| Aims:Currently,Non-communicable Chronic Diseases(NCDs)are still the leading cause of death worldwide,and the multimorbidity of NCDs is widespread.A large number of previous studies focused only on a single NCD or a combination of two or three NCDs,rather than the complex network of multimorbidity of NCDs in the population.Because NCDs are closely linked,focusing only on the prevention of single NCD is not conducive to the long-term prevention of NCDs and their multimorbidity in the population.In this study,we will intuitively describe the multimorbidity of NCDs based on complex network models,analyze and compare the different communities of NCDs with different population characteristics;so as to provide a theoretical basis of targeted and effective prevention strategy of NCDs in the public health.Methods:This study involved 43,793 participants,who were in NHANES from 1999 to 2014,and 48 NCDs,which were obtained via basic measurement,laboratory examination and medical history questionnaire.The SPSS was used to do descriptive analysis.The continuous variables were expressed by `x±SD;the categorical variables were expressed by rate or composition ratio,and the difference was tested by Rao Scott-c2.The cycle was recognized as a continuous variable in the trend test.The data was weighted by complex sampling with prevalence of single and multimorbidity of NCDs,and p<0.05 was defined as significant difference.R was used to establish the complex network and do the community detection.Cytoscape was used to visualize the results of the complex networks and community.In this study,the "nodes" of the network the diseases,while "edge" represented the coexistence of NCDs.When the participant has two or more NCDs,the count for each multimorbidity pair would increase by 1.Subsequently,the multi-level clustering method was used to detect the communities of the complex network.Results:1.Among all the participants,the prevalence of hypertension was the highest,followed by obesity,and the prevalence of NCDs showed a trend of increasing with the cycle(p<0.05).In men,the prevalence of diabetes,kidney stones,gout,heart attack and coronary heart disease were higher than those of women;the prevalence of obesity,arthritis,asthma,chronic bronchitis,and thyroid problems were lower than those of women.2.For participants of different ages,the prevalence of NCDs was higher in the elderly participants than that of middle-aged participants,and the prevalence of young participants was the lowest.The highest prevalence of NCD among young participants was the obesity,and the highest prevalence of NCD among middle-aged and elderly participants was the hypertension.The prevalence of liver condition of the other Hispanics is higher than that of the other four races(p<0.05).The prevalence of hyperlipidemia,arthritis,thyroid problems,kidney stones,chronic bronchitis,osteoporosis bones coronary heart disease and heart attack in the non-Hispanic whites were the highest among five races(p<0.05);The prevalence of hypertension,obesity,diabetes,asthma,gout,stroke,heart failure and kidney weakness/failure in nonHispanic blacks were higher than the other 4 races(p<0.05).3.The proportions with multimorbidity of different NCDs were different.For all the participants,the proportion with multimorbidity of heart attack was the highest.The proportion with multimorbidity in female patients was higher than that in male patients,the proportion with multimorbidity in elderly patients was higher than that in young and middle-aged patients.And the proportion with multimorbidity in non-Hispanic whites and non-Hispanic blacks were higher than those in the other three races.4.The prevalence of multimorbidity of NCDs pairs increased with the cycle(p<0.05).The prevalence of multimorbidity of hyperlipidemia & diabetes was higher in men than that in women.Besides,the prevalence of multimorbidity of the other NCDs pairs of the top 15 were all higher in women than those in men(p<0.05).For example,the prevalence of hypertension & obesity was 15.27% in women and 13.48% in men;the prevalence of hyperlipidemia & arthritis was 12.00% in women and 8.71% in men.5.The complex network and community of different characteristics participants were different.The network density was higher and the multimorbidity were more complicated in women,which was more affected by multimorbidity of arthritis or osteoporosis bones.The multimorbidity network of the elderly population was the most complex and dense which has more nodes and edges.The elderly population was more affected by multimorbidity of osteoporosis bones and heart disease.The multimorbidity network of the non-Hispanic white involved more types of NCDs,and the prevalence of multimorbidity of NCDs in the non-Hispanic black was higher than that in the other 4 races.The number of NCDs in each community ranged from 4 to 22.Conclusions:1.The prevalence of hypertension,hyperlipidemia,diabetes,obesity,arthritis and asthma were high,and the multimorbidity patterns of different genders,different ages and different races were different.Despite of the different characteristics,the prevalence of single and multimorbidity of NCDs had the increasing trend.2.Compared with men,women were more affected of multimorbidity of NCDs,and the multimorbidity of NCDs network was more complicated.women were more inclined to exist multimorbidity of osteoporosis bones & thyroid problems,and men were more inclined to exist multimorbidity of coronary heart disease & prostate cancer;3.Compared with the young and middle-aged participants,the multimorbidity pattern of the elderly was more complicated;the middle-aged and elderly participants were more inclined to exist multimorbidity of osteoporosis bone & stroke;4.The multimorbidity of non-Hispanic whites was more complicated than that of the other races.There were more NCDs in the community where have heart diseases in the non-Hispanic blacks. |
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