Data-driven patient stratification of UK Biobank cohort suggests five endotypes of multimorbidity

Bodhayan Prasad, AJ Bjourson, Priyank Shukla

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Multimorbidity generally refers to concurrent occurrence of multiple chronic conditions. These patients are inherently at high risk and often lead a poor quality of life due to delayed treatments. With the emergence of personalized medicine and stratified healthcare, there is a need to stratify patients right at the primary care setting. Here we developed multimorbidity analysis pipeline (MulMorPip), which can stratify patients into multimorbid subgroups or endotypes based on their lifetime disease diagnosis and characterize them based on demographic features and underlying disease–disease interaction networks. By implementing MulMorPip on UK Biobank cohort, we report five distinct molecular subclasses or endotypes of multimorbidity. For each patient, we calculated the existence of broad disease classes defined by Charlson's comorbidity classification using the International Classification of Diseases-10 encoding. We then applied multiple correspondence analysis in 77 524 patients from UK Biobank, who had multimorbidity of more than one disease, which resulted in five multimorbid clusters. We further validated these clusters using machine learning and were able to classify 20% model-blind test set patients with an accuracy of 97% and an average Jaccard similarity of 84%. This was followed by demographic characterization and development of interlinking disease network for each cluster to understand disease–disease interactions. Our identified five endotypes of multimorbidity draw attention to dementia, stroke and paralysis as important drivers of multimorbidity stratification. Inclusion of such patient stratification at the primary care setting can help general practitioners to better observe patients’ multiple chronic conditions, their risk stratification and personalization of treatment strategies.
Original languageEnglish
Article numberbbac410
Pages (from-to)bbac410
Number of pages9
JournalBriefings in Bioinformatics
Issue number6
Early online date8 Oct 2022
Publication statusPublished (in print/issue) - 19 Nov 2022

Bibliographical note

Publisher Copyright:
© The Author(s) 2022. Published by Oxford University Press.


  • multimorbidity
  • comorbidity
  • UK Biobank
  • multiple correspondence analysis
  • charlson comorbidity index
  • clustering
  • patient stratification
  • endotypes
  • machine learning
  • disease interaction network
  • multiple correspondence analysis (MCA)
  • charlson comorbidity index (CCI)


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