Abstract
BackgroundDiabetes mellitus, ischemic heart disease, and chronic kidney disease are three major chronic conditions that develop with increasing risks among adults as they get older. The interconnectedness of these three chronic conditions is well known, while each condition acts as a prognostic risk factor for the other two. It is important to understand the progressive relationships of these three conditions over time in terms of transitioning between clinical states and the impact on patients’ survival.MethodsWe investigate the survival characteristics of a Medicare population aged 65 years and above in a multistate system that contained clinical states specified by death and diagnosis combinations of three chronic conditions. The study was conducted using Hawaii Medicare claims data from 2009 to 2013. To evaluate the progression of a subject with one of the newly diagnosed chronic conditions, we analyzed quantities such as state occupation probabilities in eight states and hazards of sixteen transition types. We quantified effects and significances of potential covariates such as age, gender, race/ethnicity, comorbidity burden and financial status on these temporal functions. Nonparametric method of estimating state occupation probabilities and pseudo-value based method for estimating covariate effects of a survival system were utilized.ResultsWe found a range of age, gender, race/ethnicity and financial status based interesting covariate influences on transitions and state occupation probabilities of the system.ConclusionSurvival characteristics of the disease system are influenced by subject-specific effects. Subgroup-specific interventions/screenings should be considered for the optimal prevention and care.
Highlights
Diabetes mellitus, ischemic heart disease, and chronic kidney disease are three major chronic conditions that develop with increasing risks among adults as they get older
Transition counts At baseline, individuals entered the system initiating from 9628 Diabetes mellitus (DM), 7943 ischemic heart disease (IHD), and 5359 chronic kidney disease (CKD) states
The cell (DM, DM + IHD) shows that of the 9628 who initiated from DM state, 1163 individuals transferred to DM + IHD state
Summary
Ischemic heart disease, and chronic kidney disease are three major chronic conditions that develop with increasing risks among adults as they get older. Diabetes mellitus (DM), ischemic heart disease (IHD), and chronic kidney disease (CKD) are three major chronic conditions that develop with increasing risks among adults as they get older [1,2,3]. Approximately 31.0, 25.9, and 4.4% of the elderly US population aged 65 years and above suffered from DM, IHD, and CKD, respectively These three chronic conditions are associated with high health care expenses [4,5,6]. In 2013, the total health care costs for DM, IHD, and CKD were 101.4, 88.1, and 13.5 billion dollars, and the elderly population accounted for 42.8, 61.2, 52.5% of these costs, respectively [7] The interconnectedness of these three chronic conditions is well known, while each condition acts as a prognostic risk factor for the other two. Cardiovascular complications play a critical role in the development of CKD [10, 11], and evidence shows that CKD prevalence is high among the population with
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