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Background <p>The comorbidity rate of chronic diseases among the elderly in China is rising steadily, significantly influencing their healthcare utilization. This study aims to identify latent trajectories of chronic disease accumulation in the elderly and assess the impact of comorbidity and changes in the number of chronic diseases on outpatient and inpatient service use, providing clues for precise intervention and optimization of medical resource allocation.</p> Methods <p>Data from five waves (2011, 2013, 2015, 2018, 2020) of the China Health and Retirement Longitudinal Study (CHARLS) were utilized. Cross-sectional analysis (2020, <i>n</i> = 8,316, aged ≥ 60) employed multivariable logistic regression and zero-inflated negative binomial regression to assess comorbidity’s impact. Longitudinal analysis (<i>n</i> = 1,178, followed from 2011 to 2020, aged ≥ 60) used latent class growth model (LCGM) to identify chronic disease number trajectories. Multivariable logistic regression evaluated the dynamic impact of change in the number of diseases on service use. Binary and ordered logistic regressions analyzed baseline disease count’s effect on future increases.</p> Results <p>The comorbidity rate among Chinese elderly (≥ 60) was 66.7%. Comorbidity and increasing disease numbers significantly raised the risk and frequency of outpatient and inpatient service utilization. Latent class growth model identified four distinct chronic disease development trajectories: relative stabilized trajectory, low-increment trajectory, medium-increment trajectory, and high-increment trajectory, all showing varying degrees of upward trend. Individuals in higher increment trajectories faced significantly greater risks of increased healthcare utilization. Higher baseline disease counts also predicted greater risk of accumulating additional diseases.</p> Conclusions <p>Chronic disease comorbidity is highly prevalent and increasing among Chinese elderly. Both the number of chronic diseases and their progression significantly drive higher healthcare utilization and demand. There are also significant differences in the development of the number of chronic diseases among the population. The findings stress dynamic risk prevention, identifying high-risk populations for coordinated, proactive health management and precise resource allocation to relieve system strain from comorbidities.</p>

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Chronic disease comorbidity and its impact on healthcare utilization among older adults in China: a cross-sectional and longitudinal analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月8日

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  • Houyu Chen,
  • Xinru Huang,
  • Yu Xiang,
  • Ru Meng,
  • Muwei Zhu

摘要

Background

The comorbidity rate of chronic diseases among the elderly in China is rising steadily, significantly influencing their healthcare utilization. This study aims to identify latent trajectories of chronic disease accumulation in the elderly and assess the impact of comorbidity and changes in the number of chronic diseases on outpatient and inpatient service use, providing clues for precise intervention and optimization of medical resource allocation.

Methods

Data from five waves (2011, 2013, 2015, 2018, 2020) of the China Health and Retirement Longitudinal Study (CHARLS) were utilized. Cross-sectional analysis (2020, n = 8,316, aged ≥ 60) employed multivariable logistic regression and zero-inflated negative binomial regression to assess comorbidity’s impact. Longitudinal analysis (n = 1,178, followed from 2011 to 2020, aged ≥ 60) used latent class growth model (LCGM) to identify chronic disease number trajectories. Multivariable logistic regression evaluated the dynamic impact of change in the number of diseases on service use. Binary and ordered logistic regressions analyzed baseline disease count’s effect on future increases.

Results

The comorbidity rate among Chinese elderly (≥ 60) was 66.7%. Comorbidity and increasing disease numbers significantly raised the risk and frequency of outpatient and inpatient service utilization. Latent class growth model identified four distinct chronic disease development trajectories: relative stabilized trajectory, low-increment trajectory, medium-increment trajectory, and high-increment trajectory, all showing varying degrees of upward trend. Individuals in higher increment trajectories faced significantly greater risks of increased healthcare utilization. Higher baseline disease counts also predicted greater risk of accumulating additional diseases.

Conclusions

Chronic disease comorbidity is highly prevalent and increasing among Chinese elderly. Both the number of chronic diseases and their progression significantly drive higher healthcare utilization and demand. There are also significant differences in the development of the number of chronic diseases among the population. The findings stress dynamic risk prevention, identifying high-risk populations for coordinated, proactive health management and precise resource allocation to relieve system strain from comorbidities.