title: Longitudinal administrative data can be used to examine multimorbidity, provided false discoveries are controlled for.
abstract: OBJECTIVE
  This article presents methods for using administrative data to study multimorbidity in hospitalized individuals and indicates how the findings can be used to gain a deeper understanding of hospital multimorbidity.
  
  
  METHODS
  A Dutch nationwide hospital register (n=4,521,856) was used to calculate age- and sex-standardized observed/expected ratios of disease-pairing prevalences with corresponding confidence intervals.
  
  
  RESULTS
  The strongest association was found for the combination between alcoholic liver and mental disorders due to alcohol abuse (observed/expected=39.2). Septicemia was found to cluster most frequently with other diseases. The consistency of the ratios over time depended on the number of observed cases. Furthermore, the ratios also depend on the length of the time frame considered.
  
  
  CONCLUSIONS
  Using observed/expected ratios calculated from the administrative data set, we were able to (1) better quantify known morbidity pairings while also revealing hitherto unnoticed associations, (2) find out which pairings cluster most strongly, and (3) gain insight into which diseases cluster frequently with other diseases. Caveats with this method are finding spurious associations on the basis of too few observed cases and the dependency of the ratio magnitude on the length of the time frame observed.
authors: Department of Statistics and Mathematical Modeling, Centre for Methodology and Information Services, National Institute for Public Health and the Environment, 3720 BA Bilthoven, The Netherlands. albert.wong@rivm.nl
authors: Albert
authors: A
authors: Wong
authors: Hendriek C
authors: HC
authors: Boshuizen
authors: François G
authors: FG
authors: Schellevis
authors: Geert Jan
authors: GJ
authors: Kommer
authors: Johan J
authors: JJ
authors: Polder
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006753:Hospital Records; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000453:epidemiology; D008137:Longitudinal Studies / Q000379:methods*; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D018805:Sepsis / Q000453:epidemiology; D055815:Young Adult