Temporal Patterns of Multimorbidity Progression Among Inpatients With a Recorded Hypertension Diagnosis Across Three Counties in Rural Henan, China: Retrospective Cohort Study Using Temporal Network Analysis.
4 affiliations
- 1Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 3 Yabao Road, Chaoyang District, Beijing, 100020, China.
- 2School of Health Management, Southern Medical University, Guangzhou, Guangdong, China.
- 3Henan Key Laboratory for Health Management of Chronic Diseases, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China.
- 4People's Medical Publishing House, Beijing, China.
Abstract
Background
Hypertension is a key driver of multimorbidity; however, its role in shaping dynamic disease progression, especially in rural populations, remains underexplored.Objective
This study aimed to characterize temporal patterns of multimorbidity progression among inpatients with a recorded hypertension diagnosis and to examine whether these patterns differed by sex, age, insurance type, and county.Methods
We analyzed electronic health record data from 34,099 inpatients with a recorded hypertension diagnosis across 3 rural counties in Henan, China (2019-2023), constructing a temporal comorbidity network of 250 disease nodes and 1512 disease transitions. Statistical validation was performed using bootstrap resampling, case-dropping, and permutation tests. Subgroup analyses were conducted by sex, age, insurance type, and county.Results
The temporal comorbidity network revealed a densely interconnected core involving hypertension, atherosclerotic heart disease, and cerebral infarction, with type 2 diabetes occupying a bridging position between cardiovascular and multisystem disease clusters. The ordering of dominant recorded pathways differed by sex (earlier coronary involvement among female inpatients vs more direct progression to stroke among male inpatients), was more complex in inpatients older than 70 years of age, and was more diffuse among those covered by urban-rural resident insurance compared with urban employee insurance.Conclusions
Multimorbidity among inpatients with recorded hypertension followed structured and heterogeneous temporal patterns that differed by sex, age, insurance type, and county. Cardiovascular and cerebrovascular conditions formed the principal recorded progression pathways, while type 2 diabetes connected cardiovascular pathways with broader multisystem complications. These findings support further evaluation of risk-stratified and locally adapted approaches to chronic disease prevention and longitudinal care.
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BibTeX
@article{wang2026temporal,
title = {{Temporal Patterns of Multimorbidity Progression Among Inpatients With a Recorded Hypertension Diagnosis Across Three Counties in Rural Henan, China: Retrospective Cohort Study Using Temporal Network Analysis.}},
author = {Yifei Wang and Yanna Mao and Xi Wang and Rongmei Liu and Manman Cui and Ruihua Feng},
journal = {JMIR public health and surveillance},
year = {2026},
month = oct,
doi = {10.2196/93217},
url = {https://europepmc.org/article/MED/42912827},
note = {CC BY},
}
RIS
TY - JOUR
TI - Temporal Patterns of Multimorbidity Progression Among Inpatients With a Recorded Hypertension Diagnosis Across Three Counties in Rural Henan, China: Retrospective Cohort Study Using Temporal Network Analysis.
AU - Yifei Wang
AU - Yanna Mao
AU - Xi Wang
AU - Rongmei Liu
AU - Manman Cui
AU - Ruihua Feng
PY - 2026
DA - 2026/10/23
JO - JMIR public health and surveillance
DO - 10.2196/93217
UR - https://europepmc.org/article/MED/42912827
AB - Background Hypertension is a key driver of multimorbidity; however, its role in shaping dynamic disease progression, especially in rural populations, remains underexplored.Objective This study aimed to characterize temporal patterns of multimorbidity progression among inpatients with a recorded hypertension diagnosis and to examine whether these patterns differed by sex, age, insurance type, and county.Methods We analyzed electronic health record data from 34,099 inpatients with a recorded hypertension diagnosis across 3 rural counties in Henan, China (2019-2023), constructing a temporal comorbidity network of 250 disease nodes and 1512 disease transitions. Statistical validation was performed using bootstrap resampling, case-dropping, and permutation tests. Subgroup analyses were conducted by sex, age, insurance type, and county.Results The temporal comorbidity network revealed a densely interconnected core involving hypertension, atherosclerotic heart disease, and cerebral infarction, with type 2 diabetes occupying a bridging position between cardiovascular and multisystem disease clusters. The ordering of dominant recorded pathways differed by sex (earlier coronary involvement among female inpatients vs more direct progression to stroke among male inpatients), was more complex in inpatients older than 70 years of age, and was more diffuse among those covered by urban-rural resident insurance compared with urban employee insurance.Conclusions Multimorbidity among inpatients with recorded hypertension followed structured and heterogeneous temporal patterns that differed by sex, age, insurance type, and county. Cardiovascular and cerebrovascular conditions formed the principal recorded progression pathways, while type 2 diabetes connected cardiovascular pathways with broader multisystem complications. These findings support further evaluation of risk-stratified and locally adapted approaches to chronic disease prevention and longitudinal care.
SN - 2369-2960
ER -