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

• Published in: AIMS public health 2020-01, Vol.7 (1), p.44-65
• Main Author: Stone, Carol L
• Format: Article
• Language: English
• Subjects: 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
• ISSN: 2327-8994; 2327-8994
• DOI: 10.3934/publichealth.2020006

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.