Multiple Chronic Conditions
Visit profiles to view data profiles on chronic and disabling conditions and on young retirees and older workers.
A challenge for the 21st century
People with a chronic health condition face challenges that permeate many aspects of their life. Adults with multiple conditions, however, are substantially more likely than adults with one chronic condition to report accomplishing less, spending more time in bed sick, missing work, not working, living with less income, and having poor mental health. Longer life expectancies increase the risk of developing multiple chronic conditions. Adults are generally more likely to develop chronic conditions, but some conditions are more common in childhood. Children with just one chronic condition are less likely to be as active as children without a chronic condition.
This Data Profile examines adults with none, one, or two or more of ten chronic conditions and children with none or one of three chronic conditions. These 13 conditions are among the most expensive conditions.(1) Nearly 94 million people or about one-third of the U.S. population has at least one of these conditions — this includes 11 percent of children. More than 39 million adults have two or more of these conditions. Expenditures for these 13 conditions exceeded $184 billion in 1996 or 20 percent of personal health care expenditures.(2)
People with chronic conditions say they accomplish less than they had hoped
Many people report that they accomplish less than they would like to. This finding increases with age, particularly for those with chronic conditions. Among those with two or more chronic conditions, the proportion reporting accomplishing less is nearly four times greater than that reported by those the same age without a chronic condition.
Adults with chronic conditions are more likely to report spending a day in bed
About one-third of adults without a chronic condition report spending time in bed due to an illness or injury, compared to nearly one-half of adults with two or more chronic conditions (see Figure 1). Adults without conditions spend an average (median) of 2 days a year sick in bed. Those with one chronic condition spend, on average, 3 days in bed, but those with two or more conditions average 5 days per year in bed.
COSTLY CHRONIC CONDITIONS
* Cerebrovascular disease
* Chronic back/neck problems
* Chronic obstructive pulmonary disease
* Ischemic heart disease
* Joint disorders like arthritis or rheumatism
* Mood disorders like clinical depression and other effective psychoses.(3)
* Attention Deficit Hyperactivity Disorder/ Attention Deficit Disorder (ADHD/ADD)
SOURCES: Druss, B. G., et al. (2002). “The Most Expensive Medical Conditions in America.” Health Affairs, 21(4): 105-111. “1996 Expenditures by Condition, a Fact Sheet from the Medical Expenditure Panel Survey.” Retrieved October 28, 2003, from http://www.meps.ahrq.gov/factsheets/ fs_expbycond.htm.
Adults with multiple chronic conditions are less likely to work
Most adults under the age of 65 are working. However, those with multiple chronic conditions are substantially less likely to work (see Figure 2). Among the population ages 45 to 64, 86 percent of those without a chronic condition are working, whereas 59 percent of those with two or more chronic conditions are working.
Chronic conditions reduce attendance at work
The proportion of workers who have missed a day or more of work in the past year is greatest among those with multiple chronic conditions (see Figure 3). It is worth noting, however, that the proportion of workers missing days of work is substantially less, regardless of a condition, among older workers than among workers ages 18 to 44.
The median number of days missed from work over the year increases with the presence of a chronic condition. The median number of days missed by workers without a chronic condition is 3, compared to 4 days among those with one chronic condition and 5 days among those with two or more chronic conditions.
Adults under age 65 with multiple chronic conditions are more likely to be unable to work or to be retired
Among adults under age 65 with two or more chronic conditions, over one-quarter are not working because they are disabled, and about one-third of working-age adults report that they are unable to work because of their health. In comparison, non-working adults under age 65 who do not have a chronic condition are much more likely to report that they are taking care of their house or family or enrolled in school (see Figure 4). Compared to adults not working without a chronic condition, more than twice as many adults with one or more chronic conditions say they are retired.
People with chronic conditions are more likely to have lower incomes
Relative to people in similar age groups, persons with multiple chronic conditions are more likely to have annual family incomes of $20,000 or less, and are less likely to have incomes of $50,000 or more (see Figure 5). Persons age 65 and older have lower income, however, the income disparities among those with and without chronic conditions are smaller.
Adults with chronic conditions are more likely to report poor mental health
Among adults under the age of 45, those with two or more conditions are more than five times as likely to report their mental health status as fair to poor than those without a chronic condition (see Figure 6). Similarly, among people ages 45 to 64, those with two or more chronic conditions are about three times more likely to report fair to poor mental health.
Multiple chronic conditions are much more prevalent among older people
Nearly 20 percent of all adults have two or more chronic conditions; but the proportion is substantially higher — 52 percent — among the population age 65 and older (see Figure 7).
Chronic conditions also may limit children’s activities
Children with a chronic condition are substantially more likely than other children to experience limitations in everyday activities (see Figure 8). About one-quarter of children with any of the three most costly conditions report being limited in any way, including their ability to crawl, walk, run, play. Only 4 percent of children without a chronic condition report any activity limitation.
1. Druss, B. G., et al. (2002). “The Most Expensive Medical Conditions in America.” Health Affairs, 21(4): 105-111. Also, “1996 Expenditures by Condition, a Fact Sheet from the Medical Expenditure Panel Survey.” Retrieved October 28, 2003, from http://www.meps.ahrq.gov/factsheets/fs_expbycond.htm.
3. The two different surveys used in this Data Profile obtain information on the components of mood disorders differently. Consequently, the list of chronic conditions within this category is not exactly the same in the two surveys.
ABOUT THE DATA
Unless otherwise noted, the data presented in this Profile are from two national surveys of the United States civilian non-institutionalized population. The 2000 National Health Interview Sur-vey (NHIS), conducted annually by the National Center for Health Statistics, is the principal source of information on the health of the U.S. population. The 2000 Medical Expenditure Panel Survey (MEPS), cosponsored by the Agency for Healthcare Research and Quality and the National Center for Health Statistics, provides national estimates of health care use, expenditures, sources of pay-ment, and insurance coverage.
ABOUT THE PROFILES
This is the second set of Data Profiles in the series, Challenges for the 21st Century: Chronic and Disabling Conditions. The series is supported by a grant from the Robert Wood Johnson Foundation. This Profile was written by Robert B. Friedland with assistance from Emily Ihara and Lee Thompson. Previous Profiles in this series include:
1. Screening for Chronic Conditions: Underused services
2. Childhood Obesity: A lifelong threat to health
3. Visual Impairment: A growing concern as the population ages
4. Cancer: A major national concern
5. Prescription Drugs: A vital component of health care
6. Chronic Obstructive Pulmonary Disease: A chronic condition that limits activities
7. Rural and Urban Health: Health care service use differs
8. Chronic Back Pain: A leading cause of work limitations
9. Older Hispanic Americans: Less care for chronic conditions
10. Obesity Among Older Americans: At risk for chronic conditions
11. The Decade Preceding Medicare Coverage: Insurance matters for people with chronic conditions
The Center on an Aging Society is a Washington-based nonpartisan policy group located at Georgetown University’s Institute for Health Care Research and Policy. The Center studies the impact of demographic changes on public and private institutions and on the economic and health security of families and people of all ages.