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

Institute for Health Policy in the Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 01/2008; 22 Suppl 3(Suppl 3):391-5. DOI: 10.1007/s11606-007-0322-1
Source: PubMed


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.

Download full-text


Available from: William D. Marder,
  • Source
    • "Given the absence of previous research, a primary aim of the present study was to examine the association between comorbid behavioural and substance dependence, i.e. problematic Internet behaviour and excessive alcohol consum p tion, and cardiovascular and cortisol reactivity. Others have found that alcohol abuse is quite common among those that use the Internet excessively (Ko et al., 2008), with comorbid conditions often related to poorer health outcomes in comparison to single disorders (Vogeli et al., 2007). Our clear expectations – based on studies which showed individuals who had comorbid alcohol and substance dependency had the greatest blunting of heart rate (Panknin et al., 2002) and cortisol (Bernardy et al., 1996; Errico et al., 1993) responses relative to those who had single or no addictions – were that the group exhibiting both excessive Internet use and alcohol intake would show the most diminished stress reactivity. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background and aims: Problematic Internet use and excessive alcohol consumption have been associated with a host of maladaptive outcomes. Further, low (blunted) cardiovascular and stress hormone (e.g. cortisol) reactions to acute psychological stress are a feature of individuals with a range of adverse health and behavioural characteristics, including dependencies such as tobacco and alcohol addiction. The present study extended this research by examining whether behavioural dependencies, namely problematic Internet use, excessive alcohol consumption, and their comorbidity would also be associated with blunted stress reactivity. Methods: A large sample of university students (N = 2313) were screened using Internet and alcohol dependency questionnaires to select four groups for laboratory testing: comorbid Internet and alcohol dependence (N = 17), Internet dependence (N = 17), alcohol dependence (N = 28), and non-dependent controls (N = 26). Cardiovascular activity and salivary cortisol were measured at rest and in response to a psychological stress protocol comprising of mental arithmetic and public speaking tasks. Results: Neither problematic Internet behaviour nor excessive alcohol consumption, either individually or in combination, were associated with blunted cardiovascular or cortisol stress reactions. Discussion It is possible that problematic Internet behaviour and excessive alcohol consumption in a student population were not related to physiological reactivity as they may not reflect ingrained addictions but rather an impulse control disorder and binging tendency. Conclusions: The present results serve to indicate some of the limits of the developing hypothesis that blunted stress reactivity is a peripheral marker of the central motivational dysregulation in the brain underpinning a wide range of health and behavioural problems.
    Journal of Behavioural Addictions 05/2015; 4(2):1-9. DOI:10.1556/2006.4.2015.006 · 1.87 Impact Factor
  • Source
    • "Racial/ethnic differences in the full array of comorbid conditions are not available, but we do know that blacks and Latinos have a greater prevalence of a number of chronic conditions (e.g., diabetes [National Institute of Diabetes and Digestive and Kidney Diseases 2008], kidney disease and hypertension [National Center for Health Statistics 2008]), lower prevalence of other chronic conditions (e.g., cardiovascular disease and cancer [National Center for Health Statistics 2008]), and have an earlier onset of many comorbid conditions (McGee et al. 1996). The presence of a comorbid psychiatric disorder adds an additional burden to managing chronic conditions, contributing to greater severity of illness and functional limitation (Ciechanowski, Katon, and Russo 2000; Ciechanowski et al. 2003; Ludman et al. 2004), and increasing the number and array of health care services necessary to manage the comorbid conditions (Vogeli et al. 2007). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The association of general medical illness and mental health service use among older adults from racial-ethnic minority groups is an important area of study given the disparities in mental health and general medical services and the low use of mental health services in this population. The purpose of this report is to describe the impact of comorbid general medical illness on mental health service use and expenditures among older adults and to evaluate disparities in mental health service use and expenditures in a racially-ethnically diverse sample of older adults with and without comorbid general medical illness. Data were obtained from the Medical Expenditure Panel Survey (years 2004-2011). The sample included 1,563 whites, 519 African Americans, and 642 Latinos (N=2,724) age ≥65 with probable mental illness. Two-part generalized linear models were used to estimate and compare mental health service use among adults with and without a comorbid general medical illness. Mental health service use was greater for older adults with versus those without comorbid general medical illness. Once mental health services were accessed, no differences in mental health expenditures were found. Comorbid general medical illness increased the likelihood of mental health service use by older whites and Latinos. However, the presence of comorbidity did not affect racial-ethnic disparities in mental health service use. This study highlighted the important role of comorbid general medical illness as a potential contributor to using mental health services and suggests intervention strategies to enhance engagement in mental health services by older adults from racial-ethnic minority groups.
    Psychiatric services (Washington, D.C.) 03/2015; 66(7):appips201400246. DOI:10.1176/ · 2.41 Impact Factor
  • Source
    • "It represents a challenge for the health system, not only due to the cumulative effect of concurrent diseases but also due to the physical, cognitive , and psychosocial consequences [2]. Multimorbidity is strongly and consistently associated to adverse health outcomes, such as disability and dependence, mortality, increased use of health and social services and polypharmacy, and diminished quality of life (QoL) [2] [3] [4]. Most studies have found a relationship between the presence of chronic diseases and impaired QoL in older people [3] [5], although this was not specifically studied in the population with multimorbidity. "
    [Show abstract] [Hide abstract]
    ABSTRACT: As the population ages, the prevalence of multimorbidity also increases, with consequences to several health outcomes such as disability and quality of life (QoL). This study aimed at analyzing the relationships between chronic conditions, disability, and QoL of older adults with multimorbidity in Spain. Data on older adults aged 65 years or more, with at least two chronic health conditions were drawn from three cohort studies. Sample size was 705, 443, and 4995, respectively. For each cohort, the impact of the following chronic health conditions was analyzed: asthma, cancer, cardiac, diabetes, hypertension, mental health disorders, osteoarticular conditions, and stroke. Disability and QoL measures varied according to the survey. In older adults with multimorbidity, the most prevalent conditions were osteoarticular (59.08-67.80%) and hypertension (50.64-60.03%). The presence of disability was significantly associated to having osteoarticular (OR range: 1.53 to 2.646), diabetes (OR: 1.86 to 1.71), or mental health disorders (OR: 2.19 to 3.36) in most cohorts. Disability (OR: 1.67 to 7.67), osteoarticular conditions (OR: 3.37 to 5.10), and mental health disorders (OR: 1.83 to 4.27) showed the highest effects on lower QoL than the population. The presence of disability and diverse chronic conditions has a negative effect on QoL of older adults affected by multimorbidity in Spain. Public health and primary care interventions focusing on the integrated care of older adults with multimorbidity might give special attention to mental health and osteoarticular conditions. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
    European Journal of Internal Medicine 02/2015; 26(3). DOI:10.1016/j.ejim.2015.02.016 · 2.89 Impact Factor
Show more