The prevalence and patterns of multimorbidity among community-dwelling older adults in China: a cross-sectional study

Abstract

BackgroundStudies on the patterns of multimorbidity in nationwide older Chinese population are scarce. This study aimed to analyse the current status of multimorbidity among older Chinese people and to explore their multimorbidity patterns. MethodsThis cross-sectional study used data from the China Health and Retirement Longitudinal Study collected between 2011 and 2015. Participants aged 50 years or older with demographic and health records were included in this study. Patterns of multimorbidity were explored using hierarchical cluster analysis stratified by gender and region (south vs north, defined by the Qinling-Huai River). Findings16 965 (99·7%) of 17 021 participants had correct demographic and health record data and were eligible for inclusion in our study. The mean age of all participants was 62·3 years (SD 8·79), and 8483 (50%) of 16 965 participants were women. Of the 17 chronic diseases or conditions included, the overall prevalence ranged from 0·99% (n=167) for cancer to 33·71% (n=5712) for arthritis. 6506 (44%) of the 14 938 participants with complete disease data had two or more chronic diseases or conditions. The prevalence of multimorbidity was significantly different between regions (χ2 16·35, p<0·0001) and sexes (χ2 81·41, p<0·0001). Five consistent multimorbidity patterns were identified across all sex and region strata: metabolic cluster, hepatorenal cluster, respiratory cluster, cerebral cluster, and stomach-arthritis cluster. Some heterogeneity was observed for the composition of multimorbidity clusters across sex and region strata. A stomach-arthritis cluster was assembled with a hepatorenal cluster in the north, but the two clusters were separated in the south. For women, a cardiopulmonary cluster, including heart and respiratory problems, was seen in the north, whereas a cardiometabolic cluster occurred in the south. For men, four multimorbidity clusters (cerebral-cardiometabolic cluster, hepatorenal-stomach cluster, respiratory-skeletal-glaucoma cluster, and stomach-arthritis cluster) occurred in the south, whereas five clusters (cardiometabolic cluster, cerebral-skeletal cluster, hepatorenal-stomach-arthritis cluster, respiratory cluster, and ophthalmic-cancer cluster) occurred in the north. InterpretationOur results show that the prevalence and patterns of multimorbidity varies by sex and region among older Chinese people, which might be explained by socioeconomic, environmental, and demographic factors. Although our study is limited by the self-reported chronic diseases or conditions, our findings are useful for the identification of preventative strategies for each specific subgroup of patients showing a particular multimorbidity pattern. FundingNational Natural Science Foundation of China.