Highly Correlated Multimorbidity in Alzheimer’s Disease: An EHR Analysis

Nai-Ching Chi; Kathleen Buckwalter; Pui Ying Yew; Nanle Gusen; Hua-Chin Chi; Chih-Lin Chi; Scott Larson

doi:10.1093/geroni/igaf122.2855

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Highly Correlated Multimorbidity in Alzheimer’s Disease: An EHR Analysis

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Highly Correlated Multimorbidity in Alzheimer’s Disease: An EHR Analysis

Nai-Ching Chi, Kathleen Buckwalter, Pui Ying Yew, Nanle Gusen, Hua-Chin Chi, Chih-Lin Chi and Scott Larson

Innovation in aging, Vol.9(Supplement_2)

12/01/2025

DOI: 10.1093/geroni/igaf122.2855

PMCID: PMC12760798

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Abstract

Most multimorbidity studies focus on the prevalence of individual chronic conditions, neglecting the crucial aspect of correlated disease combinations. This study addressed this gap by investigating highly correlated multimorbidity patterns in 2,629 Alzheimer’s Disease (AD) patients using de-identified electronic health records from the University of Iowa Hospitals and Clinics. Diagnoses, coded to the first three levels of ICD-10, were analyzed using the Apriori algorithm to identify significant co-occurring chronic conditions (dyads, triads, and tetrads). Leverage metrics quantified the strength of these correlations. The hypertension-lipoprotein metabolism disorders dyad (I10-E78) was most prominent, occurring 7.8% more frequently than expected (21.4% total). Other significant dyads included depression-anxiety (F33-F41; 4.5% leverage), dyslipidemia-ischemic heart disease (E78-I25; 3.9% leverage), hypertension-ischemic heart disease (I10-I25; 3.7% leverage), and type 2 diabetes-dyslipidemia (E11-E78; 3% leverage). Key triads included hypertension-dyslipidemia-depression (I10-E78-F33; 4.5% leverage), hypertension-dyslipidemia-ischemic heart disease (I10-E78-I25; 4.5% leverage), hypertension-dyslipidemia-type 2 diabetes (I10-E78-E11; 4.2% leverage), hypertension-dyslipidemia-gastroesophageal reflux (I10-E78-K21; 3.9% leverage), and hypertension-dyslipidemia-hypothyroidism (I10-E78-E03; 3.4% leverage). The hypertension-dyslipidemia-depression-anxiety tetrad (I10-E78-F33-F41; 2.6% leverage) exhibited the strongest correlation. Additional significant tetrads revealed complex interactions involving gastroesophageal reflux, sleep disorders, ischemic heart disease, and hypothyroidism. These findings demonstrate a significant clustering of cardiovascular, metabolic, and psychiatric comorbidities in AD. Identifying these correlated multimorbidity clusters will enable the development of targeted, integrated management strategies, inform evidence-based clinical guidelines, and facilitate focused clinical screening and intervention for this vulnerable population.

Cardiovascular Disease

Chronic Illnesses

Comorbidity

Diabetes

Electronic Health Records

Heart

Hypertension

Ischemia

Metabolic Disorders

Gastroesophageal reflux

Hypothyroidism

Details

Title: Subtitle: Highly Correlated Multimorbidity in Alzheimer’s Disease: An EHR Analysis
Creators: Nai-Ching Chi - University of Iowa
Kathleen Buckwalter - University of Iowa
Pui Ying Yew - University of Minnesota
Nanle Gusen - University of Iowa
Hua-Chin Chi - Emory University
Chih-Lin Chi - University of Minnesota System
Scott Larson - University of Iowa
Resource Type: Abstract
Publication Details: Innovation in aging, Vol.9(Supplement_2)
DOI: 10.1093/geroni/igaf122.2855
PMCID: PMC12760798
ISSN: 2399-5300
eISSN: 2399-5300
Publisher: Oxford University Press
Language: English
Date published: 12/01/2025
Academic Unit: Health Management and Policy; Iowa Neuroscience Institute; Family and Community Medicine; Nursing
Record Identifier: 9985112980702771

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