Associations of multimorbidity burden with healthcare utilization and expenditures among individuals with diabetes in China
- 1Center of Integrated Chinese and Western Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University
- 2Department of Endocrinology, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine
- 3Department of Nephrology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University
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.
Methods: 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.
Results: 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.
Conclusion: 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.
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BibTeX
@article{wu2026associations,
title = {{Associations of multimorbidity burden with healthcare utilization and expenditures among individuals with diabetes in China}},
author = {Jielong Wu and Bo Li and Xuemin Wu and Xin Hu and Hengyuan Zhang and Yiling Li and Zhihai Zhang and Miaona Cai and Chunli Piao and Nengjiang Zhao and Shuyu Yang},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1975609},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1975609/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Associations of multimorbidity burden with healthcare utilization and expenditures among individuals with diabetes in China
AU - Jielong Wu
AU - Bo Li
AU - Xuemin Wu
AU - Xin Hu
AU - Hengyuan Zhang
AU - Yiling Li
AU - Zhihai Zhang
AU - Miaona Cai
AU - Chunli Piao
AU - Nengjiang Zhao
AU - Shuyu Yang
PY - 2026
DA - 2026/10/28
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1975609
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1975609/full
AB - 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. Methods: 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. Results: 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. Conclusion: 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.
SN - 2296-2565
ER -