Multimorbidity patterns and disease co‐occurrence networks in older adults with diabetes: A national population‐based network analysis

Aims This study aimed to characterize multimorbidity patterns and disease co‐occurrence networks among older adults with diabetes in China. Materials This cross‐sectional study analysed data from older adults aged ≥65 years with diabetes from the 2018 Chinese Longitudinal Healthy Longevity Survey. Network and hierarchical clustering analyses were used to examine co‐occurrence patterns among 17 chronic physical and mental conditions. Results A total of 1408 participants with diabetes were included, comprising 593 male participants (42.1%) and 815 female participants (57.9%). Overall, 91.6% of participants had ≥1 additional chronic condition, and 71.3% had ≥2 additional chronic conditions. Hypertension (75.5%), heart disease (36.7%) and affective disorder (33.7%) were the three most common conditions; the hypertension–heart disease combination was the leading comorbidity pair (31.75%). Arthritis ranked highest for strength, closeness and betweenness in the overall network; epilepsy also ranked highly for strength and betweenness, particularly among participants aged ≥75 years and in the central and western regions. Five comorbidity clusters emerged from hierarchical clustering, with centrality profiles differing by age, sex and region. Conclusions Our study indicated that multimorbidity burden was high among people with diabetes aged ≥65 years in China and was characterized by distinct network structures and clustering patterns. Arthritis and epilepsy showed high centrality in the comorbidity network, and network characteristics differed across age, sex and regional groups. These findings suggest that health management for older adults with diabetes should address not only common cardiometabolic conditions but also musculoskeletal, neurological and mental health problems.