A population-based measure of chronic disease severity for health planning and evaluation in the United States

Abstract

In the healthcare sector, patients can be categorized into clinical risk groups, which are based, in part, on multiple chronic conditions. Population-based measures of clinical risk groups for population health planning, however, are not available. Using responses of working-age adults (19-64 years old) from the Behavioral Risk Factor Surveillance System for survey years 2015-2017, a population-based measure of chronic disease severity (CDS) was developed as a proxy for clinical risk groups. Four categories of CDS were developed: low, medium-low, medium-high, and high, based on self-reported diagnoses of multiple chronic conditions, weighted by hospitalization costs. Prevalence estimates of CDS were prepared, by population demographics and state characteristics, and CDS association with perceived health-related quality of life (HRQOL) was evaluated. Age-adjusted CDS varied from 72.9% (95% CI: 72.7-73.1%) for low CDS, to 21.0% (95% CI: 20.8-21.2%), 4.4% (95% CI: 4.3-4.5%) and 1.7% (95% CI: 1.6-1.8%) for medium-low, medium-high, and high CDS, respectively. The prevalence of high CDS was significantly greater (p < 0.05) among older adults, those living below the federal poverty level, and those with disabilities. The adjusted odds of fair/poor perceived HRQOL among adults with medium-low or medium-high/high CDS were 2.39 times (95% CI: 2.30-2.48) or 6.53 times (95% CI: 6.22-6.86) higher, respectively, than adults with low CDS. Elevated odds of fair/poor HRQOL with increasing CDS coincided with less prevalence of high CDS among men, minority race/ethnicities, and adults without insurance, suggesting a link between CDS and risk of mortality. Prevalence of high CDS was significantly higher (p < 0.05) in states with lower population density, lower per capita income, and in states that did not adopt the ACA. These results demonstrate the relevance of a single continuous population-based measure of chronic disease severity for health planning at the state, regional, and national levels.

Keywords: Behavioral Risk Factor Surveillance System; chronic disease severity; clinical risk groups; disparities in mortality; health-related quality of life; multiple chronic conditions; population health planning.

Figure 1.. Prevalence of CDS, 2015–2017, combined, By State and Census Division, Adults 19–64 years old. Cumulative age-adjusted percent prevalence for high, medium-high, medium-low, and low severity chronic conditions are shown for all states in the continental United States. States are organized by census division. Age-adjusted prevalence estimates of each CDS level at the U.S. level are shown with dotted lines.

Figure 2.. Average CDS by age. Average CDS in the continental U.S. among adults 19–64 years old is shown across discrete age groups (symbols). Predicted average CDS, by single age, was fit to these estimates, using a generalized sigmoid curve: CDS = 0.382 + (2.3)/((1 + e^{(age − 19)})^1/13.2). See Methods section for more details. The cut-off criteria for low severity and medium-low CDS (0.900) is shown with a dotted line.