Comorbidity patterns and inpatient expenditure among patients with coronary heart disease in China.
5 affiliations
- 1Yuncheng Central Hospital affiliated to Shanxi Medical University, Yuncheng, shanxi, 044000, China.
- 2Department of Health Policy and Management, School of Public Health, Peking University, Beijing, 100191, China.
- 3Yuncheng Central Hospital affiliated to Shanxi Medical University, Yuncheng, shanxi, 044000, China. [email protected].
- 4Yuncheng City Health Commission, Yuncheng, shanxi, 044000, China. [email protected].
- 5Department of Health Policy and Management, School of Public Health, Peking University, Beijing, 100191, China. [email protected].
Abstract
Background
Coronary heart disease (CHD) often co-occurs with other chronic conditions. This increases care complexity and hospital costs. Most previous studies have relied on single diseases or simple comorbidity counts. Less is known about whether different multimorbidity patterns are associated with different levels and structures of inpatient expenditure. We aimed to identify comorbidity patterns among middle-aged and older inpatients with CHD and to examine their associations with hospital costs.Methods
We conducted a retrospective study using electronic health record data from a tertiary hospital in Shanxi Province, China, from 2020 to 2024. Patients aged 45 years or older with a principal discharge diagnosis of CHD (ICD-10: I20-I25) were included. The outcome was total inpatient expenditure per admission. Latent class analysis was applied to 14 comorbidities with prevalence of at least 1%. We then used generalised linear models with a gamma family and log link to examine the association between latent classes and inpatient expenditure, adjusting for sociodemographic and clinical covariates.Results
Among 33,044 patients used for pattern identification, 85.16% (28,140) had at least one included comorbidity. Five classes were identified: low comorbidity (39.89%), vascular disease (5.20%), hypertension-dominant (42.27%), diabetes-renal (3.16%), and cardiac dysfunction (9.48%). Compared with the low-comorbidity class, all other classes were associated with higher inpatient expenditure, with the largest increases observed in the cardiac dysfunction class (ER = 1.33, 95% CI: 1.30-1.36) and the diabetes-renal class (ER = 1.27, 95% CI: 1.23-1.32). Predicted mean expenditure was highest in the cardiac dysfunction class ($2,615.77; 95% CI: 2,562.30-2,669.24) and the diabetes-renal class ($2,502.99; 95% CI: 2,421.49-2,584.49), compared with $1,964.85 (95% CI: 1,943.54-1,986.16) in the low-comorbidity class. Medical consumables accounted for the largest share of expenditure in all groups, while the cardiac dysfunction class had the highest proportions of diagnostic and medication costs.Conclusions
Multimorbidity was highly prevalent among middle-aged and older inpatients with CHD. Distinct comorbidity patterns were associated with different levels and structures of inpatient expenditure. These findings may help inform more tailored care planning and more refined payment adjustment in tertiary inpatient settings.
Related
- Real-world evidence of physical comorbidity patterns and all-cause mortality in patients with mental disorders.
- Machine‐Learning Prediction of Tumor Comorbidity and Cancer‐Associated Mortality in Patients With Coronary Heart Disease: A 2‐Stage Modeling Study
- Sex stratified differences in comorbidity patterns among early- and late-onset dementia patients: original research article
- Epidemiology, comorbidity profiles, and oral anticoagulation patterns among patients with atrial fibrillation in Turkey: a meta-analysis of national registry-based and multicenter observational studies.
- Sex differences in electrocardiographic patterns among patients with acute coronary syndromes
BibTeX
@article{chen2026comorbidity,
title = {{Comorbidity patterns and inpatient expenditure among patients with coronary heart disease in China.}},
author = {Xiali Chen and Zhixin Liu and Pan Han and Rui Dong and Hongjie Zhang and Xing Lin Feng},
journal = {BMC public health},
year = {2026},
month = jul,
doi = {10.1186/s12889-026-28736-9},
url = {https://europepmc.org/article/MED/42902291},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Comorbidity patterns and inpatient expenditure among patients with coronary heart disease in China.
AU - Xiali Chen
AU - Zhixin Liu
AU - Pan Han
AU - Rui Dong
AU - Hongjie Zhang
AU - Xing Lin Feng
PY - 2026
DA - 2026/07/01
JO - BMC public health
DO - 10.1186/s12889-026-28736-9
UR - https://europepmc.org/article/MED/42902291
AB - Background Coronary heart disease (CHD) often co-occurs with other chronic conditions. This increases care complexity and hospital costs. Most previous studies have relied on single diseases or simple comorbidity counts. Less is known about whether different multimorbidity patterns are associated with different levels and structures of inpatient expenditure. We aimed to identify comorbidity patterns among middle-aged and older inpatients with CHD and to examine their associations with hospital costs.Methods We conducted a retrospective study using electronic health record data from a tertiary hospital in Shanxi Province, China, from 2020 to 2024. Patients aged 45 years or older with a principal discharge diagnosis of CHD (ICD-10: I20-I25) were included. The outcome was total inpatient expenditure per admission. Latent class analysis was applied to 14 comorbidities with prevalence of at least 1%. We then used generalised linear models with a gamma family and log link to examine the association between latent classes and inpatient expenditure, adjusting for sociodemographic and clinical covariates.Results Among 33,044 patients used for pattern identification, 85.16% (28,140) had at least one included comorbidity. Five classes were identified: low comorbidity (39.89%), vascular disease (5.20%), hypertension-dominant (42.27%), diabetes-renal (3.16%), and cardiac dysfunction (9.48%). Compared with the low-comorbidity class, all other classes were associated with higher inpatient expenditure, with the largest increases observed in the cardiac dysfunction class (ER = 1.33, 95% CI: 1.30-1.36) and the diabetes-renal class (ER = 1.27, 95% CI: 1.23-1.32). Predicted mean expenditure was highest in the cardiac dysfunction class ($2,615.77; 95% CI: 2,562.30-2,669.24) and the diabetes-renal class ($2,502.99; 95% CI: 2,421.49-2,584.49), compared with $1,964.85 (95% CI: 1,943.54-1,986.16) in the low-comorbidity class. Medical consumables accounted for the largest share of expenditure in all groups, while the cardiac dysfunction class had the highest proportions of diagnostic and medication costs.Conclusions Multimorbidity was highly prevalent among middle-aged and older inpatients with CHD. Distinct comorbidity patterns were associated with different levels and structures of inpatient expenditure. These findings may help inform more tailored care planning and more refined payment adjustment in tertiary inpatient settings.
SN - 1471-2458
ER -