Multimorbidity Patterns and Mortality Risk in 0.5 Million Chinese Adults: Key Findings from a Decade-Long Study
Chronic diseases are on the rise globally, and China is no exception. For millions of Chinese adults, living with one chronic condition like diabetes or high blood pressure is challenging—but living with two or more (a term called multimorbidity) can be life-threatening. A landmark study of 512,723 Chinese adults has shed new light on which combinations of chronic diseases are most common, who is at risk, and how these patterns affect mortality over time.
Led by researchers from Peking University’s School of Public Health and the University of Oxford’s Nuffield Department of Population Health, the study followed participants for a median of 10.8 years to uncover critical insights about multimorbidity in China. Here’s what you need to know.
What Is Multimorbidity, and Why Does It Matter?
Multimorbidity refers to having two or more chronic diseases at the same time. Unlike single diseases, multimorbidity complicates treatment, increases healthcare costs, and raises the risk of disability and death. For China—where 1 in 5 adults already lives with a chronic condition—understanding how diseases cluster is key to improving public health.
The Study: Who Was Included?
The research used data from the China Kadoorie Biobank (CKB), a large, ongoing study of adults aged 30–79 recruited from 10 regions (5 urban, 5 rural) between 2004 and 2008. Participants provided detailed health information via surveys, physical exams, and blood tests. The final analysis included 512,723 people (after excluding two with missing BMI data).
Key Finding 1: Multimorbidity Prevalence
Overall, 15.8% of participants had multimorbidity—meaning 1 in 6 Chinese adults in the study lived with two or more chronic diseases. The risk rose sharply with age:
- 6.4% of adults under 50 had multimorbidity
- 17.0% of those 50–59 had it
- 31.8% of adults over 60 had it
Urban residents (18.7%) were more likely to have multimorbidity than rural residents (13.5)—likely because urban areas have better access to healthcare, leading to more frequent disease detection. Men (16.3%) and women (15.5%) had similar rates.
Key Finding 2: Four Major Multimorbidity Patterns
Using statistical clustering, researchers identified four distinct groups of co-occurring diseases—patterns that reflect shared risk factors or biological links:
1. Cardiometabolic Multimorbidity (6.0% of participants)
The most common pattern, this includes diabetes, coronary heart disease, stroke, and hypertension. These conditions share risk factors like poor diet, lack of exercise, and obesity—and together, they create a “perfect storm” for heart and blood vessel damage.
2. Respiratory Multimorbidity (0.4% of participants)
This cluster combines tuberculosis (TB), asthma, and chronic obstructive pulmonary disease (COPD). Respiratory diseases are a major health burden in China: COPD is the 3rd leading cause of death nationwide, while TB and asthma affect millions.
3. Gastrointestinal and Hepatorenal Multimorbidity (0.8% of participants)
This group includes gallstone disease, chronic kidney disease, cirrhosis, peptic ulcer, and cancer. These conditions often stem from shared risk factors like alcohol use, unhealthy diets, or chronic inflammation.
4. Mental and Arthritis Multimorbidity (0.2% of participants)
The smallest pattern, this links neurasthenia (chronic fatigue/nervousness), psychiatric disorders (depression/anxiety), and rheumatoid arthritis. Mental health conditions and chronic pain often coexist, though the study found no strong link to mortality here (likely due to small sample size).
Key Finding 3: Multimorbidity and Mortality Risk
Over a decade of follow-up, 49,371 participants died. The study found a strong, dose-dependent link between multimorbidity and death:
- Every additional chronic disease increased mortality risk by 36%.
- Compared to people with no chronic diseases:
- Those with 1 disease had a 59% higher risk of death.
- Those with 2 diseases had a 125% higher risk.
- Those with 3+ diseases had a 219% higher risk.
Two patterns stood out as most dangerous:
- Cardiometabolic multimorbidity: 2.2x higher mortality risk than people with no multimorbidity.
- Respiratory multimorbidity: 2.1x higher mortality risk.
For cause-specific deaths:
- Cardiovascular deaths: Highest risk in the cardiometabolic group (2.98x higher).
- Respiratory deaths: Highest risk in the respiratory group (7.16x higher).
- Cancer deaths: Highest risk in the gastrointestinal/hepatorenal group (1.74x higher).
Why These Findings Matter for China’s Public Health
China’s disease landscape is changing. While infectious diseases once dominated, chronic conditions now cause 88% of deaths. This study highlights two urgent priorities:
- Target cardiometabolic diseases: With hypertension (35.2% prevalence) and diabetes (5.9%) being the most common conditions, policies promoting healthy diets, exercise, and regular screenings could reduce this deadly cluster.
- Improve respiratory care: COPD, TB, and asthma are often underdiagnosed in rural areas. Expanding access to pulmonary function tests and affordable medications could save lives.
The study also challenges the myth that multimorbidity is “only an old person’s problem.” Nearly 1 in 15 adults under 50 had multiple chronic diseases—meaning prevention must start early.
Study Strengths and Limitations
The research’s biggest strengths are its size (0.5 million participants) and duration (10.8 years of follow-up)—making results highly reliable. However, some limitations include:
- Baseline data only: The study used disease status at the start (2004–2008) and didn’t track new diagnoses during follow-up.
- Self-reported data: Some conditions (like psychiatric disorders) relied on participant reports, which may undercount cases.
Conclusion: A Call to Action for Multimorbidity Care
This study is one of the first to map multimorbidity patterns in China—and the results are clear: not all chronic disease combinations are equal. Cardiometabolic and respiratory multimorbidity pose the greatest threat to life, while gastrointestinal/hepatorenal and mental/arthritis patterns require targeted care.
For public health officials, the takeaway is simple: Move beyond treating single diseases. Develop guidelines for managing multimorbidity, train doctors to address overlapping conditions, and invest in prevention (e.g., smoke-free policies, diabetes screening). For individuals, the message is equally clear: Small changes—like eating more fruits, exercising regularly, and getting annual check-ups—can reduce the risk of developing multiple chronic diseases.
As China’s population ages, addressing multimorbidity will be critical to building a healthier future. This study provides the data needed to act.
Junning Fan, Zhijia Sun, Canqing Yu, et al. Multimorbidity patterns and association with mortality in 0.5 million Chinese adults. Chinese Medical Journal. 2022;135(6):648–657. doi:10.1097/CM9.0000000000001985
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