Association of multiple chronic conditions and pain among older black and white adults with diabetes mellitus

Fernando Ovalle,Chivon A. Mingo,Tamara A. Baker,Jacquelyn A. Minahan,Roland J. Thorpe,Vicki Johnson-Lawrence,Michael Crowe,Olivio J. Clay

doi:10.1186/s12877-017-0652-8

Abstract

BackgroundAging is often associated with the challenge of navigating daily tasks with a painful chronic medical illness. Yet, there is concern of the number of older adults impacted with more than one chronic condition. Despite the increasing number of adults diagnosed with diabetes and comorbid chronic illnesses, there remains a lack of understanding in how multiple illnesses relate to experiences of pain. To assess the association between multiple chronic conditions and pain, this study aimed to identify clusters of chronic medical conditions and their association with pain among a sample of older Black and White adults diagnosed with diabetes.MethodsTwo hundred and thirty-six participants responded to a series of questions assessing pain frequency and severity, as well as health and social characteristics. A factor analysis was used to categorize clusters of medical conditions, and multiple regression models were used to examine predictors of pain.ResultsSeven of the assessed chronic medical conditions loaded on three factors, and accounted for 57.2% of the total variance, with heart disease (factor 1) accounting for 21.9%, musculoskeletal conditions (factor 2) for another 18.4%, and factor 3 (microvascular diseases) accounting for a final 16.9% of the variability among the chronic medical conditions. Covariate-adjusted models showed that fewer years of education and higher scores on the microvascular and musculoskeletal conditions factors were associated with higher pain frequency, with the musculoskeletal conditions factor being the strongest predictor.ConclusionsFindings from this study compliment existent literature underscoring the prevalence and importance of comorbid diagnoses in relation to pain. Examining health-related factors beyond a single disease diagnosis also provides an opportunity to explore underlying disease co-occurrences that may persist beyond organ system classifications.

Highlights

Aging is often associated with the challenge of navigating daily tasks with a painful chronic medical illness
Participants recruited from the University of Alabama at Birmingham (UAB) Diabetes and Endocrinology Clinic were more likely to report renal or kidney disease, heart attack or myocardial infarction, and congestive heart failure than those recruited from the community (p’s < .05)
The seven assessed chronic medical conditions loaded on three latent factors, accounting for 57.2% of the total variance of the medical conditions assessed

Summary

Introduction

Aging is often associated with the challenge of navigating daily tasks with a painful chronic medical illness. Non-communicable diseases, known as chronic diseases, tend to be long in duration and are the result of environmental, genetic, psychological, and behavior factors.. The Agency for Healthcare Research and Quality data show that 71% of total health care expenditures is associated with care for those with MCC.5 Those diagnosed with a chronic medical illness report increased use of health care services (over 133 million dollars) compared to those with an acute illness. Baker et al BMC Geriatrics (2017) 17:255 multiple diagnoses account for 76% of all physician visits, 81% of hospital admissions, and 91% of all prescriptions filled With these expended costs, discussion remains of the onset and management of chronic illnesses, but the consequences these conditions have on the daily lived experiences of those diagnosed with a chronic disease [6]

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