Meaning of main variables.

BackgroundThe comorbidity of chronic diseases among middle-aged and elderly people is a global public health concern that has attracted great attention in recent years. It is crucial to explore the evolutionary pattern of chronic disease comorbidity in Chinese middle-aged and elderly people and to reveal the developmental trajectory of chronic diseases in this population.MethodsData from the China Health and Retirement Longitudinal Study (CHARLS 2015–2020) were utilized for the fixed cohort analysis. Based on the prevalence information of 14 chronic diseases (including hypertension, dyslipidemia, diabetes, cancer, chronic lung diseases, liver disease, heart disease, stroke, kidney disease, stomach diseases, emotional problems, memory-related diseases, arthritis, and asthma) among 10,089 participants aged ≥45 years, association rules and cluster analysis were used to identify trends and trajectories of comorbidities in the middle-aged and elderly populations in China.ResultsThe analysis revealed that the comorbidity rate of the 14 chronic diseases showed a consistent annual increase from 2015–2020. By 2020, over 85% of patients diagnosed with a single chronic condition exhibited concurrent multimorbidity. This epidemiological progression was paralleled by a progressive increase in detected disease associations: binary comorbidities rose from three significant associations in 2015–10 in 2020, whereas higher-order combinations expanded from one ternary association in 2015–35 ternary and 18 quaternary associations by 2020. Notably, hypertension maintained a central position across all identified comorbidity clusters. The comorbidity patterns identified in 2015 included respiratory, liver and kidney, and cardio-cerebral comorbidity patterns and cancer and emotional problems. The comorbidity patterns identified in 2018 included respiratory, liver and kidney, cerebrovascular, and cardiovascular metabolic comorbidity patterns. The comorbidity pattern in 2020 was the same as that in 2018.ConclusionThe issues of comorbidities in chronic diseases among Chinese middle-aged and elderly people is significant, with observed variations in the comorbidity patterns across different time periods. The development of clinical assessment and management guidelines for chronic diseases comorbid with key conditions, such as hypertension and dyslipidemia, is recommended. These guidelines aim to facilitate the co-management, co-treatment, and co-reduction of multiple diseases among middle-aged and elderly people.背景 中老年人群慢性病共病现象已成为近年来广受关注的全球公共卫生议题。探究中国中老年人群慢性病共病的演化模式，揭示该群体慢性病的发展轨迹，具有至关重要的研究意义。 方法 本研究采用固定队列分析方法，数据来源于2015-2020年中国健康与养老追踪调查（China Health and Retirement Longitudinal Study, CHARLS）。研究纳入10089名年龄≥45岁的研究对象，基于14种慢性病（包括高血压、血脂异常、糖尿病、恶性肿瘤、慢性肺部疾病、肝脏疾病、心脏疾病、脑卒中、肾脏疾病、胃部疾病、情感障碍、记忆相关疾病、关节炎及哮喘）的患病信息，采用关联规则（association rules）与聚类分析（cluster analysis）方法，识别中国中老年人群慢性病共病的趋势与轨迹。 结果 分析显示，2015-2020年间，14种慢性病的共病率呈持续逐年上升趋势。至2020年，85%以上的单一慢性病确诊患者均合并存在多种慢性病。这一流行病学进展与检出的疾病关联模式的逐步增加相平行：二元共病（binary comorbidities）从2015年的3个显著关联增至2020年的10个，而高阶共病组合则从2015年的1个三元关联（ternary association），扩展至2020年的35个三元关联与18个四元关联（quaternary associations）。值得注意的是，高血压在所有已识别的共病聚类中始终处于核心地位。2015年识别的共病模式包括呼吸系统、肝肾及心脑血管共病模式，以及恶性肿瘤与情感障碍共病模式；2018年识别的共病模式则涵盖呼吸系统、肝肾、脑血管及心血管代谢共病模式；2020年的共病模式与2018年一致。 结论 中国中老年人群慢性病共病问题突出，且不同时间段的共病模式存在差异。建议针对高血压、血脂异常等关键共病慢性病制定临床评估与管理指南，以促进中老年人群多种疾病的协同管理、联合治疗及多重疾病负担的协同降低。