Mortality Rate in Veterans with Multiple Chronic Conditions

Abstract

Background Among patients with multiple chronic conditions, there is increasing appreciation of the complex interrelatedness of diseases. Previous studies have focused on the prevalence and economic burden associated with multiple chronic conditions, much less is known about the mortality rate associated with specific combinations of multiple diseases. Objective Measure the mortality rate in combinations of 11 chronic conditions. Design Cohort study of veteran health care users. Participants Veterans between 55 and 64 years that used Veterans Health Administration health care services between October 1999 and September 2000. Measurements Patients were identified as having one or more of the following: COPD, diabetes, hypertension, rheumatoid arthritis, osteoarthritis, asthma, depression, ischemic heart disease, dementia, stroke, and cancer. Mutually exclusive combinations of disease based on these conditions were created, and 5-year mortality rates were determined. Results There were 741,847 persons included. The number in each group by a count of conditions was: none = 217,944 (29.34%); 1 = 221,111 (29.8%); 2 = 175,228 (23.6%); 3 = 86,447 (11.7%); and 4+ = 41,117 (5.5%). The 5-year mortality rate by the number of conditions was: none = 4.1%; 1 = 6.0%; 2 = 7.8%; 3 = 11.2%; 4+ = 16.7%. Among combinations with the same number of conditions, there was significant variability in mortality rates. Conclusions Patients with multiple chronic conditions have higher mortality rates. Because there was significant variation in mortality across clusters with the same number of conditions, when studying patients with multiple coexisting illnesses, it is important to understand not only that several conditions may be present but that specific conditions can differentially impact the risk of mortality.

How Can eHealth Technology Address Challenges Related to Multimorbidity? Perspectives from Patients with Multiple Chronic Conditions

“…2,3 These outcomes are in part a function of substantial self-management and coordination challenges that arise when patients have multiple health issues. For example, patients with MCCs frequently face unwieldy medication regimens and daily self-care routines that may reduce adherence to recommended treatment plans.…”

Multiple Chronic Conditions Among Medicare Beneficiaries: State-level Variations in Prevalence, Utilization, and Cost, 2011

“…One of the framework's four main goals was to facilitate research addressing key knowledge gaps about MCC (U.S. Department of Health and Human Services, 2010). Previous research on MCC has focused on national-level populations-such as community-dwelling adults (Hwang, Weller, Ireys, & Anderson, 2001;Anderson, 2010), Medicare beneficiaries (Wolff, Starfied, & Anderson, 2002; Lochner & Cox, in press), and veteran populations (Lee et al, 2007;Steinman et al, 2012). While these studies have highlighted the important issue of MCC for health care, characterizing geographic variations of MCC would be useful for targeting service delivery, resource projections, and program planning.…”

Quality of Care for Patients with Multiple Chronic Conditions: The Role of Comorbidity Interrelatedness

“…When patients have multiple health problems, it affects their quality of life and ability to work, and is associated with increased rates of functional decline and mortality. [1][2][3][4][5] Furthermore, as a patient's number of chronic conditions increases, there is a rise in associated physician visits, prescriptions, hospitalizations, home health visits, out-of-pocket expenses, and total health care expenditures. 1,[6][7][8][9] In order to optimize interventions and policies addressing multimorbidity, we must have a clear understanding of the relationship between multimorbidity and quality of care.…”