Network analysis of chronic disease among middle-aged and older adults in China: a nationwide survey

Background Given the rising prevalence of chronic diseases and multimorbidity among middle-aged and older individuals in China, it is crucial to explore the patterns of chronic disease multimorbidity and uncover the underlying mechanisms driving the co-existence of multiple chronic conditions.Methods This study analyzed data from 19,206 participants in the China Health and Retirement Longitudinal Study (CHARLS 2018). The IsingFit model was used to build the chronic disease co-morbidity network, where nodes represented diseases and edges reflected conditionally independent partial correlations. Community detection identified groups of closely related diseases using the Louvain algorithm. Multivariable linear regression with forward stepwise selection explored factors influencing chronic disease co-morbidity. A random forest model ranked these factors by importance, providing insights into relationships and key contributors.Results This study identified the most frequent multimorbidity pairs in the middle-aged and older adult population as hypertension with arthritis, and digestive diseases with arthritis. Multimorbidities were classified into four subgroups: respiratory diseases, metabolic syndrome, neurological diseases, and digestive diseases. Heart disease showed centrality in the multimorbidity network, while memory-related diseases played a bridging role. Key factors associated with multimorbidity included age, gender, pain, sleep, physical activity, depression, and education. Random forest analysis revealed that age and pain had the greatest impact on multimorbidity development, offering insights for targeted prevention and management strategies.Conclusion This study systematically analyzed multimorbidity patterns and their influencing factors in the Chinese middle-aged and older adult population. The data were examined at three levels: overall network, key influencing factors, and individual characteristics. Cardio-metabolic diseases were identified as a core component of the multimorbidity network. Advanced age, pain, and depression were found to be independent risk factors affecting the number of multimorbidities, while healthy behaviors acted as significant protective factors. The study enhances understanding of multimorbidity mechanisms and provides a scientific basis for public health interventions, emphasizing the importance of behavioral modification, health education, and social support for high-risk groups.