Physical, psychological, and cognitive multimorbidity patterns and the risk of disability among older adults in China: a prospective cohort study

Abstract Background Physical disorders frequently co-occur with psychological and cognitive conditions, increasing the risk of disability. However, the specific disability risks associated with distinct multimorbidity patterns remain unclear. This study aimed to examine the differential risks of disability associated with various combinations of physical, psychological, and cognitive disorders. Methods Data were obtained from the 2018 China Health and Retirement Longitudinal Study, involving 5186 adults aged 60 and older with a 2-year follow-up. Modified Poisson regression models were utilized to assess associations between multimorbidity patterns and disability risk, stratified by age and sex. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated. Results Five disease patterns were identified: only physical disorders, psychological or cognitive disorders, physical-cognitive multimorbidity, physical-psychological multimorbidity, and physical-psychological-cognitive multimorbidity. Compared to participants without disorders, four patterns were significantly associated with disability after two years. Specifically, physical-psychological-cognitive multimorbidity presented the highest risk (aRR = 4.02, 95%CI:2.94–5.50), followed by physical-psychological multimorbidity (aRR = 3.30, 95%CI:2.40–4.54), physical-cognitive multimorbidity (aRR = 2.20, 95%CI:1.60–3.03), and only physical disorders (aRR = 1.85, 95%CI:1.36–2.52). Subgroup analyses by age and sex yielded consistent results. Conclusions This study demonstrates a graded increase in disability risk among older adults in China across various combinations of physical, psychological, and cognitive disorders, particularly when psychological conditions coexist with physical illnesses. These findings suggest that emotional and cognitive screenings should be integrated into routine geriatric assessments.