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Multimorbidity patterns by health-related quality of life status in older adults: an association rules and network analysis utilizing the Korea National Health and Nutrition Examination Survey
Thi-Ngoc Tran, Sanghee Lee, Chang-Mo Oh, Hyunsoon Cho
Epidemiol Health. 2022;44:e2022113.   Published online November 29, 2022
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  • 1 Citations
AbstractAbstract AbstractSummary PDFSupplementary Material
Improved life expectancy has increased the prevalence of older adults living with multimorbidity which likely deteriorates their health-related quality of life (HRQoL). However, relatively little is known about patterns and the relationships of multimorbidity by HRQoL status in older adults.
Individuals aged 65 or older from the Korea National Health and Nutrition Examination Survey V-VII (2010-2018) were analyzed. HRQoL was assessed by the EuroQoL-5 dimensions questionnaire and categorized as poor, normal, or good. The impact of multimorbidity on HRQoL was evaluated using logistic regression. The patterns and inter-relationships between multimorbidity, stratified by HRQoL groups, were analyzed using the association rules and network analysis approach.
Multimorbidity was significantly associated with poor HRQoL (3 or more diseases vs. none; adjusted odds ratio, 2.70; 95% confidence interval, 2.10 to 3.46). Hypertension, arthritis, hyperlipidemia, and diabetes were the most prevalent diseases across all HRQoL groups. Complex interrelationships of morbidities, higher prevalence, and node strengths in all diseases were observed in the poor HRQoL group, particularly for arthritis, depression, and stroke, compared to other groups (1.5-3.0 times higher, p<0.05 for all). Apart from hypertension, arthritis and hyperlipidemia had a higher prevalence and stronger connections with other diseases in females, whereas this was the case for diabetes and stroke in males with poor HRQoL.
Multimorbidity patterns formed complicatedly inter-correlated disease networks in the poor HRQoL group with differences according to sex. These findings enhance the understanding of multimorbidity connections and provide information on the healthcare needs of older adults, especially those with poor HRQoL.
Korean summary
기대 수명의 증가에 따라 고령인구에서 건강관련 삶의 질을 저하시킬 수 있는 복합질환의 유병률도 함께 증가하고 있다. 본 연구에서는 국민건강영양조사 자료를 이용하여 65세 이상 우리나라 고령인구에서 건강관련 삶의 질 (HRQoL)에 따른 복합만성질환 패턴을 분석하였다. 복합만성질환은 건강관련 삶의 질 저하와 통계적으로 유의하게 연관되어 있으며, 연관성 및 네크워크 분석 결과 건강관련 삶의 질이 낮을수록 복합질환의 패턴이 복잡한 것으로 나타났다. 전체적으로 고혈압, 관절염, 고지혈증, 당뇨병이 가장 높은 발생률을 보였다. 건강관련 삶의 질이 낮은 그룹에서는 관절염, 우울증, 뇌졸중 등의 질병이 높은 발생률과 상호관련성을 보였으며, 이는 성별에 따라 차이가 있었다. 연구 결과는 고령자, 특히 건강관련 삶의 질이 낮은 노인의 의료 서비스 요구에 대해 정보를 제공해 줄 수 있을 것이다,
Key Message
Network analysis of older adults (65 or older) in Korea showed that hypertension, arthritis, hyperlipidemia, and diabetes were the most common multimorbidity regardless of HRQoL status. However, as HRQoL deteriorated, multimorbidity patterns formed complicatedly inter-correlated disease networks; the prevalence and the node strength of arthritis, depression, and stroke increased considerably and be diversified by sex.


Citations to this article as recorded by  
  • Health-promoting behavior to enhance perceived meaning and control of life in chronic disease patients with role limitations and depressive symptoms: a network approach
    Je-Yeon Yun, Young Ho Yun
    Scientific Reports.2023;[Epub]     CrossRef
Using Mining Association Rules for the Dietary Assessment of Adults in Rural Area.
J E Shim, H Y Paik, W S Shin, K C Kim
Korean J Epidemiol. 1997;19(2):220-230.
  • 4,528 View
  • 7 Download
AbstractAbstract PDF
This study was performed to find out a nutrient which could be used as an index for a quick and easy dietary assessment using mining association rules, the automated and intelligent database analysis. A Dietary survey with 24 hour recall method was conducted to 2037 adults over 30 years of age in rural area of Korea. Daily nutrient intake as the percent of the Recommended Daily Allowances(RDA) was applied to the association rules and nutrient intake over 75% of RDA was considered enough intake. Association rules in nutrient database show relation-ships among nutrients, and they are statements as this form, "50% of person that take protein under 60% of RDA also take calcium." Applying these rules between nutrients over 75% of RDA with 25% level of minimum support, we found that protein, phosphorus, niacin had 7 association rules and association rules of protein had higher level of confidence than the others. Applying between nutrients below 60% of RDA, calcium and vitamin A had the highest number of association rules, however, the levels of confidence were low. Protein had 5 association rules, 2nd higher number, and the levels of confidence were higher than others. From these results protein indicated nutrient intake patterns better than energy did, which is generally used as a representative nutrient. This results could be used in the dietary assessment and nutrition education of korean adults in rural area.

Epidemiol Health : Epidemiology and Health