Table 4. Profiles of multimorbidity identified in K-means cluster analysis.

SMI (n = 23,382)			No SMI (n = 70,003)
Cluster description	Observed in cluster/expected* >1.2 or <0.8	High frequency variables, n (%)	Cluster description	Observed in cluster/expected* >1.2 or <0.8	High frequency variables, n (%)
Varied multimorbidity
n (%): 13,107 (56.06) Median (IQR): Conditions: 3 (2 to 3) Age: 67.63 (54.75 to 80.51)	Chronic diseases High: None Low: Congestive heart failure (0.0), peptic ulcer (0.0), blood loss anaemia (0.0), paresis/paralysis (0.0), coagulopathy (0.0), asthma (0.01), and COPD (0.65) Health risk factors and demographics High: None Low: Age 18 to 40 (0.58) and drug misuse (0.76) SMI: None	Cluster contains > = 70% of all patients with this variable: None > = 70% of patients in this cluster have this variable: None	n (%): 33,610 (47.99) Median (IQR): Conditions: 3 (2 to 4) Age: 74.27 (61.89 to 85.00)	Chronic diseases High: Hypothyroidism (1.24), renal disease (1.24), and hypertension (1.21) Low: Myocardial infarction (0.0), blood loss anaemia (0.0), coagulopathy (0.0), peripheral vascular disease (0.00), pulmonary circulatory disorder (0.00), valvular disease (0.0), HIV (0.03), asthma (0.08), COPD (0.35), liver disease (0.42), neurological disease (0.44), paresis/paralysis (0.66), and congestive heart failure (0.77) Health risk factors and demographics High: None Low: Age 18 to 40 (0.41), drug misuse (0.67), underweight (0.73), and alcohol misuse (0.77)	Cluster contains > = 70% of all patients with this variable: None > = 70% of patients in this cluster have this variable: Hypertension (76.61)
Heart disease
General heart disease			Valvular disease
n (%): 1,720 (7.36) Median (IQR): Conditions: 5 (4 to 7) Age: 80.01 (68.92 to 87.28)	Chronic diseases High: Congestive heart failure (12.50), myocardial infarction (3.86), valvular disease (3.58), cardiac arrhythmia (3.21), pulmonary circulation disorders (2.01), peripheral vascular disease (1.91), renal disease (1.82), cerebrovascular disease (1.61), COPD (1.52), fluid and electrolyte disorders (1.47), hypertension (1.24), and rheumatic/collagen disease (1.22) Low: Blood loss anaemia (0.0), coagulopathy (0.0), paresis/paralysis (0.0), HIV (0.20), peptic ulcer (0.56), liver disease (0.62), neurological disease (0.78), and asthma (0.80) Health risk factors and demographics High: age 65+ (1.67) Low: Age 18 to 40 (0.21), age 41 to 64 (0.44), drug misuse (0.56), alcohol misuse (0.65), and current smoker (0.70) SMI: None	Cluster contains > = 70% of all patients with this variable: Congestive heart failure (91.93), > = 70% of patients in this cluster have this variable: Congestive heart failure (98.66)	n (%): 4,049 (5.78) Median (IQR): Conditions: 5 (3 to 6) Age: 80.93 (69.95 to 88.00)	Chronic diseases High: Valvular disease (15.54), congestive heart failure (3.13), cardiac arrhythmia (2.46), fluid and electrolyte disorders (1.53), peripheral vascular disease (1.48), renal disease (1.45), cerebrovascular disease (1.41), and myocardial infarction (1.41) Low: Blood loss anaemia (0.0), coagulopathy (0.0), pulmonary circulation disorders (0.00), HIV (0.39), paresis/paralysis (0.54), liver disease (0.67), asthma (0.73), and neurological disease (0.74) Health risk factors and demographics High: Age 65+ (1.30) Low: Age 18 to 40 (0.56), age 41 to 64 (0.50) drug misuse (0.69), alcohol misuse (0.71), and current smoker (0.78)	Cluster contains > = 70% of all patients with this variable: Valvular disease (89.86) > = 70% of patients in this cluster have this variable: Valvular disease (100.00)
			Pulmonary circulatory disorders
			n (%): 2,485 (3.55) Median (IQR): Conditions: 4 (3 to 6) Age: 77.59 (65.00 to 86.00)	Chronic diseases High: Pulmonary circulation disorders (27.44), congestive heart failure (2.08), valvular disease (1.91), COPD (1.56), cardiac arrhythmia (1.43), peripheral vascular disease (1.37), fluid and electrolyte disorders (1.34), cancer (1.29), myocardial infarction (1.28), renal disease (1.23), cerebrovascular disease (1.23), paresis/paralysis (1.23), and rheumatic/collagen disease (1.21) Low: Blood loss anaemia (0.0), coagulopathy (0.0), and HIV (0.30) Health risk factors and demographics High: Age 65+ (1.21) Low: Age 41 to 64 (0.66) and age 18 to 40 (0.67)	Cluster contains > = 70% of all patients with this variable: Pulmonary circulation disorders (97.37) > = 70% of patients in this cluster have this variable: Pulmonary circulation disorders (100.00)
			Myocardial infarctions and peripheral vascular disease
			n (%): 8,424 (12.03) Median (IQR): Conditions: 4 (3 to 6) Age: 79.00 (68.83 to 86.73)	Chronic diseases High: Myocardial infarction (7.06), peripheral vascular disease (6.91), congestive heart failure (2.14), cerebrovascular disease (1.48), renal disease (1.35), cardiac arrhythmia (1.33), peptic ulcer (1.30), COPD (1.29), and fluid and electrolyte disorders (1.20) Low: Blood loss anaemia (0.0), coagulopathy (0.0), pulmonary circulation disorders (0.00), valvular disease (0.05), HIV (0.12), liver disease (0.56), asthma (0.60), paresis/paralysis (0.68), and neurological disease (0.71) Health risk factors and demographics High: Male (1.39), age 65+ (1.32), and current smoker (1.23) Low: Age 18 to 40 (0.09), age 41 to 64 (0.58), never smoker (0.65), drug misuse (0.65), and female (0.76)	Cluster contains > = 70% of all patients with this variable: Myocardial infarction (84.97), peripheral vascular disease (83.11) > = 70% of patients in this cluster have this variable: None
Respiratory disease and HIV
n (%): 6,248 (26.72) Median (IQR): Conditions: 3 (2 to 4) Age: 52.92 (41.20 to 65.00)	Chronic diseases High: Asthma (3.19), COPD (1.59), and HIV (1.38) Low: Blood loss anaemia (0.00), coagulopathy (0.0), paresis/paralysis (0.0), peptic ulcer (0.0), congestive heart failure (0.0), myocardial infarction (0.43), cerebrovascular disease (0.47), valvular disease (0.47), renal disease (0.49), peripheral vascular disease (0.54), cardiac arrhythmia (0.56), cancer (0.59), fluid and electrolyte disorders (0.61), and hypertension (0.67) Health risk factors and demographics High: Age 18 to 40 (2.11), drug misuse (1.58), current smoker (1.26), age 41 to 64 (1.25), and alcohol misuse (1.22) Low: Age 65+ (0.52), never smoked (0.70), and underweight (0.80) SMI: None	Cluster contains > = 70% of all patients with this variable: Asthma (85.20) > = 70% of patients in this cluster have this variable: Asthma (99.87)	n (%): 19,921 (28.45) Median (IQR): Conditions: 2 (2 to 3) Age: 59.00 (47.00 to 73.00)	High: HIV (3.16), Asthma (2.80), neurological disease (2.13), liver disease (2.11), COPD (1.93), and paresis/paralysis (1.80) Low: Blood loss anaemia (0.00), coagulopathy (0.0), valvular disease (0.00), pulmonary circulation disorders (0.00), myocardial infarction (0.02), peripheral vascular disease (0.04), congestive heart failure (0.33), renal disease (0.36), cardiac arrhythmia (0.42), fluid and electrolyte disorders (0.47), cerebrovascular disease (0.49), hypertension (0.61), cancer (0.62), rheumatic/collagen disease (0.64), peptic ulcer (0.68), diabetes (0.69), and hypothyroidism (0.72) Health risk factors and demographics High: Age 18 to 40 (2.46), drug misuse (1.69), age 41 to 64 (1.45), underweight (1.46), alcohol misuse (1.42), and current smoker (1.24) Low: Age 65+ (0.61)	Cluster contains > = 70% of all patients with this variable: HIV (89.89), asthma (79.59) > = 70% of patients in this cluster have this variable: Asthma (76.90)
Blood loss anaemia
n (%): 35 (0.15) Median (IQR): Conditions: 4 (3 to 5.5) Age: 66.00 (55.00 to 80.37)	Chronic diseases High: Blood loss anaemia (668.06), deficiency anaemia (3.14), coagulopathy (2.62), pulmonary circulation disorders (2.15), peripheral vascular disease (1.94), cancer (1.45), paresis/paralysis (1.42), peptic ulcer (1.40), rheumatic/collagen disease (1.26), fluid and electrolyte disorders (1.25), and renal disease (1.22) Low: HIV (0.00), myocardial infarction (0.44), liver disease (0.48), COPD (0.58), valvular disease (0.63), congestive heart failure (0.72), and asthma (0.73) Health risk factors and demographics High: Underweight (8.20), ex-smoker (1.55), and female (1.20) Low: Age 18 to 40 (0.49), never smoked (0.50), drug misuse (0.57), alcohol misuse (0.59), current smoker (0.70), male (0.71), and normal weight (0.73) SMI: High: Schizophrenia (1.25)	> = 70% of patients in this cluster have this variable: Blood loss anaemia (100.00) > = 70% of patients in this cluster have this variable: Blood loss anaemia (100.00)	n (%): 153 (0.22) Median (IQR): Conditions: 4 (2 to 5) Age: 63.00 (52.37 to 83.72)	Chronic diseases High: Blood loss anaemia (457.73), coagulopathy (2.94), deficiency anaemia (2.75), valvular disease (2.13), HIV (1.63), and peptic ulcer (1.59) Low: Paresis/paralysis (0.0), COPD (0.44), hypothyroidism (0.65), cardiac arrhythmia (0.66), neurological disease (0.74), cancer (0.75), diabetes (0.78), cerebrovascular disease (0.78), and hypertension (0.79) Health risk factors and demographics High: Age 41 to 64 (1.53) and female (1.40) Low: Underweight (0.00), alcohol misuse (0.25), male (0.37), and age 65+ (0.75)	> = 70% of patients in this cluster have this variable: Blood loss anaemia (100.00) > = 70% of patients in this cluster have this variable: Blood loss anaemia (100.00), female (85.62)
Coagulopathy
n (%): 493 (2.11) Median (IQR): Conditions: 4 (2 to 5) Age: 59.00 (47.59 to 74.00)	Chronic diseases High: Coagulopathy (45.94), liver disease (2.41), HIV (1.49), fluid and electrolyte disorders (1.49), rheumatic/collagen disease (1.28), myocardial infarction (1.25), valvular disease (1.25), neurological disease (1.24), peripheral vascular disease (1.24), and pulmonary circulation disorders (1.22) Low: Blood loss anaemia (0.00) and hypothyroidism (0.75) Health risk factors and demographics High: Alcohol misuse (1.59), drug misuse (1.51), and age 18 to 40 (1.36) Low: None SMI: None	> = 70% of patients in this cluster have this variable: Coagulopathy (96.86) > = 70% of patients in this cluster have this variable: Coagulopathy (100.00)	n (%): 1,391 (1.99) Median (IQR): Conditions: 4 (2 to 5) Age: 68.00 (52.68 to 81.94)	Chronic diseases High: Coagulopathy (50.02), liver disease (2.83), HIV (1.74), fluid and electrolyte disorders (1.46), deficiency anaemia (1.24), and pulmonary circulation disorders (1.22) Low: Blood loss anaemia (0.0), COPD (0.74), paresis/paralysis (0.79), and myocardial infarction (0.80) Health risk factors and demographics High: Drug misuse (1.83), age 18 to 40 (1.72), and alcohol misuse (1.62) Low: None	> = 70% of patients in this cluster have this variable: Coagulopathy (99.36) > = 70% of patients in this cluster have this variable: Coagulopathy (100.00)
Clusters specific to SMI
Peptic ulcer disease
n (%): 1,313 (5.62) Median (IQR): Conditions: 4 (3 to 5) Age: 70.00 (57.97 to 82.00)	Chronic diseases High: Peptic ulcer (16.32), peripheral vascular disease (1.54), and liver disease (1.25) Low: Paresis/paralysis (0.0), blood loss anaemia (0.0), coagulopathy (0.0), HIV (0.30), hypothyroidism (0.65), congestive heart failure (0.76), diabetes (0.79), and asthma (0.80) Health risk factors and demographics High: Underweight (2.19), alcohol misuse (1.56), male (1.30), and age 65+ (1.26) Low: Never smoked (0.76) and female (0.80) SMI: Low: Schizophrenia (0.79)	> = 70% of patients in this cluster have this variable: Peptic ulcer (91.63) > = 70% of patients in this cluster have this variable: Peptic ulcer (100.00)
Paresis/paralysis
n (%): 466 (1.99) Median (IQR): Conditions: 3 (2 to 4) Age: 54.93 (47.59 to 74.00)	Chronic diseases High: Paresis/paralysis (49.54), neurological disease (2.32), cerebrovascular disease (1.44), and coagulopathy (1.38) Low: Blood loss anaemia (0.0), peripheral vascular disease (0.51), hypothyroidism (0.53), cardiac arrhythmia (0.57), rheumatic/collagen disease (0.57), COPD (0.59), hypertension (0.60), diabetes (0.64), liver disease (0.65), renal disease (0.65), valvular disease (0.66), congestive heart failure (0.71), and HIV (0.74) Health risk factors and demographics High: Age 18 to 40 (1.92), never smoked (1.40), normal weight (1.36), and male (1.27) Low: Underweight (0.62), age 65+ (0.68), and ex-smoker (0.80) SMI: Low: Schizophrenia (0.75)	> = 70% of patients in this cluster have this variable: Paresis/paralysis (98.72) > = 70% of patients in this cluster have this variable: Paresis/paralysis (100.00)

Expected: the prevalence in the multimorbidity SMI or comparator cohort.

COPD, chronic obstructive pulmonary disease; HIV, human immunodeficiency virus; SMI, severe mental illness.