多重疾病已成为中国中老年人的主要公共卫生问题，也是医疗保健系统成本最高的问题。然而，之前大多数基于人群的多发病研究都集中在有限数量的慢性疾病上，诊断基于参与者的自我报告，这可能过于简单化了问题。与此同时，关于多重发病模式与医疗保健费用之间关系的报道很少。本研究基于代表性医院电子病历数据，分析了过去十年中国中老年人的多种疾病模式和变化及其与医疗费用的关系。采用了两项基于代表性医院数据的横断面调查获取襄阳市2013年（n = 20,218）和2023年（n = 63,517）45岁及以上成年人。采用潜在类别分析法分析多发病模式的变化，利用灰色关联分析和有序物流模型评估多发病模式与医疗费用的关联。慢性病的诊断和分类基于国际疾病分类第十次修订版代码（ICD-10）。慢性病合并症检出率有所提高（70.74 vs. 76.63%，p<0.001），合并症模式也有所改变。从6种增加到9种（2013年：恶性肿瘤模式、非特异性多发病模式、缺血性心脏病  高血压模式、脑梗死  高血压模式、肾脏疾病  高血压模式、晶状体疾病  高血压模式；2023年新增：营养代谢障碍  高血压模式、慢性中国下呼吸道疾病  恶性肿瘤模式、胃肠道疾病模式）。 2013 年至 2023 年间，所有多病患者的医疗费用均有所下降（人民币：8216.74 比 7247.96，IQR：5802.28-15,737 比 5014.63-15434.06）。两项调查中排名前三位的具体多病模式分别是恶性肿瘤模式、缺血性心脏病 高血压模式和脑梗塞 高血压模式。高血压和 2 型糖尿病是多发病模式的重要组成部分。与患有单一疾病的患者相比，2013年只有晶状体疾病  高血压模式存在较高医疗费用的风险（aOR：1.23，95％CI：1.03，1.47），而所有多发病模式都与2023年医疗费用增加显着相关，除了晶状体疾病  高血压（aOR：0.35，95％CI：0.32，0.39）。此外，不同发病模式的医疗费用上涨的可能性并不一致。其中，缺血性心脏病 高血压模式[调整比值比（aOR）：4.66，95%CI：4.31，5.05]和脑梗死高血压模式（aOR：3.63，95%CI：3.35，3.92）是两种模式风险最高。同时，男性（aOR：1.12，95CI：1.09，1.16）、无配偶（aOR：1.09，95CI：1.03，1.16）对医疗费用有积极影响，而完全自费的患者（aOR：0.45，95CI： 0.29, 0.70), 没有手术 (aOR: 0.05, 95CI: 0.05, 0.05), 农村居民 (aOR: 0.92, 95CI: 0.89, 0.95), 住院 1-5 天 (aOR: 0.04, 95CI: 0.04, 0.04),住院第 6-9 天（aOR：0.15，95CI：0.15，0.16）对医疗费用产生负面影响。过去十年，中国中老年人的多发病模式呈现多样化，并与医疗费用上涨相关在中国。需要明智、果断和全面的政策和护理干预措施来有效管理非传染性疾病及其危险因素，并减轻多种疾病给患者和国家带来的经济负担。版权所有 © 2024 Ju, Liu, Gong,Guo,Ge,Liu,Luo,杨、李、刘、李、何、刘、黄、徐、刘。

Multimorbidity has become a major public health problem among Chinese middle-aged and older adults, and the most costly to the health care system. However, most previous population-based studies of multimorbidity have focused on a limited number of chronic diseases, and diagnosis was based on participants' self-report, which may oversimplify the problem. At the same time, there were few reports on the relationship between multimorbidity patterns and health care costs. This study analyzed the multimorbidity patterns and changes among middle-aged and older people in China over the past decade, and their association with medical costs, based on representative hospital electronic medical record data.Two cross-sectional surveys based on representative hospital data were used to obtain adults aged 45 years and older in Xiangyang in 2013 (n = 20,218) and 2023 (n = 63,517). Latent Class Analysis was used to analyze changes in the patterns of multimorbidity, gray correlation analysis and ordered logistics model were used to assess the association of multimorbidity patterns with medical expenses. The diagnosis and classification of chronic diseases were based on the International Classification of Diseases, Tenth Revision codes (ICD-10).The detection rate of chronic disease multimorbidity has increased (70.74 vs. 76.63%, p < 0.001), and multimorbidity patterns have increased from 6 to 9 (2013: Malignant tumors pattern, non-specific multimorbidity pattern, ischemic heart disease + hypertension pattern, cerebral infarction + hypertension pattern, kidney disease + hypertension pattern, lens disease + hypertension pattern; new in 2023: Nutritional metabolism disorders + hypertension pattern, chronic lower respiratory diseases + malignant tumors pattern, and gastrointestinal diseases pattern) in China. The medical cost of all multimorbidity patients have been reduced between 2013 and 2023 (RMB: 8216.74 vs. 7247.96, IQR: 5802.28-15,737 vs. 5014.63-15434.06). The top three specific multimorbidity patterns in both surveys were malignancy tumor pattern, ischemic heart disease + hypertension pattern, and cerebral infarction + hypertension pattern. Hypertension and type 2 diabetes are important components of multimorbidity patterns. Compared with patients with a single disease, only lens disorders + hypertension pattern were at risk of higher medical costs in 2013 (aOR:1.23, 95% CI: 1.03, 1.47), whereas all multimorbidity patterns were significantly associated with increased medical costs in 2023, except for lens disorders + hypertension (aOR:0.35, 95% CI: 0.32, 0.39). Moreover, the odds of higher medical costs were not consistent across multimorbidity patterns. Among them, ischemic heart disease + hypertension pattern [adjusted odds ratio (aOR):4.66, 95%CI: 4.31, 5.05] and cerebral infarction + hypertension pattern (aOR: 3.63, 95% CI: 3.35, 3.92) were the two patterns with the highest risk. Meanwhile, men (aOR:1.12, 95CI:1.09, 1.16), no spouse (aOR:1.09, 95CI: 1.03, 1.16) had a positive effect on medical costs, while patients with total self-pay (aOR: 0.45, 95CI: 0.29, 0.70), no surgery (aOR: 0.05, 95CI: 0.05, 0.05), rural residence (aOR: 0.92, 95CI: 0.89, 0.95), hospitalization days 1-5 (aOR: 0.04, 95CI: 0.04, 0.04), and hospitalization days 6-9 (aOR: 0.15, 95CI: 0.15, 0.16) had a negative impact on medical costs.Multimorbidity patterns among middle-aged and older adults in China have diversified over the past decade and are associated with rising health care costs in China. Smart, decisive and comprehensive policy and care interventions are needed to effectively manage NCDS and their risk factors and to reduce the economic burden of multimorbidity on patients and the country.Copyright © 2024 Ju, Liu, Gong, Guo, Ge, Liu, Luo, Yang, Li, Liu, Li, He, Liu, Huang, Xu and Liu.