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

Carol L. Stone; Carol L. Stone

doi:10.3934/publichealth.2020006

AIMS Public Health

2020, Volume 7, Issue 1: 44-65. doi: 10.3934/publichealth.2020006

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Research article

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

Carol L. Stone ^,

Institute for Families in Society, University of South Carolina, Columbia, SC, USA

Received: 22 November 2019 Accepted: 16 January 2020 Published: 04 February 2020

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.
Citation: Carol L. Stone. A population-based measure of chronic disease severity for health planning and evaluation in the United States[J]. AIMS Public Health, 2020, 7(1): 44-65. doi: 10.3934/publichealth.2020006

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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.

Abbreviation CDS: chronic disease severity; HRQOL: health-related quality of life; MCCs: multiple chronic conditions; BRFSS: Behavioral Risk Factor Surveillance System; COPD: Chronic obstructive pulmonary disease; HIV/AIDS: Human immunodeficiency virus infection and acquired immune deficiency syndrome; HMOs: Health maintenance organizations; ACA: Affordable Care Act; OR: Crude or unadjusted odds ratio; OR: Adjusted odds ratio; 95% CI: 95% confidence interval;
Acknowledgments

The author is grateful to The Institute for Families in Society at the University of South Carolina for funding and supporting this work, as well as the many citizen volunteers from across the United States who participated in the Behavioral Risk Factor Surveillance System from the 2015 through 2017 survey years.

Conflicts of interest

The author declares no conflict of interest in this paper.

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