Diabetes and depression are global public health issues. There is a significant correlation between diabetes and depression. Therefore, monitoring and intervening in diabetes, depression, and their comorbidity among middle-aged and elderly people is crucial.

To explores the prevalence of diabetes and depression, as well as their comorbidity, among the elderly population, and the impact of sleep, exercise, and social activities on these conditions.

Based on the 2018 China Health and Retirement Longitudinal Study, 11 177 participants who met the research criteria were included as subjects. A multifactorial Logistic regression analysis model was employed to investigate the association between sleep, exercise, and social activities with the comorbidity of diabetes and depression. Subsequently, the product of nap duration and nighttime sleep duration was incorporated into the regression model for interaction analysis.

A total of 11 177 subjects were included in the study, with a prevalence of diabetes of 13.95% (1 559/11 177), a prevalence of depressive status of 24.85% (2 777/11 177), and a comorbidity prevalence of both diabetes and depressive status of 14.64% (1 636/11 177). The results of the multinomial Logistic regression analysis indicated that a nighttime sleep duration of 7 to 9 hours (OR=0.337, 95%CI=0.296-0.384), a nighttime sleep duration greater than 9 hours (OR=0.509, 95%CI=0.374-0.692), and a nap duration greater than 90 minutes (OR=0.792, 95%CI=0.666-0.941) were all protective factors for the comorbidity of diabetes and depressive status. High levels of social interaction were also found to reduce the risk of comorbidity (OR=0.778, 95%CI=0.686-0.882, P<0.05). The interaction analysis results showed that maintaining a nighttime sleep duration of 7 to 9 hours, regardless of nap duration, was effective in preventing the comorbidity of diabetes and depressive status (P<0.001). If the nighttime sleep duration is less than 7 hours, a nap duration of 60 to 90 minutes can also reduce the risk of comorbidity (OR=0.740, 95%CI=0.577-0.950, P<0.05). In the case of a nighttime sleep duration greater than 9 hours, not taking a nap (OR=0.270, 95%CI=0.125-0.581) or maintaining a nap duration of 60 to 90 minutes (OR=0.165, 95%CI=0.040-0.674) can also reduce the risk of comorbidity.

The comorbidity prevalence of diabetes and depressive status among middle-aged and elderly people in China is relatively high (14.64%). Nighttime sleep duration of more than 7 hours, nap duration of more than 90 minutes, and a high level of social interaction can all effectively reduce the risk of comorbidity of diabetes and depressive status. Moderate levels of physical activity can reduce the risks of diabetes and depressive status respectively. Napping serves as a compensatory mechanism, helping to make up for insufficient nighttime sleep. If nighttime sleep is less than 7 hours, controlling the nap duration to 60 to 90 minutes can also reduce the risk of comorbidity of diabetes and depressive status.

Cardiometabolic multimorbidity (CMM) is one of the most common patterns of co-morbidity aggregated in middle-aged and older adults. It greatly increases the risk of disability and death in our country. Insulin resistance and obesity are closely related to the occurrence and development of cardiometabolic diseases (CMD). The correlation between obesity and various types of CMD has been previously confirmed. The risk of CMM in residents with varying types of obesity and gender may be different and still unclear.

To identify the correlation of the type of obesity and CMM in male and female middle-aged residents in Anhui Province.

The subjects of this study were derived from the Early Screening and Comprehensive Intervention Program for People at High Risk of Cardiovascular Disease carried out in Anhui Province from 2017 to 2021, with a total of 10 project sites involving community residents in 12 counties and cities. Finally, 70 812 permanent middle-aged residents (45-<65 years) were included. Surveying of the subjects was performed by pre-trained investigators, including the general information (age, gender, smoking, alcohol consumption, remarriage education level of high school and above, farmers), disease history (hypertension, heart disease, diabetes, stroke, dyslipidemia), physical examination (height, body mass index, waist circumference), and laboratory tests (blood glucose, blood lipids). Subjects were divided into male and female, and sub-divided into non-obese, peripheral obesity, central obesity, and compound obesity. Logistic regression analysis was conducted to explore the correlation of CMM with gender and type of obesity. The effect value in male and female groups with different types of obesity was compared by the Z-test in R package.

A total of 26 726 male and 44 086 female residents were included. The prevalence of CMM in the total population, male and female groups was 14.6% (10 361/70 812), 16.6% (4 445/26 726), and 13.4% (5 916/44 086), respectively. The prevalence of hypertension, diabetes mellitus, heart disease, stroke, and dyslipidemia among middle-aged residents of Anhui Province was 27.0%, 7.8%, 0.5%, 2.5%, and 29.5%, respectively. Logistic regression analysis showed that, after adjusting for age, smoking, alcohol consumption, remarriage, education level of high school and above, and occupation of farmers, the risk of CMD significantly increased in the peripheral obesity (OR=1.665, 95% CI=1.599-1.734), central obesity (OR=1.788, 95% CI=1.656-1.930), and compound obesity subgroups (OR=3.020, 95% CI=2.913-3.131) than the non-obesity subgroup (P<0.05). In either the male or female group, the risk of CMM increased sequentially in the peripheral obesity, central obesity, and compound obesity subgroups. In the male group, the OR (95%CI) of an increased risk of CMM in peripheral obesity, central obesity, and compound obesity subgroups compared to the non-obese subgroups was 2.008 (1.822-2.213), 2.281 (1.875-2.774), and 4.137 (3.799-4.504), respectively; while in the female group, it was 1.574 (1.443-1.717), 1.727 (1.509-1.976), and 2.916 (2.721-3.126), respectively (P<0.05). The Z-test results showed a significant difference among the peripheral obesity, central obesity, and compound obesity subgroups in male and female residents (P<0.05). After adjusting for the blood lipids and other related indexes, the risk of CMM in the peripheral obesity, central obesity, and compound obesity subgroups in male and female residents increased sequentially with a significant difference (P<0.05). Z-test showed a significant difference in the risk of CMM in the compound obesity subgroup of male and female residents (Z=2.258, P<0.05) .

The risk of CMM varies in middle-aged residents of Anhui Province with different types of obesity, showing the highest risk in those with compound obesity, followed by central obesity. Male middle-aged residents with compound obesity have a higher risk of CMM than females, serving as a highly concerned population.

With the progression of aging in China and the increase in the population with multiple coexisting diseases, the high risk associated with cardiovascular-metabolic multimorbidity (CMM) has made it a focal point for research. However, most studies have concentrated on individual cardiovascular metabolic diseases rather than exploring the comprehensive correlations within CMM.

To investigate the relationship between the triglyceride-glucose (TyG) index and the risk of CMM in middle-aged and elderly Chinese populations, and to evaluate the role of TyG in the prevention and control of CMM.

Participants were derived from the Anhui Province High-Risk Population Early Screening and Comprehensive Intervention Project for Cardiovascular Diseases conducted between 2017 and 2021. A total of 94 455 subjects were included based on inclusion and exclusion criteria. Baseline characteristics and laboratory examination indices were collected, and the TyG index was calculated. Multivariate logistic stepwise regression analysis was used to explore the impact factors of CMM by TyG as both a continuous variable and different quartiles. Z-tests were applied to compare odds ratio (OR) between groups. Restricted cubic spline (RCS) analysis was employed to assess potential non-linear associations, RCS curves were plotted, and the cutoff point where OR=1 was calculated.

Among the participants, 1 456 cases (664 males, 792 females) were identified with CMM, while 92 999 cases (38 313 males, 54 686 females) did not have CMM. In males, patients with CMM had higher age, BMI, mean arterial pressure (MAP), fasting plasma glucose (FPG), triglycerides (TG), proportion of individuals with high school education or above, diabetes, ischemic heart disease, stroke, hypertension, and TyG index compared to those without CMM (P<0.05) ; they also had lower rates of smoking, drinking, farmer occupation, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) (P<0.05). Men and women were stratified into quartiles based on their TyG index values. For men, the groups were T1 (TyG 6.90-8.33, n=9 745), T2 (TyG 8.34-8.67, n=9 744), T3 (TyG 8.68-9.08, n=9 744), and T4 (TyG 9.09-11.60, n=9 744). For women, the groups were F1 (TyG 7.07-8.49, n=13 870), F2 (TyG 8.50-8.82, n=13 870), F3 (TyG 8.83-9.21, n=13 869), and F4 (TyG 9.22-11.60, n=13 869). Multivariable Logistic stepwise regression analysis demonstrated that after adjusting for age, marital status, smoking, alcohol consumption, educational level (high school or above), occupation (farmer), TC, HDL-C, LDL-C, BMI, hypertension, and MAP, he odds of CMM were 9.045 times higher in T4 than in T1 (OR=9.045, 95%CI=6.372-13.169, P<0.001) and 7.442 times higher in F4 than in F1 (OR=7.442, 95%CI=5.576-10.080, P<0.001). The Z-test indicated no statistically significant difference in the extent of OR elevation between genders (Z=0.824, P=0.410). For each unit increase in TyG, the risk of CMM increased by 3.960 times in males (OR=3.960, 95%CI=3.388-4.620, P<0.001) and by 4.447 times in females (OR=4.447, 95%CI=3.845-5.137, P<0.001), with no statistically significant difference in OR elevation between genders (Z=-1.216, P=0.224). RCS analysis revealed a significant non-linear relationship between TyG index and CMM risk after adjusting for confounders (P_nonlinear<0.05), indicating an increased risk when TyG>8.82 with a notably steeper slope.

The TyG index is closely related to the risk of CMM occurrence in both genders and exhibits similar predictive power. Individuals with a TyG>8.82 should be particularly monitored, and proactive preventive and intervention measures should be implemented to reduce the risk of CMM.

Existing studies have extensively explored the association between the triglyceride-glucose index (TyG) and cardiometabolic diseases (CMD), while the relationship between TyG and the occurrence of cardiometabolic multimorbidity (CMM) in the elderly population has been overlooked.

This study aims to investigate the association between TyG and the incidence of CMM in the elderly population.

A prospective cohort study was conducted using the Cheeloo Lifetime Electronic Health Database (Cheeloo LEAD), selecting elderly individuals aged ≥60 years in 2016. Using 2016 as the baseline, the study endpoints were defined as the occurrence of CMM or death, with the follow-up period lasting until December 31, 2022. Participants were divided into four groups based on the quartiles of the baseline TyG: Q1 (5.88≤TyG<8.22), Q2 (8.22≤TyG<8.53), Q3 (8.53≤TyG<8.90), and Q4 (8.90≤TyG<11.33). Kaplan-Meier survival curves were plotted, and Cox proportional hazards models were used to assess the impact of TyG on the risk of incident CMM. Subgroup and sensitivity analyses were also conducted. Restrictive cubic splines (RCS) were applied to explore the relationship between TyG and CMM.

A total of 15 258 participants were included in the analysis, with 3 875 in the Q1 group, 3 776 in the Q2 group, 3 840 in the Q3 group, and 3 767 in the Q4 group. The average follow-up time was 5.63 years, totaling 85 862.48 person-years of follow-up. There were 1 328 new cases of CMM (8.70%). The cumulative incidence rates of new CMM in the Q1-Q4 groups were 5.81%, 7.65%, 9.27%, and 12.16%, respectively. The comparison of CMM incidence rates among the four groups showed statistically significant differences (χ²=104.300, P<0.001). The results of the fully adjusted Cox proportional hazards model showed that, compared to the Q1 group, the risk of incident CMM in the Q2, Q3, and Q4 groups increased by 25.4% (HR=1.254, 95%CI=1.052-1.494, P<0.05), 42.0% (HR=1.420, 95%CI=1.196-1.686, P<0.001), and 83.6% (HR=1.836, 95%CI=1.535-2.195, P<0.001), respectively. The trend test in the Cox model indicated a dose-response relationship between TyG and the risk of incident CMM. This association was consistent in subgroup analyses based on sex and BMI, as well as in sensitivity analyses (P<0.05). RCS analysis showed a dose-response relationship between TyG and the risk of new CMM (P<0.001, P_{non-linearity}=0.175) .

TyG is an independent risk factor for incident CMM in the elderly population, with a dose-response relationship between the two. As TyG levels increase, the risk of incident CMM rises, and high TyG levels significantly elevate the risk of CMM, particularly in males and individuals with higher BMI. Controlling TyG levels plays an important role in disease prevention among the elderly population.

With the acceleration of population aging, chronic disease comorbidities have become a major public health problem threatening the health of the elderly. There is a close correlation between chronic disease comorbidity and activity of daily living (ADL). However, there are few studies on the influence of chronic disease comorbidity and comorbidity pattern on ADL.

To understand the impact of chronic disease comorbidity on ADL, to provide a reference for improving the quality of life of the elderly.

From June to July 2022, a multi-stage stratified random cluster sampling method was used to conduct a face-to-face household survey among 20 821 residents in 4 counties of Ningxia Hui Autonomous Region, including demographic characteristics, chronic diseases, and ADL impairment. In this study, 4 362 elderly people (≥60 years) were included as subjects. Potential category analysis was used to determine comorbidity patterns, and Logistic regression was used to analyze the effects of chronic disease comorbidity and different comorbidity patterns on activities of daily living.

The prevalence of chronic diseases among the elderly included was 62.52% (2 727/4 362), the prevalence of comorbidities was 23.75% (1 036/4 362), the ADL damage rate was 18.36% (801/4 362). Five comorbidity patterns were identified based on the latent category analysis, namely the coronary heart disease comorbidity group, the rheumatoid arthritis comorbidity group, the diabetes comorbidity group, the hypertension comorbidity group, and the multisystem disease comorbidity group. Adjusting for factors such as gender, age, educational level, marital status, occupation, annual per capita household income, smoking, alcohol consumption, exercise status, and self-rated health status, elderly people with comorbidity had 1.909 times (95%CI=1.581-2.305, P<0.05) risk of impaired ADL than those without comorbidity, older adults in the rheumatoid arthritis comorbidity group had a higher risk of impaired ADL than those in the coronary heart disease comorbidity group [OR (95%CI) =1.834 (1.245-2.701), P<0.05] .

Older adults with chronic comorbidities have a higher risk of ADL impairment than older adults without chronic comorbidities. There are differences in the risk of ADL impairment among the elderly with different comorbidity patterns of chronic diseases. The risk of ADL impairment in the elderly in the comorbidity group of rheumatoid arthritis is higher than that in the comorbidity group of coronary heart disease. Therefore, there is an urgent need to pay more attention to elderly people with chronic disease comorbidities, appropriate measures should be taken to improve their health and improve their quality of life.

Chronic obstructive pulmonary disease (COPD) patients often present with multiple comorbidities, which increase the complexity of treatment and the healthcare of burden. While comorbidities significantly impact the management of COPD patients, existing research primarily focuses on individual comorbidities, lacking systematic analysis of multiple comorbidity patterns and hospitalization costs.

To investigate the comorbidity characteristics and patterns in patients with COPD, analyzing how different features and comorbidity patterns affect hospitalization costs. The findings will provide a basis for personalized health management and resource allocation for COPD patients.

A retrospective analysis was conducted on 5 061 inpatients diagnosed with COPD at the First Affiliated Hospital, Guangzhou Medical University from 2020 to 2023. Systematic clustering analysis was employed to construct dendrograms, identifying comorbidity patterns among COPD patients. Multiple group comparisons were performed to assess the basic characteristics of these patterns, then multiple linear regression analysis was utilized to evaluate the impact of each comorbidity pattern on total hospitalization costs, western medicine costs, and antibacterial medication costs.

There are a total of 4 343 patients with COPD, and the comorbidity was 85.81%. Systematic clustering analysis identified six comorbidity patterns among COPD patients: cardiovascular and metabolic diseases, hepatorenal diseases, digestive system diseases, arthropathy diseases, cancer and respiratory system diseases. There were significant differences in sex, age, BMI and smoking history among patients with 6 comorbidity models (P<0.05). Multiple linear regression analysis revealed that BMI, cancer pattern, and respiratory system diseases pattern all had impacts on total hospitalization costs, western medicine costs and antibacterial medication costs (P<0.05), with the respiratory system diseases pattern having the most substantial impact on total hospitalization costs (β=0.125, P<0.001) .

Comorbidity patterns in COPD can be categorized into six clusters. BMI, cancer pattern and respiratory system diseases pattern are the primary factors influencing hospitalization costs.

With the continuous development of the concept and practice of "patient-centered" medical and health service, the traditional family doctor contract service model, which focuses on single-disease treatment and management, cannot effectively meet the service needs of patients with multiple chronic diseases.

To explore that preference of patients with hypertension and type 2 diabetes for family doctor contract service in Hainan Province, and to provide empirical evidence for optimizing the contract service plan of family doctor.

A multi-stage stratified random sampling method was used to conduct a questionnaire survey from July 2023 to February 2024. The service preference of family doctors with hypertension and type 2 diabetes comorbid patients in Hainan Province was measured by discrete choice experiment (DCE). The set preference attributes were institutional nature, implementation environment, doctor's title, service mode, medication guidance and out-of-pocket expenses, service content attribute. A mixed Logit model was constructed with Python 3.11.7 software for preference analysis.

A total of 581 questionnaires were sent out, and 558 were valid, with an effective recovery rate of 96.0%. Six attributes, including institutional nature, implementation environment, doctor's title, service mode, medication guidance and out-of-pocket expenses, had significant effects on patients' preference for family doctor contracted service (P<0.05). The service content attribute had no significant effect (P>0.05). Patients with HTN-T2DM prefer to choose government-run institutions, door-to-door service, priority referral, senior doctor title, 50 yuan/month and 2 weeks medication guidance.

The institutional nature being government-run is the most highly valued attribute for patients. Home visit services and priority referral are important attributes that influence the preference for family doctor contracted services. It is suggested that a personalized family doctor contract service plan based on the preferences of patients with chronic diseases and comorbidities be formulated with a patient-centered approach to promote the high-quality development of family doctor contract services.

The lack of disease self-management awareness in patients after percutaneous coronary intervention (PCI) affects the prognosis, and the prognosis of patients with diabetes is worse. The establishment of chronic disease follow-up system and the collaborative management of the two diseases become the key to the rehabilitation of patients.

To construct a comorbidity follow-up model for patients with coronary heart disease complicated with diabetes after PCI based on the theory of chronic disease self-management and CICARE communication model, and to explore the application effect.

From January to April 2022, literature review, semi-structured interviews and expert correspondence were used to constructed a comorbidity follow-up model for patients with coronary heart disease complicated with diabetes after PCI. Patients with coronary heart disease complicated with diabetes who received PCI in the Department of Cardiology of Chu Hsien-I Memorial Hospital, Tianjin Medical University from May to December 2022 were selected as research subjects. They were divided into two groups by using the random number table method. The control group (77 cases) received routine follow-up, and the test group (78 cases) received comorbidity follow-up model. The scores of Coronary Heart Disease Self-management Scale (CSMS) and other outcome indicators were compared between the two groups before discharge, 3 months and 6 months after discharge.

The positive coefficients of experts in the two rounds of expert correspondence were both 100%, the authority coefficient was 0.87, and the coordination coefficient was 0.310 and 0.334, respectively (all P<0.001) . The comorbidity follow-up model included three dimensions, 11 modules and 30 contents. Finally, 64 patients in each group completed the follow-up. There was an interaction between group and time on the scores of CSMS (F=150.504, P<0.001) . The scores of CSMS at 3 months and 6 months after discharge were higher than those before discharge (P<0.001) , and the scores of the test group were higher than those of the control group (P<0.05) . After 6 months, the BMI of the test group was lower than that of the control group (P<0.05) .

The constructed comorbidity follow-up model after PCI was scientific and effective, which can improve the self-management behavior of patients after PCI and reduce BMI.

When insomnia and obstructive sleep apnea (OSA) coexist, it is referred to as comorbid insomnia and obstructive sleep apnea (COMISA). The prevalence of COMISA in the general population ranges from 0.6% to 19.3%. It is primarily characterized by difficulty falling asleep, frequent nighttime awakenings, early morning awakening, poor sleep quality, snoring or apnea during sleep, unrefreshing or nonrestorative sleep, excessive daytime sleepiness, fatigue, attention impairment, memory impairment, emotional disorders, and impaired quality of life. COMISA can lead to adverse outcomes in multiple systems and increase all-cause mortality. Therefore, it is significant to establish a guidline for the diagnosis, differential diagnosis, and standardized treatment of COMISA. The guideline was organized by the Chinese Academy Society of Sleep Medicine, Chinese Medical Doctor Association and Sleep Medicine Group, China Neurologist Association. It was formed by reviewing domestic and international COMISA diagnosis and treatment practices, through literature evidence review, and after extensive discussion. The guideline summarized the epidemiology, etiology and risk factors, pathophysiological mechanisms, clinical manifestations, assessment methods, diagnosis, differential diagnosis, and treatment studies of COMISA, providing a basis for decision-making in the diagnosis and treatment of COMISA for clinician.

With the acceleration of population aging in my country, the multiple chronic conditions in the elderly has become increasingly common. This not only seriously affects the quality of life of the elderly, but also places a heavy burden on families and society. Gansu is a province with a relatively high aging population in the northwest region, and it is urgent to pay attention to the multiple chronic conditions among the elderly.

In order to understand the current status and influencing factors of multiple chronic conditions among the elderly in Gansu Province, and provide a reference basis for the prevention, treatment and management of multiple chronic conditions in Gansu Province.

From 2023-07-15 to 2023-08-10, a multi-stage stratified random cluster sampling method was used to select 20 000 elderly people aged ≥60 years old in Gansu Province for a questionnaire survey. The questionnaire was designed by the research team itself and mainly investigated the prevalence of 15 common chronic diseases among the elderly, as well as their demographic characteristics and family circumstances. In the end, 19 038 valid questionnaires were collected, and the effective questionnaire recovery rate was 95.19%.

The prevalence rate of chronic diseases among the elderly in Gansu Province was 74.78% (14 236/19 038), and the incidence rate of multiple chronic conditions was 38.97% (7 419/19 038). The top six chronic diseases with the highest prevalence were hypertension[9 693 (50.91%) ], arthritis or rheumatism[3 648 (19.16%) ], and heart disease[3 418 (17.95%) ], diabetes or elevated blood sugar[3 033 (15.93%) ], chronic lung disease[1 645 (8.64%) ], stroke[1 548 (8.13%) ]. Common comorbidity combination patterns are all related to hypertension. The top-ranked binary comorbidity pattern is hypertension + diabetes or elevated blood sugar[2 112 (11.09%) ], and the top-ranked ternary comorbidity pattern is hypertension + diabetes or elevated blood sugar + heart disease[532 (2.79%) ]. The results of multi-factor Logistic regression analysis showed that gender, age, ethnicity, pre-retirement occupation, spouse, number of children, relationship with children, self-rated health status, self-rated life satisfaction, and loneliness are influencing factors for the occurrence of multiple chronic conditions in the elderly (P<0.05) .

The incidence of multiple chronic conditions among the elderly in Gansu Province is lower than the national average. Multiple chronic conditions occurs among the elderly who are female, elderly, Tibetan, have a job before retirement, have a normal relationship with their children, have average/poor self-rated health, and have average self-rated life satisfaction. The risk of chronic disease is higher, and the risk of multiple chronic conditions is lower for the elderly who have a spouse, fewer children, and do not feel lonely. Relevant departments should focus on the prevention, treatment and management of common multiple chronic conditions in the elderly, promptly intervene in variable risk factors, strengthen the elderly's awareness of self-health management, and improve the multiple chronic conditions management system in primary medical and health institutions.

Cardiometabolic multimorbidity (CMM) was one of the most common comorbidity aggregation patterns in different regions and populations, with a high risk of mortality. However, studies on the clinical and medication characteristics of CMM were limited.

To study the clinical characteristics and medication patterns of patients with CMM in the real world, and provide reference basis for the prevention and management of CMM.

Outpatient patients who were diagnosed with CMM in the hospital information system (HIS) of the First Affiliated Hospital of Ningbo University from January 2023 to June 2023 were selected. Basic prescription information was collected and analyzed using frequency analysis and association rule analysis methods.

A total of 7 059 patients with CMM were included, of which 3 960 (56.1%) were male and 3 099 (43.9%) were female, with an age range of 18 to 97 years and a mean age of (58.1±13.7) years. The results showed that 3 910 patients with less than 5 types of medication, accounting for 55.4%; 2 740 patients with 5-9 types of medication, accounting for 38.8%; and 409 patients with more than 10 types of medication, accounting for 5.8%. Hypertension, dyslipidemia, and diabetes were the core diseases of CMM. Among the comorbidities of cardiovascular metabolic diseases, chronic gastritis, renal insufficiency, and hyperuricemia were more common. In the prescription of patients with CMM, statins, calcium channel blockers (CCB), angiotensin receptor blockers (ARB), metformin, and sodium-dependent glucose transporters 2 inhibitors (SGLT2i) were the core medications.

Our findings suggest chronic gastritis, renal insufficiency, and hyperuricemia are more common diseases in patients with CMM. Screening and prevention should be strengthened and treatment strategies should be adjusted. In the CMM drug prescription, lipid-lowering, antihypertensive, and hypoglycemic drugs are the core drugs used.

Multimorbidity pose challenges to older adults' health services. It is of great importance to explore its impact on health services utilization in the elderly. The Chinese Multimorbidity-Weighted Index (CMWI) has been developed to measure the burden of multimorbidity in Chinese middle-aged and elderly, but there is a lack of cohort studies on the association between CMWI and health service utilization.

To explore the association between burden of multimorbidity and utilization of health among older adults, which provides scientific evidence for improving the intervention and management of older adults' patients with multimorbidity.

From December 2021 to January 2024, taking Sihui City of Zhaoqing City, Guangdong Province as an example, the electronic health records of residents from 2017 to 2021 were collected from the city's national health information platform to establish a natural population cohort for health examination of the elderly. We used the time of the first health examination in this period as the baseline, the CMWI was used to measure individual's baseline burden of multimorbidity .We use the negative binomial regression to analyze the association between individual's CMWI respectively and the total number of outpatient visits, chronic disease-related outpatient visits, total number of hospitalizations and chronic disease-related hospitalizations during the follow-up period.

Among the total 39 989 participants, there were 14 991 (55.18%) cases of multimorbidity, and the CMWI was 1.3 (0, 2.3). During an average 1 268 days follow-up period, 26 141 people (65.37%) had used outpatient services, the number of total outpatient visits and chronic disease-related outpatient visits was 2 (0, 6) and1 (0, 4). In our study 7 332 (18.34%) had used hospitalization services, the number of total hospitalization and chronic disease-related hospitalization was 0 (0, 0) and 0 (0, 0). Age, genders, education levels and CMWI varied significantly by the utilization of health (P<0.05). The residential type varied significantly by the utilization of outpatient services (P<0.05) but no by utilization of inpatient services (P>0.05). After adjusting the covariates of age, gender, residence and education levels, negative binomial regression analysis showed that CMWI was a risk factor on the increase of health service utilization in the elderly (IRR>1). For each unit increase in CMWI, the total number of outpatient visits increased by 1.210 (95%CI=1.196-1.224), the number of chronic disease-related outpatient visits increased by 1.276 (95%CI=1.259-1.292), the total number of hospitalizations increased by 1.277 (95%CI=1.244-1.312), and the number of chronic disease-related hospitalizations increased by 1.286 (95%CI=1.252-1.321) .

CMWI is a risk factor for the increase of health service utilization in the elderly, and the number of health service utilization in the elderly increases with the increase of CMWI. More attention should be paid to the burden of multi-chronic diseases in the elderly, so as to provide scientific basis for improving the intervention and management of multi-chronic diseases in the elderly in China.

Patients with multimorbidity often require the concomitant use of multiple medications, presenting general practitioners (GPs) with the dilemma of assessing the benefits and risks due to complex and potential interactions between diseases and medications. This article takes one case of a multimorbid patient at a community health service center to illustrate and elucidate the process by which GP employs a medication decision-making framework for multimorbidity (MDMF). Furthermore, by examining the multi-stage goals set by Ariadne principle in the process of multimorbidity management, this article analyzes the key points and considerations for GPs in the assessment, communication, and making treatment plans, thereby offering reference to improve the quality of medication decision-making for patients with multimorbidity in the community.

Primary care physicians in community settings face numerous challenges when making medication decisions for patients with multimorbidity. Enhancing their decision-making capabilities through training is an important way to address these challenges. However, there is a dearth of in-depth research on the training needs of primary care physicians in the context of medication decision-making for multimorbidity.

This study aims to explore the challenge physicians encountered in medication decision-making for patients with multimorbidity and their needs for training content and modalities, providing a reference for designing the training courses for the abilities enhancement.

From October 5th to December 21st in 2023, physicians from community health care centers in Hangzhou, Ningbo, Jiaxing, Shenzhen, and Shanghai were recruited for in-depth interviews following the principle of purposive sampling and maximum variation, which focus on the content and formats of training to enhance medication decision-making abilities. Two researchers transcribed and coded the interviews independently, and content analysis was performed on the interview data.

A total of 20 Physicians completed the interviews and 15 were females, mean age were (38.5±3.0) years. Based on the challenges faced by primary care physicians in the medication decision-making for multimorbidity, the training should cover four aspects: evaluation of medication therapy, rational selection of medication, doctor-patient communication and shared decision-making, medication education and follow-up. In terms of training form, primary care physicians are willing to accept flexible and multiple teaching approaches, and prefer case-based training that aligns with community health needs.

Primary care physicians have clear training needs of medication decision-making for patients with multimorbidity. The results of this study provide a theoretical reference for the development of training courses, which adapt to the working environment and actual requirements of primary care physicians.

Multimorbidity refers to an individual suffering from two or more chronic diseases simultaneously. Patients with multimorbidity refers often require the concurrent use of multiple medications, posing a challenge to community general practitioners in making scientific medication decisions. This paper analyzes the reasons and influencing factors that lead to the dilemmas in medication decision-making for patients with multimorbidity in the community. It also proposes a dynamic and comprehensive decision-making framework known as the Medication Decision-making for Multimorbidity Framework (MDMF). The framework consists of five stages in the process of community general practitioners treating patients with multimorbidity, which include "Health problems review""Comprehensive medication assessment""Shared decision-making""Medication therapy recording", and "Follow-up arrangement". The MDMF facilitates the development of individualized medication therapy for patients with multimorbidity by community general practitioners, but it also places certain demands on their capabilities. Therefore, it is recommended to provide training for community general practitioners centered on the MDMF, offer decision-making support, and implement reasonable incentives and supervision measures. This is expected to promote primary care institutions to provide patient-centered medication therapy, enhance its safety and efficacy, and alleviate the treatment burden on patients.

Multimorbidity accelerates cognitive decline and leads to an increased risk of cognitive impairment. However, existing studies have mainly explored the cognitive status of patients with a single or specific chronic disease, and the patient with multimorbidity remains to be urgently explored. The present study describes the epidemiological characteristics of cognitive impairment in multimorbidity, summarizes the influencing factors, organizes the association patterns between multimorbidity and cognitive impairment, elucidates the mechanisms underlying their occurrence, and finally proposes preventive and control strategies. The findings of this study are intended to serve as a valuable reference for future efforts in preventing and treating cognitive impairment in multimorbidity.

With the population aging, the number of patients with chronic diseases and disability is increasing, which brings a heavy burden on the medical system. While it is well established that comorbidity and disability are closely interconnected, there is a noticeable scarcity of studies addressing the relationship between different patterns of comorbidity and disability.

To explore the common comorbidity patterns and their associations with disability among the older adults in China taking Sichuan as an example.

A total of 501 older adults, aged 60 and above, were selected using quota sampling in Sichuan from August to Novermber 2022. Detailed data on chronic diseases, disability, and general demographics were collected. Comorbidity patterns among the older adults were identified using a two-step clustering method that combined self-organizing maps and K-Means. The association between patterns of comorbidity and disability was explored using a logistic regression model, employing the National Disability Assessment Scale for the Long-term Care issued by the National Healthcare Security Administration of China in 2021.

In this survey, The prevalence of comorbidity 62.3% (312/501) and the prevalence of disability was 74.3% (372/501). We identified six comorbidity patterns: Arthritis/Rheumatism and Hypertension diseases, Cardiovascular and Metabolic diseases, Kidney and Arthritis/Rheumatism diseases, Cancer and Arthritis/Rheumatism diseases, Asthma, Hypertension, and Gastrointestinal diseases, Emotional/Mental and Memory-related diseases. The results of binomial logistic regression showed that the risk of disability was 6.3 times higher when people suffering from two or more chronic diseases at the same time (OR=6.3, 95%CI=3.9-10.3, P<0.05). The results of multinomial logistic regression showed that the risk of disability was increased in all six comorbidity patterns (P<0.05). Compared to the population without comorbidities, the comorbid group with the emotional/mental and memory-related diseases pattern has a 10.7 times risk with more severe disability (OR=10.7, 95%CI=1.7-63.6), which had the greatest impact on disability. Next is the Cancer and Arthritis/Rheumatism pattern (OR=7.8, 95%CI=2.4-24.8) .

The incidence of comorbidity among the older adults in Sichuan is high, and there is a significant association between several comorbidity patterns and disability, especially for the Emotional/Mental and Memory-related diseases pattern and Cancer and Arthritis/Rheumatism pattern. The health care system should focus on the older adults with comorbidity, formulate accurate and effective long-term care policies and strategies based on different comorbidity patterns to prevent and reduce the occurrence of disability, improve the well-being of the older adults, and save social medical resources.

Comorbid insomnia and sleep apnea is a highly prevalent disorder characterized by both insomnia and sleep apnea, leading to more severe impairment of daytime function and quality of life than in patients with either insomnia or obstructive sleep apnea (OSA) alone. Non-benzodiazepine drugs (NBZDs) are frontline medications for insomnia treatment, as they can improve insomnia symptoms and enhance sleep quality. However, they are not recommended for OSA treatment due to their potential to increase the apnea-hypopnea index (AHI) and worsen the severity of sleep-disordered breathing. Currently, the therapeutic effects of NBZDs on COMISA are not well-established and require further investigation. Therefore, this article adopts a systematic review approach to compile relevant literature on the use of NBZDs in patients with OSA and COMISA, analyzing the impact of NBZDs on various indicators such as AHI, oxygen desaturation index, and sleep quality. It evaluates the clinical efficacy and safety of medications including zopiclone, eszopiclone, zolpidem, and zaleplon in the treatment of COMISA, aiming to provide guidance on the rational use of NBZDs for these patients.

With the acceleration of China's aging population, the prevalence of chronic diseases and comorbidity patterns pose significant challenges to global health. There is a close relationship between the prevalence of chronic diseases and individuals' self-related health (SRH) status. However, there is limited research on the prevalence of chronic diseases and comorbidity patterns among middle-aged and elderly populations in rural areas of Xinjiang, China, and their impact on SRH status.

To understand the prevalence of chronic diseases and comorbidity patterns among middle-aged and elderly populations in rural areas of Xinjiang and to explore the impact of chronic diseases and comorbidity patterns on SRH status, providing effective reference for improving the health level of this population.

The data for this study were derived from the survey database of the National Social Science Foundation project (17BRK030) from 2016 to 2019. A questionnaire survey was conducted on the demographic characteristics, chronic disease status, and self-rated health status of male and female heads of households. Ordered logistics regression analysis was used to screen the influencing factors of SRH status. SOM network training analysis and partial least squares method were employed to evaluate the interrelationships among 14 chronic diseases and the degree of their impact on SRH status.

A total of 3 400 middle-aged and elderly individuals were surveyed. Residents' SRH status varied significantly by geographical distribution, gender, age, education level, occupation, marital status, illness or disability, and chronic disease status (P<0.05). Geographical region as southern Xinjiang, education level of primary school below, and presence of chronic diseases were identified as risk factors for SRH status (P<0.05). Being male, aged 45-59 years, occupation as pastoralists, staff of government or public institutions, or technical workers, being divorced, and having illness or disability were identified as protective factors for SRH status. The prevalence of chronic diseases among middle-aged and elderly populations in rural areas of Xinjiang was 36.47%. The top three diseases were hypertension (17.47%), arthritis or rheumatism (8.62%), and heart disease (5.68%). The comorbidity rate of chronic diseases was 8.09%, with hypertension (6.12%), arthritis or rheumatism (5.18%), and heart disease (4.71%) being the top three comorbid diseases. The predominant comorbidity pattern was the co-occurrence of two chronic diseases (78.18%). The most common comorbidity pattern among individuals with two chronic diseases was hypertension combined with heart disease, and among those with three chronic diseases was hypertension combined with heart disease and arthritis or rheumatism. The impact of chronic disease status on SRH status revealed that individuals with chronic diseases had significantly lower SRH status than those without chronic diseases, and individuals with two or more chronic diseases had lower SRH status than those with one chronic disease.

The prevalence of chronic diseases and comorbidity among middle-aged and elderly populations in rural areas of Xinjiang is high. Chronic respiratory diseases, arthritis or rheumatism, heart disease, anemia, and other chronic diseases have a significant impact on SRH status. Therefore, it is necessary to further strengthen the construction of chronic disease service systems, improve the health records of middle-aged and elderly individuals, establish specialized clinics for chronic disease comorbidity to detect and control the comorbidity of chronic diseases among middle-aged and elderly populations. Additionally, efforts should be made to enhance health education for middle-aged and elderly groups, increase awareness of chronic diseases, and promote active and healthy lifestyles to improve the health level and quality of life of middle-aged and elderly populations.

In the face of the serious challenges posed by the high prevalence of chronic diseases among the elderly and the coexistence of multiple chronic diseases, the health problems of community-dwelling elderly people' with multimorbidity require urgent attention. The comorbidity management model is being explored and practiced. Disease experience, as self-reported health information from patients, is expected to become a key component of the patient-centered community multimorbidity management model.

This study aimed to gain a deeper understanding of the real disease experience of community-dwelling elderly people with multimorbidity and provide a basis for personalized health management and supportive strategies of the group.

This study used purposive sampling and maximum difference sampling to select eligible interviewees from four communities under the jurisdiction of a community health service center in Zhengzhou City from August to September in 2022. Based on the principle of information saturation, 20 subjects were ultimately included. Based on the research objective, literature review, and expert consultation results, the preliminary interview outline was formulated, and the final interview outline was determined after interviewing 2 patients. Semi-structured interviews were conducted with the study participants, guided by the phenomenological research methodology. Golaizzi analysis was used to analyse the data.

Four themes and eleven sub-themes had been extracted from this study, including mainly long-standing symptomatic distress (physical dysfunction, fatigue, sleep disorders, and pain), negative psychological experiences (feelings of helplessness and worry about future life, reduced sense of social value and self-identity, and loneliness with altered social activities), positive mindset of coexisting harmoniously with multimorbidity (being grateful for being satisfied, and positively adapting), and aspirations in times of adversity (hoping for improvement in functioning, and seeking multi-directional social support) .

Physical dysfunction, sleep disturbances, fatigue, and pain are the most concerning health disturbances for community-dwelling elderly people with multimorbidity. The symptom management and multiple social support of the multimorbidity need to be strengthened. In the future, it is expected that multidimensional data would be used for dynamic health assessment to explore the common and individual patterns of multimorbidity, and to achieve precise management and intervention of elderly multimorbidity in the community.

With the gradual aging of China's population and the gradual rise of chronic disease co-morbidities, cardiometabolic co-morbidities (CMM) have become one of the most damaging co-morbidities. Current studies on prediction and intervention methods for CMM have focused on individual cardiovascular diseases and lifestyle, while studies on CMM as a whole are lacking.

To explore the association of Continuous Metabolic Syndrome Score (cMetS) and other obesity indicators with CMM, and to further confirm whether these indicators can be used as a simple indicator for screening CMM, as well as to estimate the threshold for prediction of CMM in the middle-aged and elderly population in Anhui Province.

The study included 131 390 participants from the Anhui Province Cardiovascular Disease High-Risk Population Early Screening and Comprehensive Intervention Project from 2017 to 2021, divided into CMM (779 males, 866 females) and non-CMM groups (53 020 males, 76 725 females). General patient information and biochemical markers were collected, and the waist-to-height ratio (WHtR), WHT.5R, body roundness index (BRI), and cMetS were calculated. Differences in CMM prevalence by gender and age group were compared using the Bonferroni method. Multivariate Logistic regression analysis was employed to investigate the factors influencing CMM. Receiver operating characteristic (ROC) curves for predicting CMM using cMetS and obesity indices were plotted, and the area under the ROC curve (AUC) was calculated. The value of different indices in predicting CMM status was assessed using paired sample tests.

In the male cohort, the CMM group showed higher values for age, BMI, waist circumference (WC), mean arterial pressure (MAP), fasting plasma glucose (FPG), triglycerides (TG), diabetes, ischemic heart disease, stroke, WHtR, WHT.5R, BRI, and cMetS than the non-CMM group. Smoking and alcohol consumption, as well as total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C), were higher in the non-CMM group (P<0.05). In females, similar trends were observed, with lower levels of TC and HDL-C in the CMM group (P<0.05). The prevalence of CMM varied across different age groups in both male and female patients (P<0.05). Multivariate Logistic regression analysis indicated that increases in cMetS, WHtR, WHT.5R, BRI, and BMI are risk factors for CMM in both genders (P<0.05). ROC curve analysis showed that in males, the AUC for cMetS was higher than that for WHtR (Z=6.16, P<0.001), BRI (Z=6.16, P<0.001), WHT.5R (Z=7.21, P<0.001), and BMI (Z=9.36, P<0.001). Similar findings were observed for females, with cMetS outperforming the other indices.

In both genders, cMetS and other obesity indices are closely associated with CMM, with cMetS being a superior identifier. cMetS serves as a novel marker for diagnosing CMM, highlighting its significance in the prevention of this condition.

With the aggravation of population aging in China, the disease spectrum of the population has changed and the coexistence of multiple chronic diseases has become the norm for the health status of the older population in China. Patient delay refers to the behaviour of an individual who fails to seek medical care in a timely manner after becoming unwell for a variety of subjective or objective reasons, resulting in a decrease in the treatment effectiveness and a decrease in the quality of the patient's survival. At present, there are few researches on patient delay and the associated factors for elderly adults with multimorbidity in China.

To explore the patient delay and the associated factors for older adults with multimorbidity, so as to provide references to further reduce the incidence of patient delay.

Eligible elderly patients attending 27 community health centers in Guangdong Province from September to December 2022 were selected for the study using multi-stage stratified whole cluster random sampling method. A self-designed questionnaire was used to collect patients' general information, disease-related information and delays in seeking medical care. Multivariate Logistic regression analysis and a decision tree model based on the CHAID algorithm were used to analyse the influencing factors of patient delay in older adults with multimorbidity.

A total of 998 patients were included in the study, of which 243 (24.35%) showed delays in seeking medical care. The multivariate Logistic regression results showed that gender (OR=0.701, 95%CI=0.504-0.977, P=0.036), type of household registration (OR=0.590, 95%CI=0.358-0.973, P=0.039), type of health insurance (OR=2.660, 95%CI=1.764-4.010, P<0.001), disease-related self-efficacy (OR=4.378, 95%CI=2.079-9.217, P<0.001), family doctor contract (OR=2.277, 95%CI=1.618-3.206, P<0.001) and self-reported health (OR=1.554, 95%CI=1.073-2.250, P=0.020) were the main factors influencing patient delay in older adults with multimorbidity (P<0.05). The decision tree model has 3 levels and 13 nodes, and a total of 5 influencing factors were screened, including type of health insurance, family doctor contract, gender, self-reported health and age. The results of the two models for predicting patient delay in older adults with multimorbidity showed that the area under receiver operating characteristic curve (AUC) was 0.729 for the multivariate Logistic regression model and 0.721 for the decision tree model. There was no significant difference in AUC between the two models for predicting patients delay in elderly patients with multimorbidity (Z=0.539, P=0.590) .

The incidence of patient delay in older adults with multimorbidity is 24.35% in Guangdong province, and the type of health insurance, the contracting rate of family doctors, gender, and self-reported health status are the main factors influencing patient delay in older adults with multimorbidity. The medical insurance system should be further improved to increase the contracting rate and utilization rate of family doctors in order to reduce the incidence of patient delay.

With the aging of the population and changes in the disease spectrum, the incidence of multimorbidity among the elderly remained high, and have become the focus of the family doctor contracting service at the primary level. At present, there are many studies promoting the signing of family doctors from the perspective of increasing "quantity", but there is still a lack of studies on the factors affecting the effectiveness of family doctor contract services for elderly multimorbidity patients after signing from the perspective of improving "quality".

To explore the important influencing factors of satisfaction and usefulness evaluation of elderly multimorbidity patients with family doctor contract services in urban communities of guangdong province, and to provide a basis for future improvement of multimorbidity management services at the grassroots level.

From September to December 2022, elderly patients with multiple chronic conditions in the community of Guangdong Province (Shenzhen, Zhanjiang and Meizhou) were selected by multi-stage stratified whole cluster random sampling method and surveyed by self-administered questionnaire. Multifactorial Logistic regression analysis was used to explore the influencing factors of satisfaction and usefulness evaluation of family doctor contracting services for elderly multimorbidity patients.

A total of 636 valid questionnaires were collected, with effective recovery rate of 99.69% (636/638). There were 624 family doctors who were relatively satisfied/very satisfied, accounting for 98.11%; The service usefulness evaluation of family doctors was slightly helpful/greatly helpful to 625 people, accounting for 98.27%. The results of multivariate Logistic regression analysis showed that patients with general satisfaction of family doctor contract service were taken as reference. Patients with hyperlipidemia (OR=15.203), disease duration <3 years (OR=48 703 577.681), 4 chronic diseases (OR=135.131), and severe dependence on self-care ability (OR=668 738.913) were more likely to make satisfactory evaluations than patients with complete self-care. Patients with annual personal income of ≤ 30 000 yuan (OR<0.001), >30 000-50 000 yuan (OR<0.001), >50 000-100 000 yuan (OR<0.001) were less likely to make a satisfactory evaluation than patients with income >100 000-200 000 yuan (P<0.05). Patients aged 65-69 years (OR=12.573) were more likely to be very satisfied than those aged ≥70 years, and those with 4 chronic diseases (OR=135.131) were more likely to be very satisfied than those with 5 or more chronic diseases. The average annual income of individuals was ≤ 30 000 yuan (OR<0.001), >30 000-50 000 yuan (OR<0.001), and some understanding of the disease (OR=0.013) or more understanding (OR=0.035) patients were less likely to give a very satisfactory evaluation (P<0.05). Multivariate Logistic regression analysis of the evaluation of the effectiveness of family doctor contract services by elderly patients with comorbidity of chronic diseases showed that taking the family doctor contract service as not very useful as the dependent variable, patients aged 65-69 years old (OR=28.710) were more likely to make a slightly helpful evaluation than patients aged ≥70 years old. Working patients (OR=0.091) were less likely to give a slightly helpful evaluation than unemployed patients (P<0.05). Patients aged 65 to 69 years (OR=56.795) were more likely to make helpful evaluations than those aged ≥70 years, and patients with chronic heart failure (OR=0.023) were less likely to make helpful evaluations than those without the disease (P<0.05) .

The overall level of satisfaction and usefulness evaluation of family doctors contracted services of elderly multimorbidity patients in urban communities of Guangdong province is relatively high, both above 95%, which is influenced by a combination of factors, including changing the type of chronic disease, annual income, knowledge of the condition, and self-care ability. In the future, we should continue to standardize and improve the connotation of family doctor contracted services, optimize the management mode of key populations such as elderly multimorbidity, improve the satisfaction and sense of gain of patients, so as to ultimately enhance the effectiveness of family doctor contracted services.

As the aging population continues to increase, there has been a rise in the prevalence of multimorbidity in the elderly. The adherence to medication regimens by elderly patients with multimorbidity significantly impacts the effectiveness of chronic disease management.

This study analyses the factors that impact medication adherence among the elderly with multimorbidity in Guangdong province. This study aims to provide a foundation for the management of multimorbidity in this population.

A multi-stage stratified cluster random sampling method was used to survey a population of 998 multimorbid patients aged 60 years and above in Guangdong province from October 2022 to March 2023. Medication adherence was the dependent variable, while patient sex, age, marital status, living conditions, education level, personal annual income, family encouragement for medication adherence, family doctor support, number of diseases, disease awareness, medication awareness, BMI, smoking and alcohol consumption were considered as independent variables. Multivariate Logistic regression analysis was used to identify the factors influencing medication adherence among elderly patients with multimorbidity in Guangdong province.

A total of 1 000 questionnaires were distributed and 998 valid questionnaires were collected, with a valid recovery rate of 99.8%. Among the 998 cases of elderly patients with multimorbidity in Guangdong province, there were 719 cases (72.0%) with good adherence to medication and 279 cases (28.0%) with poor medication adherence; there were 512 cases (51.3%) of males and 486 cases (48.7%) of females. The results of multivariate Logistic regression analysis showed that: education level (high school/secondary school: OR=0.298, 95%CI=0.117-0.762; college and above: OR=0.325, 95%CI=0.127-0.831), personal annual income (>30 000 to 50 000 yuan: OR=7.694, 95%CI=2.071-28.582; >50 000 to 100 000 yuan: OR=12.408, 95%CI=3.229-47.686; >100 000 to 200 000 yuan: OR=4.893, 95%CI=1.174-20.397), and frequency of family members' supervision of medication taking (occasionally: OR=1.842, 95%CI=1.222-2.779), family doctor's help (slightly helpful: OR=2.537, 95%CI=1.531-4.205), understanding of the condition (mostly understood: OR=3.015, 95%CI=1.948-4.667; better understood: OR=3.510, 95%CI=1.955-6.300; some/no understanding: OR=3.469, 95%CI=1.338-8.994), medication concern (mostly concerned: OR=4.928, 95%CI=3.336-7.278; more concerned: OR=3.670, 95%CI=1.915-7.033; somewhat concerned/unconcerned: OR=8.560, 95%CI=2.497-29.339), BMI (too low: OR=2.303, 95%CI=1.154-4.598; overweight/obese: OR=0.598, 95%CI=0.390-0.915), and alcohol consumption (OR=1.959, 95%CI=1.270-3.022) were the influencing factors of medication adherence among elderly patients with multimorbidity in Guangdong province (P<0.05) .

The elderly patients with multimorbidity in Guangdong province had better medication adherence, at 72.0%. Medication adherence was poorer among the elderly patients with multimorbidity in Guangdong province who were high-income earners, occasionally urged to take medication by their family members, slightly assisted by their family doctors, had a low understanding of their condition, paid little attention to the use of medication, had a low BMI, and drank alcohol. All parties in society should join hands to take multiple measures to improve the medication adherence of elderly patients with multimorbidity in all aspects, strengthen the integrated management of multimorbidity, and promote the health of elderly patients.

The prevalence of multiple chronic conditions (MCCs) is continuously increasing among older adults in China, but few studies have explored complex pattern of MCCs from perspectives of patient demand and disease management.

This study aims to investigate the pattern distributions, correlates, and treatment burdens of MCCs.

Data were obtained from the 2018 and 2020 China Health and Retirement Longitudinal Study (CHARLS) waves, and the study sample included older adults aged≥60 years old (n=15 349). The generalized ordered logit model and the generalized linear model were used to examine correlates of MCCs complex pattern and its associations with outpatient/inpatient utilization and expenditure, respectively. All statistical analyses were weighted except for sample size.

Among the total sample of 15 349 older adults, there were 7 147 in 2018 and 8 202 in 2020; 2 054 participants[13.0%, defined as the relatively healthy group (RH group) ] had none of 12 chronic conditions defined in this study, 5 228 participants [33.7%, defined as the simple chronic illness group (SCI group) ] had 1-5 non-complex chronic conditions, 6 737 participants [44.7%, defined as the minor complex chronic illness group (MiCCI group) ] had 1-2 complex chronic conditions, and <6 non-complex chronic conditions, and 1 330 participants[8.6%, defined as the major complex chronic illness group (MaCCI group) ] had ≥3 complex chronic conditions or ≥6 non-complex chronic conditions. The proportion of MiCCI and MaCCI groups had an increase of 2.1% and 1.9% between 2018 and 2020, respectively. Among the SCI and MiCCI groups, the most prevalent chronic conditions were hypertension (49.2% and 56.1%) and arthritis/rheumatism (51.9% and 47.4%), respectively. Among MaCCI group, 82.0% had heart disease, and 67.9% had chronic lung diseases. There were statistically significant differences in the prevalence of chronic conditions among the three groups (P<0.05). Age, sex, education level, annual household expenditure per capita, medical insurance, depression status, and survey year were associated with being in SCI, MiCCI, and MaCCI groups (P<0.05) ; age, education level, urban-rural location, region, annual per capita household expenditure, and survey year were associated with being in MiCCI and MaCCI groups (P<0.05) ; age, region, annual per capita household expenditure, depression status, and survey year were associated with being in MaCCI group (P<0.05). In 2018, compared to the RH group, the MiCCI and MaCCI group had more outpatient numbers, and the SCI, MiCCI, and MaCCI groups had higher outpatient expenses, inpatient numbers and expenses (P<0.05). In 2020, compared to the RH group, the SCI, MiCCI, MaCCI groups utilized more outpatient and inpatient services (P<0.05) .

According to the most recent CHARLS data, over half of older adults in China suffers from complex chronic comorbidities, with 44.7% for the MiCCI group and 8.6% for MaCCI group. The heart disease and chronic lung disease was the most prevalent in the MaCCI group. Furthermore, as the complexity of multimorbidity increases, there is a noticeable increase in outpatient and inpatient utilization as well as medical expenditures. Therefore, it is recommended to explore effective MCC management models based on healthcare demands to improve health outcomes and reduce disease burdens.

The challenge of aging is becoming increasingly severe in China. Understanding the trends in chronic disease prevalence and comorbidity spectrum among the elderly is crucial for primary healthcare.

To analyze the prevalence and comorbidity patterns of chronic diseases among the elderly in China based on data from the China Health and Retirement Longitudinal Study (CHARLS) .

Participants aged ≥60 years from the 2011 (Wave 1) and 2015 (Wave 3) CHARLS dataset were selected. Their physical examination data and self-reported disease conditions, as well as the questionnaire data were extracted for descriptive statistical analysis of chronic disease and comorbidity prevalence, comparing changes over time. Latent class analysis (LCA) was employed to identify common clusters of comorbidities in the elderly and to assess their impact on daily living activities (evaluated using the Activities of Daily Living Scale, ADL) .

A total of 7 290 individuals in 2011 and 9 845 in 2015, all aged≥60 years, were included in the study. The prevalence of chronic disease comorbidity increased from 85.96% in 2011 to 92.24% in 2015, indicating a significant rise (χ²=109.65, P<0.05). Except for pain and oral diseases, the prevalence of all other chronic diseases increased in 2015 (P<0.05). Combining self-reported diseases and laboratory results, the prevalence of overweight or obesity increased from 39.53% in 2011 to 42.88% in 2015 (χ²=35.12, P<0.01), and abdominal obesity from 45.37% to 47.99% (χ²=18.09, P<0.01). The prevalence of cardiovascular-metabolic disease comorbidity increased from 52.75% in 2011 to 60.49% in 2015 (χ²=64.39, P<0.01), becoming the primary form of chronic disease comorbidity in this population. The LCA categorized the elderly population into five comorbidity patterns in the elderly, with the "cardiovascular-metabolic + musculoskeletal diseases" pattern showing higher ADL scores compared to the "cardiovascular-metabolic diseases""musculoskeletal diseases""respiratory diseases" and "nonspecific comorbidities" patterns.

According to CHARLS data from 2011 and 2015, there is a high prevalence (85.96% in 2011 and 92.24% in 2015) and increasing trend in chronic disease comorbidity among Chinese individuals aged ≥60. Cardiovascular-metabolic comorbidity pattern is the most common, with many cases undetected, and the combination of cardiovascular-metabolic and musculoskeletal diseases has the most significant impact on the daily living abilities of the elderly.

Multimorbidity increases the burden of disease and treatment for patients, which is becoming an essential research issue in the field of public health and primary care. As medical research advances, the understanding of how to deal with the challenge of multimorbidity is undergoing a profound shift, the most significant of which is the focus on the potential influence of social and environmental factors on disease clustering and development. Syndemic theory provides a new perspective for exploring the clustering of multiple conditions, as well as their interaction with social and environmental factors, which is of great significance for analyzing the interaction of chronic comorbidities at the social and environmental levels, and contributing to improve health outcomes of vulnerable populations. However, there is a lack of introduction and research on this theory in China. This article mainly reviews the basic concepts and viewpoints of the syndemic theory, as well as the classical models proposed by foreign scholars, analyzes the common disease synergistic factors with previous research findings, and puts forwards suggestions and countermeasures for general practitioners in China to improve the quality of managing multimorbidity.

Cardiovascular disease is the leading cause of death among Chinese residents, hypertension, hyperglycemia and hyperlipidemia are important risk factors for cardiovascular disease. Therefore, China proposes to implement the co-management of these three diseases. At present, there is a lack of relevant research on the three diseases comorbidities of the Kazakhs in Xinjiang.

To investigate the prevalence and status of dyslipidemia, hypertension and diabetes comorbidities among Kazakhs, and explore the related factors.

Kazakh residents over 18 years old from Dure Town and Tuerhong Township with large populations mainly consist of Kazakh in Fuyun County, Altay Prefecture, Xinjiang from March to June in 2022 were selected to conduct the cross-sectional study. Patient information was collected through questionnaires (general information, history of smoking, alcohol consumption, and diseases), physical examination (waist circumference, hip circumference, height, weight, blood pressure, heart rate, etc.), and laboratory tests (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triacylglycerol, and fasting blood glucose, etc.). Multivariate Logistic regression analysis was used to explore the factors related to dyslipidemia, hypertension and diabetes comorbidities among Kazakhs.

A total of 4 835 Kazakh residents were included, 48.2% (2 231/4 835) and 51.8% (2 504/4 835) were male and female respectively, with an average age of (45.8±12.7) years. The standardized prevalence of dyslipidemia, hypertension and diabetes mellitus were 37.9%, 21.1% and 4.0%, respectively. The standardized prevalence of hypercholesterolemia, high low-density lipoprotein cholesterol, low high-density lipoprotein cholesterol and hypertriacylglycerolemia in the dyslipidemic population was 24.1%, 24.8%, 10.0% and 7.3%, respectively. The standardized prevalence of comorbidities was 11.8%. Univariate Logistic regression analysis showed that gender, age, BMI, waist circumference, hip circumference, heart rate, marital status, and education level were correlated with the comorbidities (P<0.05). Multivariate Logistic regression analysis showed that gender, age, marital status, BMI and heart rate were correlated with three diseases comorbidities (P<0.05) .

The prevalence of dyslipidemia is higher than that of hypertension and diabetes, and dyslipidemia is dominated by hypercholesterolemia. The comorbidities of dyslipidemia and hypertension are the most common among the three diseases comorbidities, and the elderly, males and people with high BMI should be prioritized for the three diseases co-management.

Recent studies have found that middle-aged individuals account for over 40% of patients with chronic disease comorbidities, and this percentage is still increasing. This comorbidity not only reduces the quality of life for these patients but can also lead to premature death. However, research on the distribution and influencing factors of chronic comorbidities in middle-aged adults is still limited.

To provide a scientific basis for managing such patients by retrospectively analyzing the disease distribution and influencing factors of chronic comorbidities among middle-aged inpatients.

From July 1, 2017 to February 28, 2023, a total of 5 931 inpatients were admitted to the Department of General Medicine, the Second Hospital of Lanzhou University. Among them, 1 650 middle-aged patients (aged 45 to 59 years) were included as subjects for this study. General information of the subjects was collected, and the comorbidity conditions of chronic diseases were statistically analyzed. Multifactorial Logistic regression analysis was employed to investigate the influencing factors associated with different chronic disease comorbidities.

Among the 1 650 middle-aged patients attending the department of general practice, 79 (4.8%), 359 (21.8%), and 1 212 (73.4%) patients suffered from 0, 1, and ≥2 chronic diseases, respectively. Comparison of gender, age, ethnicity, occupation, and route of admission of patients with 0, 1, and ≥2 chronic diseases showed statistically significant differences (P<0.05). The three most common chronic diseases were heart disease (66.1%, 1 091/1 650), hypertension (41.1%, 678/1 650), and cerebrovascular disease (20.7%, 342/1 650). The top three comorbid conditions with other chronic diseases were diabetes or hyperglycemia (97.3%, 215/221), hypertension (98.5%, 668/678), and dyslipidemia (96.1%, 246/256). Of the 1 650 middle-aged patients hospitalized in general practice, 581 (35.2%) had 2 chronic comorbidities and 455 (27.6%) had 3 chronic comorbidities. Among patients with two comorbidities, the most frequent combinations were heart disease+hypertension (22.7%, 132/581), heart disease+chronic lung disease (13.1%, 76/581), and heart disease+cerebrovascular disease (8.4%, 49/581) ; for three comorbidities, the top combinations were hypertension+heart disease+cerebrovascular disease (14.5%, 66/455), hypertension+heart disease+diabetes or hyperglycemia (10.5%, 48/455), and hypertension+heart disease+chronic lung disease (7.9%, 36/455). Multivariate Logistic regression analysis showed that ethnicity of Han (OR=26.778, 95%CI=3.120-229.793), Hui (OR=46.143, 95%CI=3.456-616.090), or Dongxiang (OR=52.966, 95%CI=2.502-1 121.195) were influencing factors for middle-aged inpatients with 1 chronic disease (P<0.05). For ≥2 chronic diseases, influencing factors included 50-54 age group (OR=0.461, 95%CI=0.266-0.801), being of Han (OR=3.783, 95%CI=1.433-9.983) or Hui (OR=6.055, 95%CI=1.107-33.126) ethnicity, occupation of farmer (OR=0.460, 95%CI=0.252-0.839) (P<0.05) .

Approximately one-third of patients in the general practice department of tertiary hospitals are middle-aged, and most of them present with chronic comorbidities. While focusing on the chronic diseases of the elderly, there is a need for enhanced focus on chronic diseases management and clinical awarenes improvement in middle-aged individuals, enhancing the content of health management services provided by general practitioners, and establishing a more comprehensive model of general practice services. Additionally, research indicates that patients with diabetes are more prone to chronic disease comorbidities. The phenomenon is particularly prevalent among residents of Hui or Han ethnicity. These groups should receive focused attention during screening and management processes.

With the rapid progression of aging in China, the challenge of multimorbidity has become a significant concern for both public health and clinical practice. Nocturnal sleep status, including sleep duration and quality, is crucial for regulating body metabolism and physiological functions in the elderly. However, current research on the relationship between nocturnal sleep status and multimorbidity was limited to specific regions or the middle-aged population. The association between nocturnal sleep status and prevalence of multimorbidity among community-dwelling older adults remains ambiguous.

To investigate the association between nocturnal sleep status and prevalence of multimorbidity among community-dwelling older adults.

In April 2023, a total of 11 917 community-dwelling older adults from the Chinese Longitudinal Healthy Longevity and Happy Family Study (CLHLS-HF, wave 2018) were selected as the participants. Multivariate Logistic regression was used to explore the association of sleep duration and sleep quality with the prevalence of multimorbidity, represented by odds ratios (OR) and 95% confidence intervals (95%CI). Additionally, restrictive cubic splines (RCS) based on Logistic regression analysis were utilized to analyze the dose-response relationship between sleep duration and prevalence of multimorbidity.

Of the 11 917 community-dwelling older adults, with an average age of (84.4±11.4) years ranged from 65.0 to 117.0 years, 6 477 were females (54.35%) and 5 440 were males (45.65%). Multivariate Logistic regression results after adjusting for covariates such as gender, age, region, and years of education, indicated that compared to those with 6-8 h of nocturnal sleep duration, older adults with shorter sleep duration (<6 h) had a higher prevalence of multimorbidity (OR=1.51, 95%CI=1.36-1.67, P<0.05) ; compared to those with good sleep quality, individuals with fair sleep quality (OR=1.34, 95%CI=1.22-1.46, P<0.05) and poor sleep quality (OR=2.14, 95%CI=1.91-2.40, P<0.05) were associated with higher prevalence of multimorbidity. RCS plots revealed a "U" -shaped nonlinear association between sleep duration and prevalence of multimorbidity, with an optimal sleep duration of approximately 7 hours.

Community-dwelling older adults with sleep durations less than 6 hours, fair or poor sleep quality, are associated with an increased prevalence of multimorbidity. The optimal sleep duration for community-dwelling older adults is approximately 7 hours. Normal sleep duration and good sleep quality are important for the prevention of multimorbidity.

With the acceleration of population aging, the health problems of middle-aged and elderly people are prominent. Multimorbidity seriously threaten the health and quality of life of middle-aged and elderly people, and hinder the progress of Healthy China Initiative. It is of positive significance to explore the relationship between multimorbidity and social determinants of health.

To understand the multimorbidity and social determinants of health among the middle-aged and elderly people in Ningxia, and analyze the relationship between the social determinants of health and multimorbidity, so as to provide reference for the health management and intervention strategies for middle-aged and elderly people.

A multi-stage stratified random sampling method was used to investigate the health related data of 1 997 middle-aged and elderly people in 10 districts/counties of Shizuishan City, Yinchuan City, and Guyuan City in Ningxia from June 27, 2022 to August 27, 2022. The Apriori algorithm was used to analyze the comorbidity patterns of middle-aged and elderly people in Ningxia, and unconditional Logistic regression analysis was used to explore the correlation between multimorbidity and social determinants of health among middle-aged and elderly people in Ningxia.

There were 418 middle-aged and elderly people in Ningxia with a comorbidity rate of 20.9%; the results of association rules showed 14 comorbidity patterns, of which 11 were related to coronary heart disease, 9 to hypertension, and 9 to diabetes; the results of unconditional Logistic regression analysis showed that middle-aged and elderly people aged ≥60 years, with 2-3 children, established family archives, retired or unemployed work status, and resident pension insurance had a higher incidence of multimorbidity (P<0.05), while middle-aged and elderly people with nighttime sleep duration of 7-8 hours and more than 8 hours, and education level of college or above had a lower incidence of multimorbidity (P<0.05). Conclusion The factors influencing the comorbidity of chronic diseases in middle aged and elderly people involve individual, community and social aspects. It is recommended to intervene in chronic comorbidity patients from a multidimensional perspective with a view to improving the health of the population.

As aging process continues to accelerate in China, multimorbidity have become a major public problem that threatens the health of the entire population. In the current context of "Healthy China 2030", the health management of patients with multimorbidity needs to be urgently addressed.

To understand the preferences influencing the choice of community health services for patients with multimorbidity, explore the willingness to pay (WTP) of patients, so as to provide recommendations for improvements to the existing community health service system for chronic diseases.

Patients with multimorbidity were randomly selected from eight community health service centers in Chengdu during the period from May to August 2022 as survey subjects. General patient data and preferences related to discrete choice experiments were collected through on-site questionnaire surveys. Based on different types of comorbidities, patients with type 2 diabetes combined with hypertension, hypertension combined with coronary heart disease, type 2 diabetes combined with hypertension and coronary heart disease were categorized into ClassⅠ, ClassⅡ, and ClassⅢ. Regression analysis was conducted using mixed Logit model to analyze the preferences of multimorbidity patients for community health services, and to quantitatively analyze their WTP for community health services.

A total of 360 questionnaires were distributed and 296 valid questionnaires were recovered, with a valid recovery rate of 82.7%. ClassⅠpatients (β=3.260, 95%CI=2.610 to 3.910), ClassⅡpatients (β=3.697, 95%CI=2.612 to 4.781), and ClassⅢpatients (β=3.220, 95%CI=2.271 to 4.169) expressed the strongest preference for services with high accessibility to drugs, followed by appointment referral services and traditional Chinese medicine (TCM) services. Regarding physician types and prescription service duration, both ClassⅠpatients (β=0.971, 95%CI=0.585 to 1.357) and ClassⅡpatients (β=0.686, 95%CI=0.176 to 1.197) preferred services with extended prescription services, while ClassⅢpatients (β=0.804, 95%CI=0.196 to 1.413) preferred services provided by general practitioners (β=0.804, 95%CI=0.196 to 1.413). ClassⅠpatients (β=-0.049, 95%CI=-0.057 to -0.041), ClassⅡpatients (β=-0.040, 95%CI=-0.051 to -0.029), and ClassⅢpatients (β=-0.037, 95%CI=-0.048 to -0.027) preferred services with lower out-of-pocket expenses. The results of the regression analysis of WTP for patients with different chronic comorbidity types showed that the WTP of all 3 types of patients was related to their level of preference for each attribute, with ClassⅠ, ClassⅡ, and ClassⅢpatients all had the highest WTP for a high level of drug accessibility, which were RMB 66.77/month, RMB 91.97/month, and RMB 85.95/month, respectively.

Patients with multimorbidity exhibit significant preferences for six attributes considered in this study (physician type, TCM service, prescription service duration, drug accessibility, appointment referral, and monthly out-of-pocket costs). Drug accessibility is the most important attribute influencing multimorbidity patients' health service preferences. It is recommended to target patients' specific needs accurately, improve appointment referral services, establish standards for the management of chronic diseases in the community, and accelerate the integration of TCM into the prevention and treatment of chronic diseases in the community.

Middle-aged and elderly ischemic stroke patients suffer from multiple co-morbid chronic diseases, and this co-morbidity status has a great impact on the patients' healthy living standard. Currently, there are few studies on the current status of ischemic stroke co-morbidities and the analysis of co-morbidity patterns.

To understand the current status of ischemic stroke co-morbidities in middle-aged and elderly people in Henan Province, and explore the association between ischemic stroke co-morbidities, so as to provide a reference basis for the management of ischemic stroke co-morbidities, as well as the preventive and control measures.

Ischemic stroke patients over 45 years of age attending Henan Provincial People's Hospital from January 2021 to December 2022 were selected for the study, with their chronic disease prevalence counted, the status of ischemic stroke co-morbidities was compared by different demographic characteristics, and the co-morbidity patterns of ischemic stroke in the middle-aged and elderly population were investigated using cluster analysis.

A total of 1 685 middle-aged and elderly ischemic stroke patients were enrolled in this study, of whom 90.0% (1 516/1 685) had at least 1 co-morbid chronic disease; 13.6% (230/1 685) had 2 co-morbid chronic diseases, 26.9% (454/1 685) had 3 co-morbid chronic diseases, and 49.4% (832/1 685) had 4 or more co-morbid chronic diseases. The chronic diseases with high prevalence were hypertension in 1 047 cases (62.1%) and dyslipidemia in 755 cases (44.8%). Among ischemic stroke patients, the prevalence of co-morbidities was higher in females compared with males (χ²=14.516, P<0.05) ; the prevalence of co-morbidities tended to increase with age (χ²_trend=148.889, P<0.001) ; and the prevalence of co-morbidities tended to decrease with higher education (χ²_trend=30.890, P<0.001). Cluster analysis showed four patterns of co-morbidity, which were cardiovascular-metabolic patterns (hypertension, dyslipidemia, heart attack, and diabetes mellitus), patterns characterized by hepato-pulmonary-gastrointestinal-urinary disorders (chronic lung disease, renal disease, hepatic disease, gastrointestinal disorders, and urinary disorders), psychiatric-degenerative patterns (neurological or psychiatric problems, arthritis or rheumatism, disorders related to memory), and cancer.

The prevalence of co-morbidities of ischemic stroke in middle-aged and elderly people in Henan province is high, and their co-morbidity patterns include cardiovascular-metabolic patterns, patterns characterized by hepato-pulmonary-gastrointestinal-urinary disorders, psychiatric-degenerative patterns, and cancers, among which cardiovascular-metabolic patterns are more associated with ischemic stroke, and the screening and prevention of which should be better controlled.

The number of elderly comorbidity patients in our country is continuously increasing. With the accumulation of chronic diseases, older adults experience varying degrees of health loss. Currently, there is a lack of research analyzing the multi-level factors influencing the number of chronic conditions in elderly comorbidity patients.

To explore the factors influencing the number of chronic conditions in elderly patients from different levels combining with the etiology and characteristics of chronic diseases based on the health ecology model, so as to provide evidence for the management and prevention of chronic diseases in community-dwelling elderly comorbidity patients in our country.

In February 2023, a multi-stage stratified cluster random sampling method was used to select community-dwelling elderly (≥60 years old) comorbidity patients in Guangdong province as the survey subjects. A face-to-face interview was conducted using the "Survey Questionnaire on the Status and Influencing Factors of Elderly Patients with Multiple Chronic Conditions", which was based on the health ecology model and included five levels of individual trait, behavioral characteristic, interpersonal relationship, living and working conditions, and policy environment. The number of chronic conditions in elderly comorbidity patients was considered as the dependent variable, and an unordered multivariate Logistic regression analysis was conducted by incorporating independent variables according to the five levels.

A total of 1 000 questionnaires were distributed, and 987 valid questionnaires were collected, with a recovery rate of 98.7%. Among the 987 elderly comorbidity patients, 346 (35.1%) had two concurrent chronic diseases, 456 (46.2%) had three concurrent chronic diseases, and 185 (18.7%) had more than three concurrent chronic diseases. The results of unordered multivariate logistic regression analysis showed that, compared to elderly patients with two concurrent chronic diseases, disease duration less than 6 years and 6-10 years, local urban household were risk factors for elderly patients with three concurrent chronic diseases (P<0.05), with OR (95%CI) values of 2.100 (1.284-3.435), 1.948 (1.201-3.158), and 4.103 (1.496-11.250), respectively. Having at least 6 hours of sleep daily, self-rating good health status, taking 1-3 types of medication daily, regularly participating in social activities, level of junior high school or below and high school/secondary school, and having urban employee medical insurance/rural resident medical insurance were protective factors for elderly patients with three concurrent chronic diseases (P<0.05), with OR (95%CI) values of 0.528 (0.322-0.867), 0.570 (0.325-0.998), 0.385 (0.261-0.569), 0.348 (0.208-0.582), 0.412 (0.175-0.972), 0.486 (0.298-0.790), and 0.392 (0.242-0.634), respectively. Being male, exercising less than 3 times a week were risk factors for elderly patients with more than three concurrent chronic diseases (P<0.05), with OR (95%CI) values of 2.563 (1.634-4.021), 2.990 (1.429-6.256), respectively. Having at least 6 hours of sleep daily, self-rating good and fair health status, taking 1-3 types of medication daily, having an annual average income below ≤30 000 and >30 000-50 000 yuan, and having urban employee medical insurance/rural resident medical insurance were protective factors for elderly patients with more than three concurrent chronic diseases (P<0.05), with OR (95%CI) values of 0.300 (0.159-0.565), 0.247 (0.125-0.487), 0.448 (0.240-0.837), 0.288 (0.178-0.467), 0.318 (0.155-0.654), 0.489 (0.293-0.816), and 0.416 (0.229-0.755), respectively.

The proportion of elderly comorbidity patients having 2-3 types of chronic diseases is relatively high in Guangdong province, accounting for over 80%. The factors influencing the number of chronic conditions in elderly comorbidity patients are complex, including gender, duration of disease, physical activity, sleep quality, self-rated health status, medication adherence, household registration type, supervision by children or family members in medication adherence or exercise, income level, educational level, and type of medical insurance. Moreover, there are significant differences in the risk factors across different comorbidity counts. Therefore, corresponding intervention measures should be implemented at different levels to reduce the number of chronic conditions in elderly comorbidity patients and improve their overall health level.

The continuous increase in the prevalence of comorbidities has severe challenges to population health management, and the World Health Organization (WHO) recommends the development of integrated medical care models to cope with the pressure of health management of patients with comorbidities. In this paper, we constructed an integrated management model for geriatric comorbidities under medical association based on PDSA theory, in order to continuously improve the management ability and effect in the reciprocal cycle of "plan-execute-research-act". The model consists of four key elements, including management team, management process, management tools and management effect. Based on previous intervention research, the model integrates patient-centered care, multidisciplinary team, patient self-management and other intervention methods, and relies on big data technology to establish a decision support platform, thus realizing the whole life cycle health management of patients with comorbidities.

In the context of aging society in China, the prevalence of Alzheimer's disease increases and multimorbidity becomes more common with years. However, the extensive investigations of Alzheimer's disease in Hunan province have not been reported adequately and the multimorbidity relationship between relevant diseases remains unclear.

To completely understand the prevalence of Alzheimer's disease in residents aged 65 or above in Hunan and analyze its multimorbidity relationships with 11 common chronic diseases.

The residents aged 65 years and above in 30 districts (counties), 60 streets (townships), and 180 neighborhood (village) committees in Hunan Province were randomly selected between April and May 2021 by using stratified multistage sampling method. Alzheimer's disease was diagnosed by a neurologist or psychiatrist using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), after using the Community Screening Interview for Dementia (CSI-D) or the 8-item ascertain dementia (AD8) as the screening tools. In addition, all respondents were investigated for the prevalence of hypertension, cerebrovascular disease, ischemic heart disease, rheumatoid arthritis, intervertebral disc disease, diabetes, gastroenteritis, chronic obstructive pulmonary disease, calculous cholecystitis, peptic ulcer and cancer.

A total of 5 979 residents were sampled, 5 616 of them completed the examinations and 785 (13.98%) were diagnosed with Alzheimer's disease. There were significant differences in the prevalence of Alzheimer's disease among respondents with different regions, gender, age, smoking history and presence of other chronic diseases (P<0.05). The total number of patients with other chronic diseases among all respondents was 5 606, with the top five diseases of hypertension〔2 205 (39.33%) 〕, intervertebral disc disease〔553 (9.86%) 〕, diabetes 〔526 (9.38%) 〕, cerebrovascular disease〔492 (8.78%) 〕, and ischemic heart disease〔467 (8.33%) 〕. The top five diseases in the dementia patients were hypertension〔325 (41.40%) 〕, cerebrovascular disease〔111 (14.14%) 〕, ischemic heart disease〔91 (11.59%) 〕, rheumatoid arthritis 〔89 (11.33%) 〕, and intervertebral disc disease〔81 (10.31%) 〕. The prevalence of dementia in patients with no chronic disease, with 1, 2, 3 or more types of other chronic diseases was 11.46% (214/1 867), 13.66% (309/2 262), 17.50% (176/1 006), and 18.26% (86/471), respectively. There were statistically significant differences in the prevalence of Alzheimer's disease between the subjects with and without gastroenteritis, rheumatoid arthritis, cerebrovascular disease, chronic obstructive pulmonary disease, and ischemic heart disease, respectively (P<0.05). Binary Logistic regression analysis showed that living in rural areas〔OR=2.048, 95%CI (1.655, 2.536) 〕, female〔OR=1.388, 95%CI (1.163, 1.655) 〕, aging〔OR=1.348, 95%CI (1.270, 1.431) 〕, and suffering from other chronic diseases〔OR=1.195, 95%CI (1.101, 1.297) 〕 were risk factors for the development of Alzheimer's disease in residents aged 65 years and above (P<0.05). The investigation results of timely medication taking in the patients with Alzheimer's disease showed that 12.79% (99/774) reported difficulties, 6.59% (51/774) needed help, and 2.97% (23/774) were unable to complete independently.

The prevalence of Alzheimer's disease in residents aged 65 years and above in Hunan Province increases with the number of other chronic diseases and correlates with multiple diseases. Great attention should be paid on the self-care ability and family care burden of Alzheimer's disease by society. The prevalence and multimorbidity of Alzheimer's disease were basically grasped by the investigation, in order to provide an objective basis for the formulation of policies on its prevention and treatment.

In the context of increasing population aging, maintaining the health of the elderly is the key to successful aging. Multimorbidity is an important factor threatening the health of the elderly, and its relationship with the health promotion behaviors of the elderly has been rarely reported.

To understand the multimorbidity patterns and distribution of health promotion behaviors among the elderly in Ningxia, analyze the relationship between multimorbidity patterns and health promotion behaviors in the elderly, so as to provide a reference for the development of management and intervention strategies for the health of elderly.

The population aged 65 years and above in Ningxia were selected as study subjects by using random cluster sampling method from January 2021 to July 2021, and surveyed by self-designed questionnaire〔including general information questionnaire, patient health questionnaire-9 (PHQ-9) , mini-mental state examination (MMSE) , health promoting lifestyle profile-Chinese version (HPLP-C) 〕. Multimorbidity patterns of the elderly was analyzed by association rules of Apriori algorithm, the correlation between multimorbidity and health promotion behaviors of the elderly was analyzed by multivariable Logistic regression analysis.

A total of 2 010 older adults aged 65 years and above were included, with the multimorbidity rate of 31.00% (623/2 010) . The most common binary multimorbidity pattern was coronary heart disease and hypertension〔25.36% (158/623) 〕, the most common ternary multimorbidity pattern was hypertension, coronary heart disease and stroke〔4.49% (28/623) 〕. The association rules revealed 16 patterns of multimorbidity, 15 of which were related to hypertension, 10 were related to coronary heart disease, and 7 were related to asthma. The multivariate Logistic regression analysis showed that compared with older adults with poor health promotion behaviors, those with general〔OR (95%CI) =0.364 (0.185, 0.714) 〕, good〔OR (95%CI) =0.488 (0.251, 0.948) 〕, excellent〔OR (95%CI) =0.426 (0.213, 0.853) 〕health promotion behaviors had a lower risk of multimorbidity (P<0.05) . HPLP-C physical activity〔OR (95%CI) =0.960 (0.925, 0.997) 〕and stress management〔OR (95%CI) =0.963 (0.938, 0.989) 〕dimension scores in older adults were negatively associated with the occurrence of multimorbidity; HPLP-C health responsibility〔OR (95%CI) =1.038 (1.013, 1.063) 〕dimension score was positively associated with the occurrence of multimorbidity.

The multimorbidity patterns of the elderly in Ningxia are complex, and there is an association between health promotion behaviors and occurrence of multimorbidity. The risk of multimorbidity can be reduced by interventions such as encouraging the elderly to practice health promotion behaviors and improve their lifestyles.

The estimation of the prevalence of multimorbidity and identification of high-risk populations can directly affect the corresponding rational allocation of public health resources.

To comprehensively describe the prevalence trends and population characteristics of multimorbidity among residents in mainland China from 1998-2019 through Meta-analysis.

The databases including Web of Science, PubMed, CNKI, Wanfang Data Knowledge Service Platform and VIP were searched for journal literature relevant to the prevalence of multimorbidity in mainland China from inception to 2022-04-30. Data extraction and quality evaluation were performed on the literature and meta-analysis was performed using Stata 14.0 software. The pooled prevalence of multimorbidity was calculated by using random effects model, and subgroup analysis of the prevalence of multimorbidity was conducted based on survey time (before 2004, 2004-2013, since 2014), gender, region (urban, rural), geographical area (east, central, west, northeast), education level (uneducated, primary school, secondary school and above), marital status (married, others), and research quality (low, medium, high) .

A total of 123 papers were included into analysis with a total sample size of 7 714 313 cases. There was significant heterogeneity among studies (I²=100.0%, P<0.001), and the prevalence of multimorbidity was 36.3%〔95%CI (32.8%, 39.9%) 〕. Meta-linear regression model showed a non-linear increasing trend in the prevalence of multimorbidity from 1998 to 2019〔β=0.013, 95%CI (0.006, 0.019) 〕. The results of the subgroup analysis showed that the prevalence of multimorbidity was higher since 2014〔40.4%, 95%CI (33.0%, 47.8%) 〕 than before 2004〔14.5%, 95%CI (12.5%, 16.5%) 〕 and 2004-2013〔35.2%, 95%CI (32.2%, 38.2%) 〕 (P<0.001) ; the prevalence of multimorbidity was higher among those aged 60-79 years〔38.1%, 95%CI (34.6%, 41.5%) 〕 than those aged ≥80 years〔36.6%, 95%CI (32.5%, 40.8%) 〕, 40-59 years〔27.7%, 95%CI (24.4%, 31.1%) 〕, and <40 years〔10.6%, 95%CI (9.0%, 12.3%) 〕 (P<0.001). There was no significant difference in the subgroup analysis of gender, education level, marital status, region, geographical area, type of chronic disease, quality of research, and the comparison of the prevalence of multimorbidity (P>0.05) .

The prevalence of multimorbidity among residents in mainland China was 36.3% from 1998 to 2019 with a rising trend and significant differences in age, therefore, attention should be paid to the early screening of high-risk population, active and effective strategies for prevention and control should be adopted.