Abstract
Cardiometabolic multimorbidity (CMM) is a prevalent syndrome among middle-aged and older adults, significantly impairing quality of life and imposing substantial health and economic burdens on China's aging healthcare system. The development of timely predictive models is crucial for enabling early intervention. This study aimed to integrate multidimensional data from the China Health and Retirement Longitudinal Study (CHARLS) to develop an effective predictive model for assessing the five-year risk of CMM onset, thereby facilitating early intervention and management for individuals at risk in China. We analyzed data from the 2015 to 2020 CHARLS surveys, involving 5,388 middle-aged and older adults initially free of CMM. The dataset was randomly split into a training set (70%) and a validation set (30%). Key predictors were identified from 31 potential variables using LASSO regression with 10-fold cross-validation. Selected predictors underwent correlation analysis and were used to construct both Extreme Gradient Boosting (XGBoost) and Logistic Regression (LR) models. Variable contributions in the XGBoost model were interpreted using SHapley Additive exPlanations (SHAP) values, while the LR model was visualized via a nomogram. The performance of the superior model was evaluated using receiver operating characteristic curves, calibration curves, and decision curve analysis. LASSO regression screened significant variables from the initial 31 candidates. Correlation analysis ultimately identified nine key predictors: systolic blood pressure, BMI, fasting blood glucose, total cholesterol, triglycerides, uric acid, age, comorbidities, and pain. The logistic regression model demonstrated superior and more stable predictive performance on the validation set, with an area under the curve (AUC) of 0.732 (95% CI: 0.703-0.761). Calibration curves indicated reliable predictive accuracy, and decision curve analysis established the clinical net benefit across a range of risk thresholds. This study developed and validated a reliable, clinically applicable logistic regression model, supplemented by a nomogram, for assessing the five-year risk of CMM in Chinese middle-aged and older adults. The model effectively identifies high-risk individuals, supporting targeted early intervention and management strategies to alleviate the health and economic burdens associated with CMM in this population.