The prevalence and care management of multiple (two or more) chronic conditions (MCC) are important public health concerns. Approximately 25% of U.S. adults have MCC, meaning they have been diagnosed with two or more of the following: arthritis, asthma, cancer, chronic obstructive pulmonary disease (COPD), coronary heart disease, diabetes, hepatitis, hypertension, stroke, or weak or failing kidneys. Care management of MCC presents a challenge to both patients and providers because of the substantial costs associated with treating more than one condition and the traditional care strategies that focus on single conditions as opposed to enhanced care coordination.
A report published by the CDC on July 29, 2016, identified state and other regional variations in MCC prevalence. Maintaining surveillance, targeting service delivery, and projecting resources are all important to meet this challenge, and these actions can be informed by identifying state and other regional variations in MCC prevalence. Data from the 2014 National Health Interview Survey (NHIS) were used to estimate prevalence of MCC for each U.S. state and region by age and sex. Significant state and regional variation in MCC prevalence was found, with state-level estimates ranging from 19.0% in Colorado to 38.2% in Kentucky.
MCC prevalence also varied by region ranging from 21.4% in the Pacific region to 34.5% in the East South Central region. The prevalence of MCC was higher among women than among men within certain U.S. regions, and was higher in older persons in all regions. Such findings further the research and surveillance objectives stated in the U.S. Department of Health and Human Services (HHS) publication, Multiple Chronic Conditions: A Strategic Framework. Geographic disparities in MCC prevalence can inform state-level surveillance programs and groups targeting service delivery or allocating resources for MCC prevention activities.
Adults who reported a diagnosis of two or more of the following selected conditions were categorized as having MCC: arthritis, asthma, cancer, chronic obstructive pulmonary disease (COPD), coronary heart disease, diabetes, hepatitis, hypertension, stroke, or weak or failing kidneys. These conditions were selected to ensure an approach to measuring MCC consistent with previous research using NHIS data, and have been included in a condition list developed by HHS. Estimates were generated for 50 U.S. states and the District of Columbia, and nine U.S. regions.
Reported prevalence estimates of MCC in the East South Central (34.5%) and East North Central (28.4%) regions were higher than the national average. Prevalence estimates in the Pacific (21.4%), West North Central (23.4%), and Middle Atlantic (24.1%) regions were lower than the national average. Six states (Colorado [19.0%], Alaska [19.6%], California [20.1%], Wyoming [20.3%], Minnesota [20.4%], and New York [21.3%]) and the District of Columbia (19.2%) had lower rates than the national average.
Approximately one in four U.S. adults had a diagnosis of MCC in 2014, which was similar to the prevalence previously reported for 2012. This 2014 prevalence differed by region and by state. Ten states had prevalence estimates higher than the national average, (Kentucky [38.2%], Alabama [35.8%], West Virginia [34.6%)], Mississippi [34.2%], Montana [33.2%], New Mexico [32.9%], Maine [30.9%], Michigan [30.3%], Ohio [29.6%], and Pennsylvania [29.6%]). Similar to previous research that found state-level differences among Medicare recipients, the findings reported here display differences among U.S. civilian, noninstitutionalized adults at least 18 years old (regardless of insurance coverage type). Furthermore, a number of states with higher observed MCC prevalence estimates overlap geographically with states with high stroke mortality rates (the so-called “stroke belt,” which includes all of Mississippi and parts of Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and West Virginia), and the “diabetes belt” (which also includes all of Mississippi and parts of Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and West Virginia), where past research has noted high diabetes prevalence estimates. In addition to state-level differences, regional differences also existed. Examination of MCC by sex and age indicated that, for all regions, prevalence of MCC was higher among older persons; however, differences in MCC among men and women were region-specific.
A stable national MCC prevalence indicates that diagnoses of MCC continue to be a public health issue. Through Multiple Chronic Conditions: A Strategic Framework, HHS has established objectives for addressing this issue. Similar to previous research that found geographic disparities in prevalence of MCC, this study provides state and regional estimates that can be used to understand which areas of the country have the highest adult prevalence of MCC. Geographic disparities in MCC prevalence can inform state-level surveillance programs and groups targeting service delivery or allocating resources for MCC prevention activities.
See the CDC Report
Also see the HHS publication, Multiple Chronic Conditions: A Strategic Framework
See also Medical Law Perspectives September 2016 Report: Stroke (to be published September 6, 2016).
See also Medical Law Perspectives, September 2015 Report: Arthritis Pain and Inflammation: Diagnosis and Treatment Risks
See also Medical Law Perspectives, April 2015 Report: COPD Liability Risks: When Taking a Breath Is Not Easy
See also Medical Law Perspectives, February 2015 Report: Mending a Broken Heart: Malpractice Risks in Diagnosing and Treating Heart Disease
See also Medical Law Perspectives, September 2014 Report: Hepatitis: Provider Malpractice and Patient Injury
See also Medical Law Perspectives, May 2014 Report: Diabetes and Its Complications: Malpractice and Other Liability Issues
See also Medical Law Perspectives, February 2014 Report: Congenital Heart Conditions: How Infants, Adults, and Healthcare Providers Handle the Risks
See also Medical Law Perspectives, November 2013 Report: Diagnosis and Treatment of Heart Attacks: Liability Issues
See the Medical Law Perspectives July 17, 2015, Blog: Blaming the Victim: Challenges of COPD Treatment and Subsequent Lawsuits