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.