Multimorbidity Patterns and Related Treatment Costs Among Middle-Aged and Older Diabetes Patients in China

OBJECTIVES: This study aimed to evaluate the multimorbidity patterns of middle-aged and older Chinese patients with diabetes and assess treatment costs across different multimorbidity patterns.

METHODS: This study's data were derived from the cross-sectional data of 2526 patients with diabetes aged 45 or over in the 2018 wave of China Health and Retirement Longitudinal Study (CHARLS) survey. Diabetes and multimorbidity patterns were determined based on 14 self-reported chronic disease diagnoses, informed by physicians. Treatment costs were primarily based on respondents' self-reported total outpatient and inpatient costs. Descriptive statistics and latent class analysis (LCA) were used to analyze multimorbidity patterns and related treatment costs.

RESULTS: In 2526 diabetic patients, almost 93% had two or more chronic diseases, and more than 50% had hypertension or dyslipidemia. The LCA identified 5 multimorbidity clusters among all patients with diabetes: minimal disease, cardiovascular disease, arthritis and gastric disease, respiratory disease, and multisystem diseases. The LCA further identified 3 multimorbidity clusters in the 13 dyads patient groups and 48 groups with ternary diseases: hypertension, dyslipidemia, and multisystem diseases. Compared to other multimorbidity groups, diabetes patients with multisystem diseases are more likely to have additional liver disease, psychiatric illness, kidney disease, heart disease, stroke, and memory-related conditions. Treatment costs of diabetes patients increased with the number of morbidities. Treatment costs for multimorbidity cluster of multisystem diseases were significantly higher than those of other multimorbidity clusters.

CONCLUSIONS: There was a high proportion of multimorbidity among middle-aged and older patients with diabetes. The extra treatment costs and corresponding distribution of diabetes patients with multimorbidity may associate with both the number of morbidities and what systems were suffered in addition to diabetes.