{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T18:41:06Z","timestamp":1790620866750,"version":"4.1.0"},"reference-count":66,"publisher":"JMIR Publications Inc.","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Med Inform"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Multiple chronic diseases in patients are a major burden on the health service system. Currently, diseases are mostly treated separately without paying sufficient attention to their relationships, which results in the fragmentation of the care process. The better integration of services can lead to the more effective organization of the overall health care system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to analyze the connections between diseases based on their co-occurrences to support decision-makers in better organizing health care services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a cluster analysis of diagnoses by using data from the Finnish Health Care Registers for primary and specialized health care visits and inpatient care. The target population of this study comprised those 3.8 million individuals (3,835,531\/5,487,308, 69.90% of the whole population) aged \u226518 years who used health care services from the years 2015 to 2018. They had a total of 58 million visits. Clustering was performed based on the co-occurrence of diagnoses. The more the same pair of diagnoses appeared in the records of the same patients, the more the diagnoses correlated with each other. On the basis of the co-occurrences, we calculated the relative risk of each pair of diagnoses and clustered the data by using a graph-based clustering algorithm called the M-algorithm\u2014a variant of k-means.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The results revealed multimorbidity clusters, of which some were expected (eg, one representing hypertensive and cardiovascular diseases). Other clusters were more unexpected, such as the cluster containing lower respiratory tract diseases and systemic connective tissue disorders. The annual cost of all clusters was \u20ac10.0 billion, and the costliest cluster was cardiovascular and metabolic problems, costing \u20ac2.3 billion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The method and the achieved results provide new insights into identifying key multimorbidity groups, especially those resulting in burden and costs in health care services.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/35422","type":"journal-article","created":{"date-parts":[[2022,3,2]],"date-time":"2022-03-02T01:55:07Z","timestamp":1646186107000},"page":"e35422","source":"Crossref","is-referenced-by-count":24,"title":["Clustering Diagnoses From 58 Million Patient Visits in Finland Between 2015 and 2018"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9554-2827","authenticated-orcid":false,"given":"Pasi","family":"Fr\u00e4nti","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9110-2421","authenticated-orcid":false,"given":"Sami","family":"Sieranoja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8716-2875","authenticated-orcid":false,"given":"Katja","family":"Wikstr\u00f6m","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6614-4782","authenticated-orcid":false,"given":"Tiina","family":"Laatikainen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2022,5,4]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2296-15-61"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.3109\/13814789609162146"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1016\/s0895-4356(97)00306-5"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.3109\/02813432.2016.1153242"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1016\/j.arr.2017.05.003"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1007\/s40258-017-0346-6"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0066742"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m160"},{"issue":"2","key":"ref9","first-page":"110","volume":"12","author":"Farley, JF","year":"2006","journal-title":"Am J Manag Care"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2003.tb00008.x"},{"issue":"1","key":"ref11","first-page":"69","volume":"22","author":"Schneeweiss, R","year":"1986","journal-title":"J Fam Pract"},{"key":"ref12","author":"Jain, AK","year":"1988","journal-title":"Algorithms for clustering data"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2013.09.021"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pcbi.1000353"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1186\/s12911-019-0852-6"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103291"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2017.09.014"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-642-15020-3_10"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-642-32395-9_8"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1080\/00207543.2016.1208372"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/43.5.649"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1089\/rej.2009.1002"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.3390\/app11052373"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-018-0790-x"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1016\/j.patcog.2019.04.014"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1007\/s10115-021-01623-y"},{"key":"ref27","unstructured":"Multimorbidity network analysisUniversity of Eastern Finland2022-04-26http:\/\/cs.uef.fi\/ml\/impro\/DiagnosisClusters\/"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1038\/d41586-020-00837-4"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.7326\/M14-0698"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.0601602103"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.1103\/physreve.70.056131"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1002\/j.1538-7305.1970.tb01770.x"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1109\/34.868688"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00171614"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-19890-3_61"},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.1016\/j.physrep.2009.11.002"},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.1016\/j.physrep.2016.09.002"},{"key":"ref38","doi-asserted-by":"publisher","DOI":"10.1088\/1742-5468\/2008\/10\/P10008"},{"key":"ref39","doi-asserted-by":"publisher","DOI":"10.1103\/PhysRevE.80.016118"},{"key":"ref40","doi-asserted-by":"publisher","DOI":"10.1109\/tkde.2016.2518687"},{"key":"ref41","doi-asserted-by":"publisher","DOI":"10.1109\/percom.2013.6526730"},{"key":"ref42","doi-asserted-by":"publisher","DOI":"10.1103\/PhysRevE.80.056117"},{"key":"ref43","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-642-33718-5_31"},{"key":"ref44","doi-asserted-by":"publisher","DOI":"10.1109\/icpp.2016.34"},{"key":"ref45","doi-asserted-by":"publisher","DOI":"10.1016\/j.patcog.2011.06.018"},{"key":"ref46","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.13251"},{"key":"ref47","author":"Linna, M","year":"2016","journal-title":"Rekistereist\u00e4 tietoa vanhuspalveluiden johtamiseen? Ik\u00e4\u00e4ntyneen v\u00e4est\u00f6n sosiaali- ja terveyspalveluiden k\u00e4yt\u00f6n arviointi rekisteriaineistoja hy\u00f6dynt\u00e4m\u00e4ll\u00e4"},{"key":"ref48","unstructured":"KapiainenSV\u00e4is\u00e4nenAHaulaTTerveyden- ja sosiaalihuollon yksikk\u00f6kustannukset Suomessa vuonna 201120142022-03-23https:\/\/www.julkari.fi\/bitstream\/handle\/10024\/114683\/THL_RAPO3_2014_web.pdf?sequence=1&isAllowed=y"},{"key":"ref49","doi-asserted-by":"publisher","DOI":"10.1109\/JBHI.2017.2783049"},{"key":"ref50","doi-asserted-by":"publisher","DOI":"10.22329\/amr.v12i3.658"},{"key":"ref51","doi-asserted-by":"publisher","DOI":"10.1145\/253260.253327"},{"key":"ref52","doi-asserted-by":"publisher","DOI":"10.1186\/2043-9113-4-8"},{"key":"ref53","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-015-0096-9"},{"key":"ref54","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-59336-1"},{"key":"ref55","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pcbi.1004125"},{"key":"ref56","unstructured":"HuDiNe Search2022-03-23https:\/\/web.archive.org\/web\/20160426043824\/http:\/\/hudine.neu.edu\/"},{"key":"ref57","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4614-6170-8_299"},{"key":"ref58","doi-asserted-by":"publisher","DOI":"10.1145\/3341161.3342890"},{"key":"ref59","doi-asserted-by":"publisher","DOI":"10.1016\/j.datak.2014.07.008"},{"key":"ref60","doi-asserted-by":"publisher","DOI":"10.3844\/jcssp.2008.252.255"},{"key":"ref61","doi-asserted-by":"publisher","DOI":"10.1037\/0003-066X.59.7.614"},{"key":"ref62","unstructured":"Findicator - Mortality from ischaemic heart diseaseStatistics Finland20202022-03-23https:\/\/findikaattori.fi\/en\/83"},{"key":"ref63","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/ckaa132"},{"key":"ref64","unstructured":"Official Statistics of Finland (OSF): BirthsStatistics Finland20212021-06-14http:\/\/www.stat.fi\/til\/synt\/2019\/synt_2019_2020-04-24_tie_001_en.html"},{"key":"ref65","unstructured":"WatersHGrafMThe costs of chronic disease in the U.SThe Milken Institute201882022-03-23https:\/\/milkeninstitute.org\/sites\/default\/files\/reports-pdf\/ChronicDiseases-HighRes-FINAL.pdf"},{"key":"ref66","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-019-00568-5"}],"container-title":["JMIR Medical Informatics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/medinform.jmir.org\/2022\/5\/e35422","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:56:53Z","timestamp":1782842213000},"score":1,"resource":{"primary":{"URL":"https:\/\/medinform.jmir.org\/2022\/5\/e35422"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,4]]},"references-count":66,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.2196\/35422","relation":{"has-preprint":[{"id-type":"doi","id":"10.2196\/preprints.35422","asserted-by":"object"}]},"ISSN":["2291-9694"],"issn-type":[{"value":"2291-9694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,4]]}}}