Combinations Of Chronic Conditions Research Articles

Spatial Associations of Multiple Chronic Conditions Among Older Adults.

Multimorbidity, the presence of two or more chronic conditions in an individual, presents a major challenge for meeting the health care needs of older adults. This study advances understanding of multiple chronic conditions by using local colocation quotients to reveal spatial associations for five chronic conditions (arthritis, diabetes, heart disease, hypertension, and pulmonary disease) in a statewide panel of older adults in New Jersey. Among adults with three or more conditions, large concentrations of Arthritis-Heart Disease-Pulmonary Disease, Arthritis-Hypertension-Pulmonary Disease, and Diabetes-Heart Disease-Hypertension were observed, each triad located in different regions of the state. Individuals with other triads of conditions, in contrast, were distributed among all older adults in the sample as expected with no areas of local concentration. The study provides gerontologists with a new and effective method for uncovering geographical patterns in combinations of chronic conditions among the populations they serve, thereby enabling more effective interventions.

Chronic Condition Combinations and Productivity Loss Among Employed Nonelderly Adults (18 to 64 Years).

We examined the relationship between specific chronic condition combinations and productivity loss measured by missed work days among nonelderly employed adults with at least two physical chronic conditions of arthritis, diabetes mellitus, heart disease, and hypertension. We analyzed data from the Medical Expenditure Panel Survey for the years 2004 to 2012. Adults with arthritis/diabetes/heart disease had the highest average missed work days (14.42). In the adjusted model, compared with adults with arthritis/hypertension, adults with diabetes/heart disease and arthritis/heart disease/hypertension had significantly higher missed work days, while adults with diabetes/hypertension had significantly lower missed work days. Specific chronic condition combinations have a high burden of disease in terms of productivity loss. Workplace health programs that address multiple health conditions at the same time should be implemented to reduce missed work days.

PIH43 - Chronic Condition Combinations and Productivity Loss among Employed Non-Elderly Adults (18-64 Years)

PIH43 - Chronic Condition Combinations and Productivity Loss among Employed Non-Elderly Adults (18-64 Years)

Capsule Commentary on Koroukian et al., Combinations of Chronic Conditions, Functional Limitations, and Geriatric Syndromes that Predict Health Outcomes.

Capsule Commentary on Koroukian et al., Combinations of Chronic Conditions, Functional Limitations, and Geriatric Syndromes that Predict Health Outcomes.

Multiple Chronic Condition Combinations and Depression in Community-Dwelling Older Adults.

The U.S. Department of Health and Human Services recently called for a paradigm shift from the study of individual chronic conditions to multiple chronic conditions (MCCs). We identify the most common combinations of chronic diseases experienced by a sample of community-dwelling older people and assess whether depression is differentially associated with combinations of illnesses. Self-reports of diagnosed chronic conditions and depressive symptoms were provided by 5,688 people participating in the ORANJ BOWL(SM) research panel. Each respondent was categorized as belonging to one of 32 groups. ANOVA examined the association between depressive symptoms and combinations of illnesses. People with more health conditions experienced higher levels of depression than people with fewer health conditions. People with some illness combinations had higher levels of depressive symptoms than people with other illness combinations. Findings confirm extensive variability in the combinations of illnesses experienced by older adults and demonstrate the complex associations of specific illness combinations with depressive symptoms. Results highlight the need to expand our conceptualization of research and treatment around MCCs and call for a person-centered approach that addresses the unique needs of individuals with MCCs.

Combinations of Chronic Conditions, Functional Limitations, and Geriatric Syndromes that Predict Health Outcomes.

The strategic framework on multiple chronic conditions released by the US Department of Health and Human Services calls for identifying homogeneous subgroups of older adults to effectively target interventions aimed at improving their health. We aimed to identify combinations of chronic conditions, functional limitations, and geriatric syndromes that predict poor health outcomes. DESIGN, SETTING AND PARTICIPANTS Data from the 2010-2012 Health and Retirement Study provided a representative sample of U.S. adults 50years of age or older (n = 16,640). Outcomes were: Self-reported fair/poor health, self-rated worse health at 2years, and 2-year mortality. The main independent variables included self-reported chronic conditions, functional limitations, and geriatric syndromes. We conducted tree-based classification and regression analysis to identify the most salient combinations of variables to predict outcomes. Twenty-nine percent and 23% of respondents reported fair/poor health and self-rated worse health at 2years, respectively, and 5% died in 2years. The top combinations of conditions identified through our tree analysis for the three different outcome measures (and percent respondents with the outcome) were: a) for fair/poor health status: difficulty walking several blocks, depressive symptoms, and severe pain (> 80%); b) for self-rated worse health at 2years: 68.5years of age or older, difficulty walking several blocks and being in fair/poor health (60%); and c) for 2-year mortality: 80.5years of age or older, and presenting with limitations in both ADLs and IADLs (> 40%). Rather than chronic conditions, functional limitations and/or geriatric syndromes were the most prominent conditions in predicting health outcomes. These findings imply that accounting for chronic conditions alone may be less informative than also accounting for the co-occurrence of functional limitations and geriatric syndromes, as the latter conditions appear to drive health outcomes in older individuals.

Patient-Centered Medical Home Features and Health Care Expenditures of Medicare Beneficiaries with Chronic Disease Dyads

Three out of 4 Medicare beneficiaries have multiple chronic conditions, and managing the care of this growing population can be complex and costly because of care coordination challenges. This study assesses how different elements of the patient-centered medical home (PCMH) model may impact the health care expenditures of Medicare beneficiaries with the most prevalent chronic disease dyads (ie, co-occurring high cholesterol and high blood pressure, high cholesterol and heart disease, high cholesterol and diabetes, high cholesterol and arthritis, heart disease and high blood pressure). Data from the 2007-2011 Medical Expenditure Panel Survey suggest that increased access to PCMH features may differentially impact the distribution of health care expenditures across health care service categories depending on the combination of chronic conditions experienced by each beneficiary. For example, having no difficulty contacting a provider after regular hours was associated with significantly lower outpatient expenditures for beneficiaries with high cholesterol and diabetes (n = 635; P = 0.038), but it was associated with significantly higher inpatient expenditures for beneficiaries with high blood pressure and high cholesterol (n = 1599; P = 0.015), and no significant differences in expenditures in any category for beneficiaries with high blood pressure and heart disease (n = 1018; P > 0.05 for all categories). However, average total health care expenditures are largely unaffected by implementing the PCMH features considered. Understanding how the needs of Medicare beneficiaries with multiple chronic conditions can be met through the adoption of the PCMH model is important not only to be able to provide high-quality care but also to control costs. (Population Health Management 2016;19:206-211).

Chronic Condition Combinations and Health Care Expenditures and Out-of-Pocket Spending Burden Among Adults, Medical Expenditure Panel Survey, 2009 and 2011

IntroductionLittle is known about how combinations of chronic conditions in adults affect total health care expenditures. Our objective was to estimate the annual average total expenditures and out-of-pocket spending burden among US adults by combinations of conditions.MethodsWe conducted a cross-sectional study using 2009 and 2011 data from the Medical Expenditure Panel Survey. The sample consisted of 9,296 adults aged 21 years or older with at least 2 of the following 4 highly prevalent chronic conditions: arthritis, diabetes mellitus, heart disease, and hypertension. Unadjusted and adjusted regression techniques were used to examine the association between chronic condition combinations and log-transformed total expenditures. Logistic regressions were used to analyze the relationship between chronic condition combinations and high out-of-pocket spending burden.ResultsAmong adults with chronic conditions, adults with all 4 conditions had the highest average total expenditures ($20,016), whereas adults with diabetes/hypertension had the lowest annual total expenditures ($7,116). In adjusted models, adults with diabetes/hypertension and hypertension/arthritis had lower health care expenditures than adults with diabetes/heart disease (P < .001). In adjusted models, adults with all 4 conditions had higher expenditures compared with those with diabetes and heart disease. However, the difference was only marginally significant (P = .04).ConclusionAmong adults with arthritis, diabetes, heart disease, and hypertension, total health care expenditures differed by type of chronic condition combinations. For individuals with multiple chronic conditions, such as heart disease and diabetes, new models of care management are needed to reduce the cost burden on the payers.

Research on Multiple Chronic Conditions

Research on Multiple Chronic Conditions

Examining the relationship between chronic conditions, multi-morbidity and labour market participation in Canada: 2000–2005

ABSTRACTRelatively little attention has been paid to understanding and addressing the potential health-related barriers faced by older workers to stay at work. Using three representative samples from the Canadian Community Health Survey, we examined the relationship between seven physical chronic conditions and labour market participation in Canada between 2000 and 2005. We found that all conditions were associated with an increased probability of not being able to work due to health reasons. In our adjusted models, heart disease was associated with the greatest probability of not working due to health reasons. Arthritis was associated with the largest population attributable fraction. Other variables associated with not being able to work due to health reasons included older age, female gender and lower educational attainment. We also found particular combinations of chronic conditions (heart disease and diabetes; and arthritis and back pain) were associated with a greater risk than the separate effects of each condition independently. The results of this study demonstrate that chronic conditions are associated with labour market participation limitations to differing extents. Strategies to keep older workers in the labour market in Canada will need to address barriers to staying at work that result from the presence of chronic conditions, and particular combinations of conditions.

The effect of multiple chronic conditions on self-rated health, disability and quality of life among the older populations of Northern Ireland and the Republic of Ireland: a comparison of two nationally representative cross-sectional surveys

ObjectivesMultimorbidity is common in the older population, but the impact of combinations of chronic conditions on disability and quality of life (QoL) is not well known. This analysis explores the...

Multimorbidity in older women: The negative impact of specific combinations of chronic conditions on self-rated health

Background: Chronic diseases are considered major threats to self-rated health (SRH). In many elderly people multimorbidity is present, in elderly women more than in elderly men. This study aims at establishing the impact of multimorbidity and specific disease combinations on SRH in elderly women.Objectives: To study the relationship between the number of chronic diseases and SRH and explore possible effects of combinations of chronic conditions on SRH in elderly women.Methods: Health interview data used for this study originated from the second Dutch National Survey of General Practice, a study with a response rate of 64.5%. From the 12 699 respondents, 315 were females between 70 and 74 years old.Results: Of the women, 87% reported one or more chronic condition. Women without any chronic condition rated their health significantly better than those with one or more chronic conditions. Either severe back pain or severe headache was included in return the most prevalent combinations of two chronic conditions with a significantly higher negative impact on SRH than expected.Conclusion: All combinations including severe headache and some combinations including severe back pain and another chronic condition had a significantly more negative impact on SRH than expected in women aged 70–74 years. General practitioners should be alert on severe headache and severe back pain in elderly women to improve proactive the quality of care and thus add to the quality of later years of life.

A comparative study demonstrated that prevalence figures on multimorbidity require cautious interpretation when drawn from a single database

ObjectiveWe investigated the degree of comparability of the prevalence of chronic diseases and disease combinations in the elderly in two databases comparable with regard to diseases included, sex and age of the patients (65–85 years), and cutoff score for case definition. Study Design and SettingOne study is based on chart-supported interviews with the primary care physicians within a cohort study of 3,189 multimorbid elderly patients. The second study analyzed claims data from ambulatory care delivered to the multimorbid members of one German Health Insurance (n = 70,031). Multimorbidity was defined by the presence of three or more chronic conditions from an identical list of 46 diseases. ResultsThe difference of the median number of chronic conditions was 1 (mean 6.7 vs. 5.7). The prevalences of individual conditions were approximately one-third lower in the claims data, but the relative rank order corresponded well between the two databases. These relatively small prevalence differences cumulate when combinations of chronic conditions are investigated, for example, the prevalence differences between the two databases increased to nearly 100% for triadic combinations and nearly 170% for quartets. ConclusionThe study shows that conclusions regarding the prevalence of combinations of diseases should be drawn with caution when based on a single database.

Current Guidelines Have Limited Applicability to Patients with Comorbid Conditions: A Systematic Analysis of Evidence-Based Guidelines

BackgroundGuidelines traditionally focus on the diagnosis and treatment of single diseases. As almost half of the patients with a chronic disease have more than one disease, the applicability of guidelines may be limited. The aim of this study was to assess the extent that guidelines address comorbidity and to assess the supporting evidence of recommendations related to comorbidity.Methodology/Principal FindingsWe conducted a systematic analysis of evidence-based guidelines focusing on four highly prevalent chronic conditions with a high impact on quality of life: chronic obstructive pulmonary disease, depressive disorder, diabetes mellitus type 2, and osteoarthritis. Data were abstracted from each guideline on the extent that comorbidity was addressed (general comments, specific recommendations), the type of comorbidity discussed (concordant, discordant), and the supporting evidence of the comorbidity-related recommendations (level of evidence, translation of evidence). Of the 20 guidelines, 17 (85%) addressed the issue of comorbidity and 14 (70%) provided specific recommendations on comorbidity. In general, the guidelines included few recommendations on patients with comorbidity (mean 3 recommendations per guideline, range 0 to 26). Of the 59 comorbidity-related recommendations provided, 46 (78%) addressed concordant comorbidities, 8 (14%) discordant comorbidities, and for 5 (8%) the type of comorbidity was not specified. The strength of the supporting evidence was moderate for 25% (15/59) and low for 37% (22/59) of the recommendations. In addition, for 73% (43/59) of the recommendations the evidence was not adequately translated into the guidelines.Conclusions/SignificanceOur study showed that the applicability of current evidence-based guidelines to patients with comorbid conditions is limited. Most guidelines do not provide explicit guidance on treatment of patients with comorbidity, particularly for discordant combinations. Guidelines should be more explicit about the applicability of their recommendations to patients with comorbidity. Future clinical trials should also include patients with the most prevalent combinations of chronic conditions.

How do common chronic conditions affect health-related quality of life?

Comorbidity is common. National Institute for Health and Clinical Excellence (NICE) guidelines have been created to make best use of resources to improve patients' quality of life but do not currently take account of comorbidity. The effect of multiple chronic conditions with regard to health-related quality of life (HRQoL) is poorly researched. Criticisms of previous research have been due to patient-defined chronic conditions, lack of quantification of the effects of confounding factors, selection of affected patients only, small sample sizes, and upper age limits. This study aims to address these issues, looking into the impact of combinations of chronic conditions on HRQoL. Participants filled in a questionnaire containing general health information, specific respiratory questions, and the EQ-5D measure of HRQoL. The questionnaires were then matched up to their GP records to obtain their disease status for six common chronic diseases (asthma, chronic obstructive pulmonary disease, ischaemic heart disease, hypertension, diabetes, and cerebrovascular disease). Data from a mailed questionnaire were analysed from 5169 patients aged >16 years from two general practices in Wythenshawe, Manchester in 2004. Completion of the questionnaire was taken to indicate consent to participate. Significant correlations were found between a lower HRQoL and increasing numbers of chronic conditions (P<0.001), increasing age, possible obstructive airway disease, lack of higher education, smoking, and female sex. These all remained significant following regression, except for sex, with number of chronic conditions being a strong predictor of the weighted health state index score, EQ-5D(index) (coefficient = -0.079, P<0.001). Increasing numbers of chronic conditions have a strong negative effect on HRQoL.

Multiple Chronic Conditions: Prevalence, Health Consequences, and Implications for Quality, Care Management, and Costs

Persons with multiple chronic conditions are a large and growing segment of the US population. However, little is known about how chronic conditions cluster, and the ramifications of having specific combinations of chronic conditions. Clinical guidelines and disease management programs focus on single conditions, and clinical research often excludes persons with multiple chronic conditions. Understanding how conditions in combination impact the burden of disease and the costs and quality of care received is critical to improving care for the 1 in 5 Americans with multiple chronic conditions. This Medline review of publications examining somatic chronic conditions co-occurring with 1 or more additional specific chronic illness between January 2000 and March 2007 summarizes the state of our understanding of the prevalence and health challenges of multiple chronic conditions and the implications for quality, care management, and costs.

Stroke in Diabetic Patients: Is It Really a Macrovascular Complication?

To the Editor: We have read with interest the article by Wilcox et al,1 in which they demonstrated the positive effect of pioglitazone on stroke recurrence in patients with type 2 diabetes mellitus (DM). However, we would like to stress a particular concern regarding a basic concept in the difficult question of DM and stroke. In this study, as in other previous studies, stroke is considered a macrovascular event in diabetic patients, but is …

Medicare Prescription Drug Plan Costs and Affordability—2007

To the Editor:— In February 2007, we published estimated annual costs of Medicare Part D prescription drug plans (PDPs) that were implemented in January 2006.1 We found substantial variation in such costs across states and within states for identical combinations of medications. We sought to compare the patterns we found in 2006 PDPs—the first year of Medicare Part D—with PDPs newly available for 2007. Methods: As in our previous work,1 we compared the estimated annual costs for 4 prototypical patients with combinations of chronic conditions, using the Medicare Part D 2007 drug plan online calculator provided by the Centers for Medicare and Medicaid Services (available at: http://www.medicare.gov/). We also generated estimates of affordability with the most recent state data regarding median income for zero-earner households.2 Results: For all 4 patient cases, the mean estimated annual cost of the lowest-cost PDPs across the nation was lower in 2007 than in 2006 (Case 1—$676 vs $852; Case 2—$1,615 vs $1,878; Case 3—$1,725 vs $2,326; Case 4—$2,218 vs $8,146). In 2007, the estimated annual costs of lowest-cost PDPs varied across states by a maximum of $195 for Case 2 and a minimum of $49 for Case 3; all ranges of variation across states were narrower than in 2006. Importantly, the health plans that were the dominant low-cost options in 2006 were no longer the dominant plans in 2007 for any of the cases. When taking cost-of-living adjusted median income into account, the mean affordability for lowest-cost PDPs was 2.3% of annual income for Case 1, 5.5% for Case 2, 5.9% for Case 3, and 7.6% for Case 4. Although the mean lowest-cost PDPs were all more affordable in 2007 than in 2006, affordability across states for each case varied at least twofold (Table 1). Table 1 Affordability of Lowest-Cost Medicare PDPs in Each State, for Each Patient Case Within states, the mean difference between the lowest-cost PDP and highest-cost PDP for the same medications (i.e., fiscal risk of plan selection for beneficiaries) was $2,457 for Case 1, $2,769 for Case 2, $4,525 for Case 3, and $1,781 for Case 4. Conclusion: In 2007, the lowest-cost Medicare PDPs for 4 prototypical patients are less expensive and more affordable than in 2006. Affordability of lowest-cost PDPs living continues to vary, twofold or more for beneficiaries living in different states. Moreover, differences of thousands of dollars between the lowest-cost and highest-cost PDPs within a given state, and the changing dominance of specific plans as the lowest-cost options, continue to underscore how critical it is for Medicare beneficiaries to reconsider the choice of their PDP for each plan year.