Modeling the dynamics of multiple disease occurrence by latent states

The current availability of large volumes of health care data makes it a promising data source to new views on disease interaction. Most of the times, patients have multiple diseases instead of a single one (also known as multimorbidity), but the small size of most clinical research data makes it hard to impossible to investigate this issue. In this paper, we propose a latent-based approach to expand patient evolution in temporal electronic health records, which can be uninformative due to its very general events. We introduce the notion of clusters of hidden states allowing for an expanded understanding of the multiple dynamics that underlie events in such data. Clusters are defined as part of hidden Markov models learned from such data, where the number of hidden states is not known beforehand. We evaluate the proposed approach based on a large dataset from Dutch practices of patients that had events on comorbidities related to atherosclerosis. The discovered clusters are further correlated to medical-oriented outcomes in order to show the usefulness of the proposed method.