{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:57:09Z","timestamp":1790384229415,"version":"4.1.0"},"reference-count":6,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T00:00:00Z","timestamp":1752192000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Epidemiol."],"abstract":"\n Introduction<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fepid.2025.1577333","type":"journal-article","created":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T05:23:48Z","timestamp":1752211428000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Complex interrelationships among respiratory diseases and chronic multimorbidity: a longitudinal network analysis and implications for future viral respiratory pandemic preparedness"],"prefix":"10.3389","volume":"5","author":[{"given":"Daniel E.","family":"Zoughbie","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyongsik","family":"Yun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1016\/S0140-6736(17)32152-9","article-title":"Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016","volume":"390","author":"Naghavi","year":"2017","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/S0140-6736(12)60240-2","article-title":"Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study","volume":"380","author":"Barnett","year":"2012","journal-title":"Lancet"},{"key":"B3","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1001\/jama.2012.113905","article-title":"Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis","volume":"309","author":"Flegal","year":"2013","journal-title":"JAMA"},{"key":"B4","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1089\/tmj.2020.29040.rb","article-title":"Telemedicine and the COVID-19 pandemic, lessons for the future","volume":"26","author":"Bashshur","year":"2020","journal-title":"Telemed E-Health"},{"key":"B5","doi-asserted-by":"publisher","first-page":"7039","DOI":"10.3390\/jcm12227039","article-title":"The diagnostic utility of artificial intelligence-guided computed tomography-based severity scores for predicting short-term clinical outcomes in adults with COVID-19 pneumonia","volume":"12","author":"Atceken","year":"2023","journal-title":"J Clin Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"7","DOI":"10.31887\/DCNS.2011.13.1\/wkaton","article-title":"Epidemiology and treatment of depression in patients with chronic medical illness","volume":"13","author":"Katon","year":"2011","journal-title":"Dialogues Clin Neurosci"}],"container-title":["Frontiers in Epidemiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fepid.2025.1577333\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T05:23:49Z","timestamp":1752211429000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fepid.2025.1577333\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,11]]},"references-count":6,"alternative-id":["10.3389\/fepid.2025.1577333"],"URL":"https:\/\/doi.org\/10.3389\/fepid.2025.1577333","relation":{},"ISSN":["2674-1199"],"issn-type":[{"value":"2674-1199","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,11]]},"article-number":"1577333"}}