Complex interrelationships among respiratory diseases and chronic multimorbidity: a longitudinal network analysis and implications for future viral respiratory pandemic preparedness.

Introduction: Respiratory diseases such as asthma, chronic obstructive pulmonary disease (COPD), pneumonia, and acute respiratory failure contribute significantly to the global health burden, particularly when co-occurring with chronic systemic conditions. Understanding these interrelationships is essential for designing resilient and integrated healthcare systems, especially in the context of pandemic stress. Methods: We analyzed over 82 million de-identified healthcare claims from the Comprehensive Health Care Information System (CHIS), spanning 2020 to 2024. A disease co-occurrence matrix was constructed by identifying overlapping ICD-10 codes across individual patient timelines. Pairwise associations were quantified using Spearman's rank-order correlation. The resulting associations were visualized as an undirected disease network. Results: COPD (J44.9) and asthma (J45.909) emerged as central nodes in the multimorbidity network, showing strong associations with metabolic (E11.9-Type 2 diabetes, E78.5-hyperlipidemia), cardiovascular (I10-hypertension), and mental health disorders (F32.9-depression, F41.9-anxiety). A significant reduction in chronic disease management services was observed in 2022, corresponding with the peak impact of the COVID-19 pandemic, followed by a partial rebound in 2023. Discussion: The findings reveal the integrative role of respiratory diseases within broader patterns of multimorbidity, reinforcing the need for cross-disciplinary management approaches. The observed pandemic-related disruption in chronic care delivery highlights systemic vulnerabilities. Future preparedness strategies should integrate multimorbidity frameworks and ensure continuity of care for both respiratory and systemic conditions.