JMIR Publications

ABSTRACT

Background:

Hypertension is a key driver of multimorbidity, yet its role in shaping dynamic disease progression, especially in rural populations, remains underexplored.

Objective:

This study aims to apply temporal network analysis to examine hypertension-driven multimorbidity trajectories across three socioeconomically diverse counties in Henan Province, China. Specifically, we sought to investigate how disease patterns evolve over time and identify heterogeneity in progression pathways by sex, age, payment method, and geographic region, to inform precision public health strategies.

Methods:

We analyzed EHR data from 34,099 hypertensive inpatients across three rural counties in Henan, China (2019-2023), constructing a temporal comorbidity network (TCN) of 250 diseases and 1,512 disease transitions. Statistical validation was performed using bootstrap resampling, case-dropping, and permutation tests. Subgroup analyses were conducted by sex, age, insurance type, and region.

Results:

The TCN revealed a “malignant triangle” of hypertension → atherosclerotic heart disease → cerebral infarction. Type 2 diabetes served as a bridging node between macrovascular and microvascular diseases. Sex-stratified analysis showed that women transitioned from hypertension to coronary disease before cerebrovascular events, while men progressed more directly to stroke and diabetes complications. Age-stratified analysis identified complex multi-system progression in patients aged >70. Rural patients under urban–rural resident insurance exhibited more diffuse and complex disease patterns compared to those with urban employee insurance.

Conclusions:

This study demonstrates that hypertension-driven multimorbidity follows a dynamic, heterogeneous trajectory influenced by sex, age, insurance, and region. Temporal network analysis offers a robust framework for identifying critical disease transitions, informing tailored public health strategies.