Multimorbidity and associated factors among older adults with hypertension: Network analysis based on a...

Multimorbidity has emerged as a growing public health challenge, particularly within the context of global population aging. Approximately over half of older adults with hypertension suffer from at least one additional chronic condition. This study aimed to assess the prevalence of multimorbidity, explore associated factors, and identify central diseases among older adults with hypertension in rural China.

A cross-sectional study.

A total of 16,953 older adults (aged ≥65 years) with hypertension were included. Multimorbidity was defined as hypertensive participants with one or more chronic diseases. The analysis included demographic and health behavior variables, as well as clinical attributes. Logistic regression analysis was performed to examine influencing factors of multimorbidity. A network analysis was used to identify core diseases and disease relationships.

The prevalence of multimorbidity was 77.32% among older adults with hypertension. Increased age (aOR: 0.984, 95%CI: 0.977-0.991), healthy physical activity (aOR: 0.760, 95%CI: 0.696-0.829), healthy diet quality (aOR: 0.736, 95%CI: 0.616-0.879), healthy sleep duration (aOR: 0.768, 95%CI: 0.710-0.831) were protective factors of multimorbidity, while female (aOR: 1.418, 95%CI: 1.289-1.559), higher numbers of antihypertensive medicine (with no antihypertensive medication as the reference, aOR: 1.499, 95%CI: 1.327-1.693 for 1 medication; aOR: 1.894, 95%CI: 1.629-2.202 for ≥2 medications), duration of hypertension (aOR: 1.030, 95%CI: 1.025-1.035) and higher BMI (aOR: 1.140, 95%CI: 1.125-1.155) were risk factors of multimorbidity. Network analysis revealed that biliary disease (strength: 1.347), vision impairment (strength: 1.346), and arthritis or rheumatism (strength: 1.178) were central diseases. The correlation stability coefficient of the network model was 0.672, indicating excellent stability. The nodes of chronic kidney disease and liver disease were most strongly correlated (edge weight: 1.538), followed by the connection between arthritis or rheumatism and stomach or other digestive disease (edge weight: 1.050).

Multimorbidity in rural older adults with hypertension is associated not only with demographics but also with modifiable lifestyle factors and clinical characteristics. Network analysis reveals that chronic conditions co-occur non-randomly. These findings highlight the need for integrated care models that address these specific patterns, promote prudent prescribing, and support lifestyle modification as a key strategy in resource-limited settings.