Comorbidity patterns of chronic respiratory diseases in older Chinese adults: A repeated cross-sectional study from CHARLS

Chronic respiratory diseases (CRDs) are prevalent among Chinese adults aged 45 and older, and the increasing prevalence of multimorbidity in this population presents significant public health challenges. Understanding the comorbidity patterns and their determinants is crucial for targeted interventions. To identify and characterize multimorbidity patterns among Chinese adults aged ≥45 years, delineate the centrality of CRDs within these patterns, and identify biopsychosocial-behavioral determinants for tailored interventions. Data from China Health and Retirement Longitudinal Study (2011-2020) were analyzed using hierarchical clustering and Apriori association rules; multivariable logistic regression was employed to evaluate biopsychosocial-behavioral correlates. From 2011 to 2020, multimorbidity increased from 12.39% to 24.92%. CRDs served as network hubs, asthma and other CRDs frequently co-occurred with hypertension and diabetes. Factors associated with a higher risk of multimorbidity included lower educational attainment, smoking, poor sleep quality, poor mental health, impaired activities of daily living/instrumental activities of daily living and healthcare utilization. CRDs represent critical nodes within growing multimorbidity networks. To address multimorbidity effectively, integrated and personalized strategies, including smoking cessation, sleep enhancement, functional assessment, and optimized healthcare utilization, are essential.