Longitudinal Insights into Comorbidity Patterns and Burden among Middle-aged and older Adult with Diabetes in China: A 9-year Cohort Study Using CHARLS
1
Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China 中国
2
China Center for Health Development Studies, Peking University, Beijing, China 中国
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
China has the largest diabetic population, accounting for over a quarter of global cases. As a chronic condition frequently accompanied by comorbidities, diabetes requires research on the patterns and burdens of associated conditions, particularly within primary care settings. This study provides longitudinal insights into the evolution of comorbidity patterns and burdens among China’s diabetic population, examining trends and influencing factors.
METHODS:
Data were drawn from a longitudinal data in five waves (2011–2020) of the China Health and Retirement Longitudinal Study (CHARLS). Comorbidities were classified into three categories based on etiological relationship with diabetes: Traditional Concordant (TCC), Non-traditional Concordant (NCC), and Discordant (DC). Generalized Estimating Equation (GEE) models were used to identify factors influencing comorbidity burden.
RESULTS:
Between 2011 and 2020, the prevalence of diabetes among individuals aged 45 years and older in China increased from 6.3% to 17.6%, while diabetes-related comorbidities rose from 5.3% to 16.9%. The most prevalent comorbidities in 2020 were hypertension (68.3%) and dyslipidemia (62.3%). The average number of conditions per diabetic patient increased by 1.5, and the Charlson Comorbidity Index (CCI) increased by 50%. At the final follow-up, 65.4% of patients had TCC, 92.4% had NCC, and 75.9% had DC. GEE analysis showed that the number and CCI of comorbidities increase with age (0.034, p = 0.009; 0.041, p = 0.021). Diabetes control is significantly associated with a decrease in both the numbers and CCI of TCC (-0.720, p < 0.001; -0.951, p < 0.001), a modest but significant reduction in NCC numbers (-0.134, p = 0.021) without a corresponding reduction in its CCI, and no significant association with DC.
CONCLUSIONS:
The increasing comorbidity burden in diabetic patients highlights the need for primary care-centered interventions tailored to comorbidity types. Targeted management of diabetes is instrumental in reducing the severity of comorbidities within the TCC pattern.
China has the largest diabetic population, accounting for over a quarter of global cases. As a chronic condition frequently accompanied by comorbidities, diabetes requires research on the patterns and burdens of associated conditions, particularly within primary care settings. This study provides longitudinal insights into the evolution of comorbidity patterns and burdens among China’s diabetic population, examining trends and influencing factors.
METHODS:
Data were drawn from a longitudinal data in five waves (2011–2020) of the China Health and Retirement Longitudinal Study (CHARLS). Comorbidities were classified into three categories based on etiological relationship with diabetes: Traditional Concordant (TCC), Non-traditional Concordant (NCC), and Discordant (DC). Generalized Estimating Equation (GEE) models were used to identify factors influencing comorbidity burden.
RESULTS:
Between 2011 and 2020, the prevalence of diabetes among individuals aged 45 years and older in China increased from 6.3% to 17.6%, while diabetes-related comorbidities rose from 5.3% to 16.9%. The most prevalent comorbidities in 2020 were hypertension (68.3%) and dyslipidemia (62.3%). The average number of conditions per diabetic patient increased by 1.5, and the Charlson Comorbidity Index (CCI) increased by 50%. At the final follow-up, 65.4% of patients had TCC, 92.4% had NCC, and 75.9% had DC. GEE analysis showed that the number and CCI of comorbidities increase with age (0.034, p = 0.009; 0.041, p = 0.021). Diabetes control is significantly associated with a decrease in both the numbers and CCI of TCC (-0.720, p < 0.001; -0.951, p < 0.001), a modest but significant reduction in NCC numbers (-0.134, p = 0.021) without a corresponding reduction in its CCI, and no significant association with DC.
CONCLUSIONS:
The increasing comorbidity burden in diabetic patients highlights the need for primary care-centered interventions tailored to comorbidity types. Targeted management of diabetes is instrumental in reducing the severity of comorbidities within the TCC pattern.
| eISSN: | 2654-1459 |
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