Objective To analyze multimorbidity networks in community-dwelling elderly adults in Yuexiu district, Guangzhou and provide evidence to inform chronic disease management in community settings.

Methods A total of 54 829 individuals aged ≥ 65 years who participated in the National Free Health Examination Program in Yuexiu district, Guangzhou from January to December 2020 were included. Python 3.14.0 was used for hierarchical cluster analysis of the multimorbidity patterns, and Gephi 0.9.2 was employed to visually analyze the multimorbidity networks. Subsequently, subgroup analyses were conducted based on gender and clustering results.

Results The overall prevalence of multimorbidity in community-dwelling elderly adults in Yuexiu district, Guangzhou was 45.5% (24 922/54 829). The prevalence among males 44.2% (10 594/23 957) was lower than that among females 46.4% (14 328/30 872) (χ² = 28.00, P < 0.001). Hierarchical cluster analysis identified 105 binary and 455 ternary disease combinations. The top three binary combinations were coronary heart disease (CHD) + hypertension (36.9%), hyperlipidemia + hypertension (18.6%), and gout + osteoarthritis (5.7%), while the top three ternary combinations were CHD + hypertension + heart failure (8.8%), bronchial diseases + chronic obstructive pulmonary disease (COPD) + asthma (2.3%), and arrhythmia + hyperlipidemia + osteoporosis (1.5%). Network analysis of 15 chronic diseases revealed a network consisting of 15 nodes and 87 edges, with a network density of 0.83. The core diseases were osteoarthritis, gout, and CHD, with weighted degrees of 2.9, 2.6, and 2.1, respectively. Gender-specific subgroup analyses showed that the network density for males was 0.78, with CHD, heart failure, and stroke as key hubs (betweenness centrality: 3.7, 3.7, and 3.1, respectively). For females, the network density was 0.83, with gout, hyperlipidemia, and osteoarthritis as key hubs (betweenness centrality: 2.3, 2.1, and 1.8, respectively). Clustering-based subgroup analysis showed that in the CHD + hypertension + heart failure group, hypertension was closely associated with CHD (weight: 0.39) and acted as the core disease (weighted degree: 0.73). For bronchial diseases + COPD + asthma, COPD was strongly connected to bronchial diseases (weight: 0.50) and served as the core disease (weighted degree: 0.77). In the arrhythmia + hyperlipidemia + osteoporosis combination, hyperlipidemia was associated with osteoporosis (weight: 0.07), with osteoporosis identified as the core disease (weighted degree: 0.11).

Conclusions Multimorbidity is highly prevalent among community-dwelling elderly adults in Yuexiu district, Guangzhou, with complex interrelationships among chronic diseases. The multimorbidity network in females is more intricate than that in males. These findings highlight the need for community health institutions to implement targeted interventions tailored to gender differences.