journal-title":"J Clin Epidemiol"},{"issue":"1","key":"2026041002362593600_ref60","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1186\/1472-6963-14-281","article-title":"Rethinking the patient: using burden of treatment theory to understand the changing dynamics of illness","volume":"14","author":"May","year":"2014","journal-title":"BMC Health Serv Res"},{"key":"2026041002362593600_ref61","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g6680","article-title":"Thinking about the burden of treatment","volume":"349","author":"Mair","year":"2014","journal-title":"BMJ"},{"issue":"3","key":"2026041002362593600_ref62","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1007\/s10654-014-9983-3","article-title":"The global impact of non-communicable diseases on households and impoverishment: a systematic review","volume":"30","author":"Jaspers","year":"2015","journal-title":"Eur J Epidemiol"},{"issue":"3","key":"2026041002362593600_ref63","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1016\/j.dhjo.2014.01.003","article-title":"The neglected burden of caregiving in low- and middle-income countries","volume":"7","author":"Thrush","year":"2014","journal-title":"Disabil Health J"},{"key":"2026041002362593600_ref64","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.ensci.2016.11.004","article-title":"An exploration into caring for a stroke-survivor in Lima, Peru: emotional impact, stress factors, coping mechanisms and unmet needs of informal caregivers","volume":"6","author":"Pesantes","year":"2017","journal-title":"eNeurologicalSci"}],"container-title":["American Journal of Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/aje\/advance-article-pdf\/doi\/10.1093\/aje\/kwae466\/61231874\/kwae466.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/aje\/article-pdf\/195\/4\/901\/61231874\/kwae466.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/aje\/article-pdf\/195\/4\/901\/61231874\/kwae466.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T06:36:35Z","timestamp":1775802995000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/aje\/article\/195\/4\/901\/7928186"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,19]]},"references-count":64,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,12,19]]},"published-print":{"date-parts":[[2026,3,17]]}},"URL":"https:\/\/doi.org\/10.1093\/aje\/kwae466","relation":{},"ISSN":["0002-9262","1476-6256"],"issn-type":[{"value":"0002-9262","type":"print"},{"value":"1476-6256","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,4]]},"published":{"date-parts":[[2024,12,19]]}}}