Comorbidity Network Analysis Reveals Diagnostic Disparities Between Austrian and Non-Austrian Inpatients: A Population-Wide Cohort Study

Abstract

International migrants face well-documented barriers to healthcare access, yet the extent to which these barriers shape patterns of disease co-occurrence remains poorly understood. Drawing on a nationwide dataset of approximately 13 million hospital admissions from around 4 million individuals in Austria (2015-2019), we constructed and compared comorbidity networks between Austrian nationals and non-Austrian migrants, matched 1:1 by age, sex, and time of first hospital admission (272,779 per group). Following matching, metabolic and cardiovascular diagnoses, including type 2 diabetes and myocardial infarction, were more common among non-Austrians, while depression was more common among Austrians. Comorbidity network analysis showed that among all disease pairs that differed significantly between groups, 70% showed stronger co-occurrence in Austrian patients and 30% in non-Austrian patients. Distinct sex-specific patterns appeared: Austrian males showed stronger associations between alcohol use disorder and mental health diagnoses, whereas non-Austrian males more frequently presented with acute somatic conditions. Among non-Austrian women, a pronounced cluster of recurrent depression, somatoform disorders, and dorsalgia was observed. We interpret the disproportionately fewer comorbidity links observed in non-Austrians not as evidence of lower disease burden, but as a likely reflection of structural access barriers, including language differences, cultural factors, and crisis-oriented admission patterns, that prevent comprehensive diagnostic assessment, though a contribution from the healthy migrant effect cannot be excluded. These findings stress the need for culturally aware care strategies and earlier identification of high-risk multimorbidity profiles in migrant populations.