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Multiple chronic conditions at a major urban health system: a retrospective cross-sectional analysis of frequencies, costs and comorbidity patterns.

ABSTRACT: OBJECTIVE:To (1) examine the burden of multiple chronic conditions (MCC) in an urban health system, and (2) propose a methodology to identify subpopulations of interest based on diagnosis groups and costs. DESIGN:Retrospective cross-sectional study. SETTING:Mount Sinai Health System, set in all five boroughs of New York City, USA. PARTICIPANTS:192 085 adult (18+) plan members of capitated Medicaid contracts between the Healthfirst managed care organisation and the Mount Sinai Health System in the years 2012 to 2014. METHODS:We classified adults as having 0, 1, 2, 3, 4 or 5+ chronic conditions from a list of 69 chronic conditions. After summarising the demographics, geography and prevalence of MCC within this population, we then described groups of patients (segments) using a novel methodology: we combinatorially defined 18 768 potential segments of patients by a pair of chronic conditions, a sex and an age group, and then ranked segments by (1) frequency, (2) cost and (3) ratios of observed to expected frequencies of co-occurring chronic conditions. We then compiled pairs of conditions that occur more frequently together than otherwise expected. RESULTS:61.5% of the study population suffers from two or more chronic conditions. The most frequent dyad was hypertension and hyperlipidaemia (19%) and the most frequent triad was diabetes, hypertension and hyperlipidaemia (10%). Women aged 50 to 65 with hypertension and hyperlipidaemia were the leading cost segment in the study population. Costs and prevalence of MCC increase with number of conditions and age. The disease dyads associated with the largest observed/expected ratios were pulmonary disease and myocardial infarction. Inter-borough range MCC prevalence was 16%. CONCLUSIONS:In this low-income, urban population, MCC is more prevalent (61%) than nationally (42%), motivating further research and intervention in this population. By identifying potential target populations in an interpretable manner, this segmenting methodology has utility for health services analysts.

SUBMITTER: Majumdar UB

PROVIDER: S-EPMC6797368 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ObjectivesTo analyse how comorbidity among patients with back pain, depression and osteoarthritis influences healthcare costs per patient. A special focus was made on the distribution of costs for primary healthcare compared with specialist care, hospital care and drugs.DesignPopulation-based cross-sectional study.SettingThe County of Östergötland, Sweden.PatientsData on diagnoses and healthcare costs for all 266?354 individuals between 20 and 75 years of age, who were residents of the County of Östergötland, Sweden, in the year 2006, were extracted from the local healthcare register and the national register of drug prescriptions.Main outcome measuresThe effects of comorbidity on healthcare costs were estimated as interactions in regression models that also included age, sex, number of other health conditions and education.ResultsThe largest diagnosed group was back pain (11?178 patients) followed by depression (7412 patients) and osteoarthritis (5174 patients). The largest comorbidity subgroup was the combination of back pain and depression (772 patients), followed by the combination of back pain and osteoarthritis (527 patients) and the combination of depression and osteoarthritis (206 patients). For patients having both a depression diagnosis and a back pain diagnosis, there was a significant negative interaction effect on total healthcare costs. The average healthcare costs among patients with depression and back pain was SEK 11?806 lower for a patient with both diagnoses. In this comorbidity group, there were tendencies of a positive interaction for general practitioner visits and negative interactions for all other visits and hospital days. Small or no interactions at all were seen between depression diagnoses and osteoarthritis diagnoses.ConclusionsA small increase in primary healthcare visits in comorbid back pain and depression patients was accompanied with a substantial reduction in total healthcare costs and in hospital costs. Our results can be of value in analysing the cost effects of comorbidity and how the coordination of primary and secondary care may have an impact on healthcare costs.

Project description:Purpose: This study aimed to determine the patterns associated with adult mandibular fractures from a Level-I trauma center in southern Taiwan. Methods: The data of adult trauma patients admitted between 1 January 2009 and 31 December 2014 were retrieved from the Trauma Registry System and retrospectively reviewed. Fracture site and cause of injury were categorized into groups for comparison, and corresponding odds ratios (ORs) and 95% confidence intervals (CIs) were obtained by multivariate logistic regression. Results: Motorcycle accidents were the most common cause of mandibular fractures (76.3%), followed by falls (10.9%), motor vehicle accidents (4.8%), and being struck by/against objects (4.5%). Of the 503 cases of mandibular fractures, the condylar neck and head were the most common sites (32.0%), followed by the parasymphysis (21.7%), symphysis (19.5%), angle and ramus (17.5%), and body (9.3%). The location of mandibular fractures in patients who had motorcycle accidents was similar to that in all patients. Motor vehicle accidents resulted in a significantly higher number of body fractures (OR 3.3, 95% CI 1.24-8.76, p = 0.017) and struck injury in a significantly higher number of angle and ramus fractures (OR 3.9, 95% CI 1.48-10.26, p = 0.006) compared to motorcycle accidents. The helmet-wearing status and body weight were not associated with the location of mandibular fractures in motorcycle accidents. Conclusions: Our study revealed that the anatomic fracture sites of mandible were specifically related to different etiologies. In southern Taiwan, motorcycle accidents accounted for the major cause of mandibular fractures and were associated with the condylar neck and head as the most frequent fracture sites. In contrast, motor vehicle accidents and struck injuries tended to cause more body fracture as well as angle and ramus fracture compared to motorcycle accidents. Furthermore, the status of helmet-wearing and body weight were not associated with the location of mandible fractures caused by motorcycle accidents.

Project description:BackgroundMultimorbidity is associated with physical-mental health comorbidity (PMHC). However, the scope of overlap between physical and mental conditions, associated factors, as well as types of mental illness involved are not well described in Eastern Europe. This study aims to assess the PMHC burden in the Estonian population.MethodsIn this population-based cross-sectional study we obtained health claims data for 55 chronic conditions from the Estonian Health Insurance Fund (EHIF) database, which captures data for all publicly insured individuals (n = 1 240 927 or 94.1% of the total population as of 31 December 2017). We assessed the period-prevalence (3 years) of chronic physical and mental health disorders, as well as associations between them, by age and sex.ResultsHalf of the individuals (49.1% (95% CI 49.0-49.3)) had one or more chronic conditions. Mental health disorders (MHD) were present in 8.1% (8.1-8.2) of individuals, being higher among older age groups, women, and individuals with a higher number of physical conditions. PMHC was present in 6.2% (6.1-6.2) of the study population, and 13.1% (13.0-13.2) of the subjects with any chronic physical disorder also presented with at least one MHD. Dominating MHDs among PMHC patients were anxiety and depression. The prevalence of MHD was positively correlated with the number of physical disorders. We observed variation in the type of MHD as the number of physical comorbidities increased. The prevalence of anxiety, depression, and mental and behavioral disorders due to the misuse of alcohol and other psychoactive substances increased as physical comorbidities increased, but the prevalence of schizophrenia and dementia decreased with each additional physical disease. After adjusting for age and sex, this negative association changed the sign to a positive association in the case of dementia and mental and behavioral disorders due to psychoactive substance misuse.ConclusionsThe burden of physical-mental comorbidity in the Estonian population is relatively high. Further research is required to identify clusters of overlapping physical and mental disorders as well as the interactions between these conditions. Public health interventions may include structural changes to health care delivery, such as an increased emphasis on integrated care models that reduce barriers to mental health care.

Project description:IntroductionPrevious studies suggest that the type and combination of comorbidities may impact diabetes care, but their cost implications are less clear. This study characterized how diabetes patients' health care utilization and costs may vary according to comorbidity type classified on the basis of the Piette and Kerr framework.MethodsWe conducted a retrospective observational study of privately insured US adults newly diagnosed with type 2 diabetes (n = 138,466) using the 2014-2016 Optum Clinformatics® Data Mart. Diabetes patients were classified into five mutually exclusive comorbidity groups: concordant only, discordant only, both concordant and discordant, any dominant, and none. We estimated average health care costs of each comorbidity group by using generalized linear models, adjusting for patient demographics, region, insurance type, and prior-year costs.ResultsMost type 2 diabetes patients had discordant conditions only (27%), dominant conditions (25%), or both concordant and discordant conditions (24%); 7% had concordant conditions only. In adjusted analyses, comorbidities were significantly associated with higher health care costs (p < 0.0001) and the magnitude of the association varied with comorbidity type. Diabetes patients with dominant comorbidities incurred substantially higher costs ($38,168) compared with individuals with both concordant and discordant conditions ($20,401), discordant conditions only ($9173), concordant conditions only ($9000), and no comorbidities ($3365). More than half of the total costs in our sample (53%) were attributable to 25% of diabetes patients who had dominant comorbidities.ConclusionsDiabetes patients with both concordant and discordant conditions and with clinically dominant conditions incurred substantially higher health costs than other diabetes patients. Our findings suggest that diabetes management programs must explicitly address concordant, discordant, and dominant conditions because patients may have distinctly different health care needs and utilization patterns depending on their comorbidity profiles. The Piette and Kerr framework may serve as a screening tool to identify high-need, high-cost diabetes patients and suggest targets for tailored interventions.FundingSanofi.

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Multiple chronic conditions at a major urban health system: a retrospective cross-sectional analysis of frequencies, costs and comorbidity patterns.

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