Multimorbidity (more than 2 chronic diseases or health conditions) was common in the Chinese population. Patients with multimorbidity have more complex healthcare requirements, which often result in more frequent hospitalizations, premature death, longer hospital stays, and greater costs.Little research has examined the relationship between multimorbidity phenotypes and clinical outcomes. Hence, this study aimed to investigate the clusters of multimorbidity and ascertain the relationship between the clusters and hospital service utilization and mortality.This population-based retrospective cohort study used data from 13,792 China Health and Retirement Longitudinal Study (CHARLS) participants.This population-based retrospective cohort study used data from the CHARLS, the baseline data collected in 2011. Participants were followed up in 2013, 2015, and 2018. The questionnaire information, laboratory data, hospital admission, and medication records were captured at each time. Data were analyzed between September 2023 to May 2024. Cox proportional hazards models were used to evaluate associations between multimorbidity clusters and future mortality. Negative binomial regression models were used to evaluate the relationship between the health service burden associated with various multimorbidity groups.Out of the 13,792 participants who were recognized as having multiple health conditions, four clusters were identified as multimorbidity clusters, including digestion and respiratory, hypertension, heart and digestion, and cancer. During the follow-up of 7 years, 1,743 individuals died. In a multifactorial Cox model, participating in the hypertension cluster was found to be associated with a higher risk of all-cause mortality [hazard ratio (HR): 1.398] compared to the cancer cluster.  In 2018, the heart and digestive cluster had the highest risk of hospitalization. The incidence rate ratio (IRR) for hospital stays in the heart and digestion cluster was 1.661, indicating an elevated risk.These data indicate that multimorbidity manifests in various ways, and the clusters of multimorbidity are linked to varied levels of mortality and health burden in the general population. These findings could aid in identifying the population, rather than individual patients, to target treatments that can support healthcare systems.These specific multimorbidity patterns emphasize the need to accurately and specifically identify, prevent, and manage multimorbidity in Chinese.