The Contribution of Chronic Conditions to Hospitalization, Skilled Nursing Facility Admission, and Death: Variation by Race

Abstract

Multimorbidity (≥2 chronic conditions) is a common and important marker of aging. To better understand racial differences in multimorbidity burden and associations with important health-related outcomes, we assessed differences in the contribution of chronic conditions to hospitalization, skilled nursing facility admission, and mortality among non-Hispanic Black and non-Hispanic White older adults in the United States. We used data from a nationally representative study, the National Health and Aging Trends Study, linked to Medicare claims from 2011-2015 (n = 4,871 respondents). This analysis improved upon prior research by identifying the absolute contributions of chronic conditions using a longitudinal extension of the average attributable fraction for Black and White Medicare beneficiaries. We found that cardiovascular conditions were the greatest contributors to outcomes among White respondents, while the greatest contributor to outcomes for Black respondents was renal morbidity. This study provides important insights into racial differences in the contributions of chronic conditions to costly health-care utilization and mortality, and it prompts policy-makers to champion delivery reforms that will expand access to preventive and ongoing care for diverse Medicare beneficiaries.

Keywords: aging; attributable fraction; chronic disease; health-care utilization; longitudinal studies; mortality; multimorbidity; race/ethnicity.

Figure 1

Baseline prevalence (A) and incidence (B) of 11 medical conditions by race, National Health and Aging Trends Study, 2011–2015. AF, atrial fibrillation; COPD, chronic obstructive pulmonary disease; HF, heart failure; IHD, ischemic heart disease; KD, kidney disease; MI, myocardial infarction; TIA, transient ischemic attack.

Figure 2

Associations between 11 medical conditions and hospitalization (A), skilled nursing facility admission (B), and mortality (C), National Health and Aging Trends Study, 2011–2015. Adjusted risk ratios (aRRs) were estimated from generalized estimating equations models according to outcome and race. Bars represent 95% confidence intervals (CIs). AF, atrial fibrillation; COPD, chronic obstructive pulmonary disease; HF, heart failure; IHD, ischemic heart disease; KD, kidney disease; MI, myocardial infarction; TIA, transient ischemic attack.

Figure 3

Longitudinal extension of the average attributable fraction (LE-AAF) contributions to hospitalizations (A), skilled nursing facility admissions (B), and mortality (C) for 11 medical conditions, by outcome and race, National Health and Aging Trends Study, 2011–2015. The 95% confidence intervals (CIs), shown as bars, were derived from a bias-corrected and accelerated bootstrap procedure. AAF, average attributable fraction; AF, atrial fibrillation; COPD, chronic obstructive pulmonary disease; HF, heart failure; IHD, ischemic heart disease; KD, kidney disease; MI, myocardial infarction; TIA, transient ischemic attack.