Generalizing Multimorbidity Models Across Countries: A Comparative Study of Austria and Denmark

Abstract: Chronic diseases frequently co-occur in patterns that are unlikely to arise by chance, a phenomenon known as multimorbidity. This growing challenge for patients and healthcare systems is amplified by demographic aging and the rising burden of chronic conditions. However, our understanding of how individuals transition from a disease-free-state to accumulating diseases as they age is limited. Recently, data-driven methods have been developed to characterize morbidity trajectories using electronic health records; however, their generalizability across healthcare settings remains largely unexplored. In this paper, we conduct a cross-country validation of a data-driven multimorbidity trajectory model using population-wide health data from Denmark and Austria. Despite considerable differences in healthcare organization, we observe a high degree of similarity in disease cluster structures. The Adjusted Rand Index (0.998) and the Normalized Mutual Information (0.88) both indicate strong alignment between the two clusterings. These findings suggest that multimorbidity trajectories are shaped by robust, shared biological and epidemiological mechanisms that transcend national healthcare contexts.