title: Applying multivariate clustering techniques to health data: the 4 types of healthcare utilization in the Paris metropolitan area.
abstract: Cost containment policies and the need to satisfy patients' health needs and care expectations provide major challenges to healthcare systems. Identification of homogeneous groups in terms of healthcare utilisation could lead to a better understanding of how to adjust healthcare provision to society and patient needs.
  
  
  
  This study used data from the third wave of the SIRS cohort study, a representative, population-based, socio-epidemiological study set up in 2005 in the Paris metropolitan area, France. The data were analysed using a cross-sectional design. In 2010, 3000 individuals were interviewed in their homes. Non-conventional multivariate clustering techniques were used to determine homogeneous user groups in data. Multinomial models assessed a wide range of potential associations between user characteristics and their pattern of healthcare utilisation.
  
  
  
  We identified four distinct patterns of healthcare use. Patterns of consumption and the socio-demographic characteristics of users differed qualitatively and quantitatively between these four profiles. Extensive and intensive use by older, wealthier and unhealthier people contrasted with narrow and parsimonious use by younger, socially deprived people and immigrants. Rare, intermittent use by young healthy men contrasted with regular targeted use by healthy and wealthy women.
  
  
  
  The use of an original technique of massive multivariate analysis allowed us to characterise different types of healthcare users, both in terms of resource utilisation and socio-demographic variables. This method would merit replication in different populations and healthcare systems.
authors.affiliation: Inserm, UMRS 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMRS 1136, Paris, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lefèvre
authors.affiliation: Inserm, UMRS 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, Faculty of Medicine Pierre and Marie Curie, Department of general practice, Paris, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Rondet
authors.affiliation: CNRS, UMR 8997, Centre Maurice Halbwachs, Research group on social inequalities, Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Parizot
authors.affiliation: Inserm, UMRS 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMRS 1136, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Chauvin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016000:Cluster Analysis; D054242:Emigrants and Immigrants; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D010297:Paris; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D055815:Young Adult