Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Jul-Aug;126(4):495-507.
doi: 10.1177/003335491112600406.

The complex web of health: relationships among chronic conditions, disability, and health services

Stephen P Gulley  1 , Elizabeth K Rasch, Leighton Chan
Affiliations

The complex web of health: relationships among chronic conditions, disability, and health services

Stephen P Gulley et al. Public Health Rep. 2011 Jul-Aug.

Abstract

Objectives: A critical issue in health-care reform concerns how to realign health-care delivery systems to manage medical care services for people with ongoing and costly needs for care. We examined the overlapping health-care needs of two such population groups among the U.S. working-age population (those aged 18-64 years): people with chronic medical conditions and people with disabilities.

Methods: Using the Medical Expenditure Panel Survey (2002-2004), we examined differences in health status, service use, and access to care among and between working-age adults reporting disabilities and/or one or more chronic conditions. We also analyzed people with three key chronic conditions: arthritis, diabetes, and depression.

Results: More than half of working-age people with disabilities reported having more than one chronic condition. Among those with activities of daily living or instrumental activities of daily living limitations, 35% reported four or more chronic conditions at a time. We found considerable variability in access problems and service use depending on how we accounted for the overlap of multiple conditions among people with arthritis, diabetes, and depression. However, disability consistently predicted higher emergency department use, higher hospitalization rates, and greater access problems.

Conclusions: The overall prevalence of chronic conditions among the U.S. working-age population, coupled with the high concentration of multiple chronic conditions among those with disabilities, underscores the importance of reforming health-care delivery systems to provide person-centered care over time. New policy-relevant measures that transcend diagnosis are required to track the ongoing needs for health services that these populations present.

PubMed Disclaimer

Figures

Figure.
Figure.
The overlap of chronic conditions and disability-related limitations in the U.S.: pooled annual estimates of people aged 18–64 years, 2002–2004 MEPS
See this image and copyright information in PMC

References

    1. Anderson G, Herbert R, Zeffiro T, Johnson N. Chronic conditions: making the case for ongoing care. Baltimore: Partnership for Solutions, Johns Hopkins University; 2004. [cited 2011 Jan 24]. Also available from: URL: http://www.partnershipforsolutions.org/DMS/files/chronicbook2004.pdf.
    1. Anderson G, Horvath J. The growing burden of chronic disease in America. Public Health Rep. 2004;119:263–70. - PMC - PubMed
    1. Chan L, Beaver S, Maclehose RF, Jha A, Maciejewski M, Doctor JN. Disability and health care costs in the Medicare population. Arch Phys Med Rehabil. 2002;83:1196–201. - PubMed
    1. Dejong G, Palsbo SE, Beatty PW, Jones GC, Knoll T, Neri MT. The organization and financing of health services for persons with disabilities. Milbank Q. 2002;80:261–301. - PMC - PubMed
    1. Machlin S, Cohen JW, Beauregard K. Health care expenses for adults with chronic conditions, 2005. 2008. May, [cited 2009 Oct 1]. Available from: URL: http://www.meps.ahrq.gov/mepsweb/data_files/publications/st203/stat203.pdf.

MeSH terms