Spatial and temporal patterns and determinants of chronic disease multimorbidity among middle-aged and older adults in China: Evidence from two longitudinal cohort studies

Abstract

Objectives

This study aims to investigate the spatial and temporal heterogeneity in the evolution and determinants of multimorbidity among middle-aged and elderly populations, thereby providing data support for formulating regionalized prevention and control measures for multimorbidity.

Study design

Retrospective analysis of two longitudinal cohort studies.

Methods

We utilized longitudinal data from five waves of the China Health and Retirement Longitudinal Study (CHARLS, 2011–2020) and the China Family Panel Study (CFPS, 2012–2020), focusing on individuals aged 45 years and older. Sociodemographic information and chronic disease prevalence were extracted and analyzed using geographic information system (GIS) technology to identify spatial and temporal patterns in the development of multimorbidity and the identification of determinants influencing multimorbidity across different provinces.

Results

Between 2011 and 2020, the prevalence of chronic diseases among middle-aged and elderly individuals showed a fluctuating but overall upward trend at both the national level and within the regions of China. A spatial pattern of stepwise increase from east to west emerged, with Henan Province consistently serving as the epicenter of multimorbidity prevalence. Significant spatial autocorrelation was detected in the distribution of multimorbidity. Moreover, the determinants behind multimorbidity exhibited marked spatial heterogeneity, indicating region-specific influences. Alcohol consumption leads to increased risk of multimorbidity, especially in the East China regions. The Northwest region is the primary location where smoking has a negative effect.

Conclusions

Multimorbidity among middle-aged and elderly adults in China is not only highly prevalent but also increasing at a rapid pace. The spatial distribution highlights the need for geographically differentiated public health strategies. Particular attention should be paid to the higher prevalence among women, and targeted tobacco and alcohol control policies are especially warranted in northwestern regions of the country.