Multimorbidity and its associations with physical function, fall risk, and hospitalization cost in adults with type 1 diabetes: a cross-sectional study

Abstract

Background – Multiple long-term conditions co-occur in people with type 1 diabetes. We aim to investigate the association between comorbidities and physical function, fall risk and hospitalization cost. Methods – A cross-sectional study was conducted at the First Affiliated Hospital of Sun Yat-sen University. Adult patients with type 1 diabetes admitted between 2021 and 2025 were included. Prevalence of each morbidity was compared in people with different diabetes duration. ADL was assessed by the Barthel Index. Fall risk was evaluated by the Johns Hopkins Fall Risk Assessment Tool. Logistic regression models were used to analyze the association between multimorbidity and physical function and fall risk. Linear regression was used between eight variables and hospitalization costs. Variables associated with increasing risk of multimorbidity were identified using multivariate logistic regression model. Results – The mean number of morbidities per patient was 3.6 ± 1.8, with 31.4% (n=118), 41.5% (n=156), and 27.1% (n=102) had 1-2, 3-4, and ≥5 morbidities. Cardiovascular, kidney, metabolic conditions were the most prevalent comorbidities. Cataract, anemia, cancer, autoimmune thyroid disorders, chronic obstructive pulmonary disease, and mental health disorders were also notable. Older age and longer diabetes duration were strongly associated with higher multimorbidity burden. Increased multimorbidity was associated with higher fall risk (odds ratio (OR): 1.23, 95% confidence interval (CI): 1.01-1.52) (P<0.05), greater dependence in Activities of daily living (OR: 1.58, 95% CI: 1.08-2.32) (P = 0.02) and elevated hospitalization costs (β: 66.12, 95% CI: 14.65–117.58) (P = 0.012). Conclusions – Our findings demonstrate that multimorbidity is highly prevalent among Chinese adults with T1D. A higher burden of multimorbidity is significantly associated with adverse functional outcomes, including increased fall risk and greater dependence in ADL, as well as higher hospitalization costs. These findings highlight the critical need to integrate assessments of functional status, fall risk, and multimorbidity into routine clinical care for adults with T1D.