{
  "abstract": "Objective: Multimorbidity is common among people with diabetes, but its associations with healthcare utilization and medical expenditures in China remain insufficiently characterized. This study aimed to examine these associations using different measures of multimorbidity burden and assess potential sex differences.\n\nMethods: We conducted cross-sectional analyses using the 2018 China Health and Retirement Longitudinal Study (CHARLS) and a retrospective hospital-based cohort. Multimorbidity burden was assessed using four measures: multimorbidity, ≥3 LTCs, number of long-term conditions (LTCs), and the Chinese Multimorbidity-Weighted Index (CMWI). Multivariable regression models were used to examine associations with healthcare utilization and expenditures. Sex-stratified analyses, interaction tests, and sensitivity analyses were also performed.\n\nResults: Among 2,531 CHARLS participants with diabetes, 92.9% had multimorbidity and 77.7% had ≥3 LTCs. All four measures were positively associated with inpatient and outpatient utilization, visit counts, and medical expenditures. The presence of ≥3 LTCs was associated with higher odds of inpatient (OR, 2.44; 95% CI, 1.90–3.16) and outpatient utilization (OR, 2.17; 95% CI, 1.68–2.84), as well as higher total inpatient (cost ratio, 2.98; 95% CI, 1.94–5.24) and outpatient expenditures (cost ratio, 3.15; 95% CI, 1.92–5.72). In the hospital cohort ( n = 3,963), all four measures were positively associated with hospitalization frequency, cumulative inpatient days, and inpatient expenditure. Most sex interaction tests were not statistically significant. Sensitivity analyses yielded generally consistent findings.\n\nConclusion: Greater multimorbidity burden was associated with higher healthcare utilization and medical expenditures among individuals with diabetes across two different settings. These findings highlight the importance of considering coexisting conditions in healthcare planning.",
  "abstract_shown": true,
  "affiliations": [
    "Center of Integrated Chinese and Western Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University",
    "Department of Endocrinology, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine",
    "Department of Nephrology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 11,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Jielong Wu"
    },
    {
      "affs": [
        0
      ],
      "name": "Bo Li"
    },
    {
      "affs": [
        1
      ],
      "name": "Xuemin Wu"
    },
    {
      "affs": [
        0
      ],
      "name": "Xin Hu"
    },
    {
      "affs": [
        2
      ],
      "name": "Hengyuan Zhang"
    },
    {
      "affs": [
        1
      ],
      "name": "Yiling Li"
    },
    {
      "affs": [
        0
      ],
      "name": "Zhihai Zhang"
    },
    {
      "affs": [
        0
      ],
      "name": "Miaona Cai"
    },
    {
      "affs": [
        1
      ],
      "name": "Chunli Piao"
    },
    {
      "affs": [
        0
      ],
      "name": "Nengjiang Zhao"
    },
    {
      "affs": [
        0
      ],
      "name": "Shuyu Yang"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/bqf9rr7ffh7kj.bib",
  "cited_by": 0,
  "doi": "10.3389/fpubh.2026.1975609",
  "fulltext_url": null,
  "id": "bqf9rr7ffh7kj",
  "issns": [
    "2296-2565"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fpubh.2026.1975609/full",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2713|Chronic Disease Management Strategies"
    ]
  ],
  "openalex": "W7224107223",
  "pdf_url": "https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2026.1975609/pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-28",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/bqf9rr7ffh7kj.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:24Z",
      "native_id": "10.3389/fpubh.2026.1975609",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fpubh.2026.1975609/full"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2713|Chronic Disease Management Strategies",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Associations of multimorbidity burden with healthcare utilization and expenditures among individuals with diabetes in China",
  "title_text": "Associations of multimorbidity burden with healthcare utilization and expenditures among individuals with diabetes in China",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:24Z",
  "url": "https://research.draconitic.com/paper/bqf9rr7ffh7kj",
  "venue": "Frontiers in Public Health",
  "versions": []
}