COMORBIDITY OF MENTAL ILLNESS, NON-COMMUNICABLE DISEASES AND POLYPHARMACY IN HOME MEDICAL CARE USING MEDICAL BIG DATA

Abstract Background According to the progress of super-aging society in Japan, the number of patients with non- communicable diseases (NCDs) and the number of people requiring medical care and nursing care is rapidly increasing. The number of receiving home medical care (HMC) is also rapidly increasing. In HMC, most of patients are elderly people and a lot of patients with NCDs, such as diabetes mellitus, hypertension, cardiovascular disease, and cerebrovascular disorders, and mental illnesses, such as dementia and depression, are containing. At the same time, polypharmacy such as psychotropic drugs was often recognized. Aims & Objectives In this study, using NDB (National Database of Health Insurance Claims and Specific Health Checkups of Japan) established by the Ministry of Health, Labour and Welfare, comorbidity of mental Illness, NCDs and polypharmacy in HMC were analyzed. Method This study was conducted using the NDB Sampling Dataset in NDB provided by the Ministry of Health, Labor and Welfare. Medical Non-Hospitalization Receipts and Prescription Receipts were linked by patient ID. Based on the Injury/Disease Code and Drug Code, the disease prevalence and drug prescription status of patients receiving HMC were summarized. Patients receiving HMC were counted as patients containing the phrase "home medical care (zaitaku)" in Prescription Codes. Results When investigating the status of polypharmacy in patients receiving HMC, polypharmacy was observed almost 90% of patients, most of whose possessing NCDs and mental illness. The peak of patients receiving HMC with polypharmacy was around 85 years of age. In the Injury/Disease Codes, among patients receiving HMC, many of patients with mental illnesses were found to suffer from diseases that showed neurocognitive disorders, such as unspecified dementia, delirium, and Parkinson's disease. Polypharmacies were recognized to include psychotropic drugs and drugs related to NCDs such as diabetes mellitus and hypertension. These results were visualized using various methods such as word clouds and co-occurrence networks to understand the overall trends of comorbidities. Discussion & Conclusion Analysis of NDB reveals that in HMC, there are many elderly patients, many patients with comorbidities with mental illnesses and NCDs, and polypharmacy of psychotropic drugs and drugs related to NCDs such as diabetes mellitus and hypertension is significant. These findings suggest the need to reduce the adverse events of polypharmacy by optimizing drug prescriptions.