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ORIGINAL RESEARCH
BACKGROUND
Today, nearly half of the over 19 million current veterans are 65 and older (U.S. Department of Veterans Affairs).1 Aging
for chronic conditions.2 In veterans,
risk for chronic conditions is further issues (substance abuse, physical and mental stressors, war injuries, and civilian reintegration obstacles) unique to this population.3 Veterans are living with not just one chronic condition but with two or more conditions.4 Multiple concurrent chronic conditions and refer to two or more chronic conditions that affect a person at the same time.5 These conditions result in increased health care expenditures, premature death, increased hospitalizations, activity limitations, increased caregiver burden, and other adverse health outcomes.6 Patients with such conditions receive disproportionate amounts of health care services and therefore cost more per capita than the average patient.4,6 Research evidence from the Veterans Affairs (VA) Health Care System shows the burden of chronic conditions among veterans remains high.4,7 The majority of past MCC studies in veterans have used information from military or veteran databases, which limits the ability to make comparisons with the overall population. Before this study, a report published by the Centers for Disease Control and Prevention (CDC) was the only one to address
MCC prevalence among U.S. veterans analyzing a national database.8 Moreover, CDC analyses on the burden of two or more chronic conditions was limited
to male veterans aged 25-64 years.
This analysis extends the CDC’s work. Mindful of the objectives of the Health and Human Services (HHS) framework9 — to stimulate MCC research, elucidate disparities in MCC among various socio-demographic groups, and identify
the most common MCC dyads and
triads — we sought to perform a detailed assessment of MCC among veterans, including female veterans, using national population-based data from the Behavioral Risk Factor Surveillance System (BRFSS).
Veterans are seeking health care services
in the VA Health Care System as well as civilian facilities.10 than 30% of the total veteran population sought VA health care, and more than 70% of veterans sought care outside the VA system.11 address health care needs of the growing veteran population, capturing data outside the VA system is critical. In addition, given that veterans seek health care not only at
the VA, but also at civilian facilities, it is also important to present state-level data
on MCC. Local data will facilitate the allocation of state resources in coordinating and managing MCC care for veterans.12
The objectives of this study were to (1) explore the prevalence of MCC in veterans, including stateside distribution and most commonly occurring disease combinations, and (2) compare the prevalence of MCC among veterans and non-veterans by
select socio-demographic characteristics. descriptive details among the veteran population with MCC is viewed as critical in ongoing efforts to ensure a more coordinated and comprehensive approach in MCC management.4,7
METHODS
Data Source
BRFSS is a cross-sectional telephone survey of the civilian, non- institutionalized adult population aged 18 years or older, conducted by the CDC and state health departments. Established in 1984 with 15 states, BRFSS now collects data in all 50 states as well as the District
of Columbia and three U.S. territories regarding health-related risk behaviors, chronic health conditions, and use of preventive services. BRFSS completes more than 400,000 adult interviews each year, making it the largest continuously conducted health survey system in the world. The BRFSS questionnaire is designed to include a core set of questions used by all states and an additional set sponsored by each state that may be derived from optional modules developed by the CDC or other appropriate sources. By collecting behavioral health risk
data at the state and local level, BRFSS has become a powerful data source for chronic disease surveillance.13 Data from 1,814,571 respondents surveyed from 2015 through 2018 were analyzed in 2019 and 2020. BRFSS response rates varied from 47.1% in 2015 to 49.8% in 2018.
someone no longer in the Armed Forces of the United States and is the basic criterion currently on active duty are not eligible the BRFSS question ascertaining military service was worded identically; it asked, “Have you ever served on active duty in the United States Armed Forces, either
in the regular military or in a National Guard or military reserve unit?” However, the responses to this question do not distinguish current service (active duty personnel) and past service (veterans). includes both current and past service.
someone who never served on active duty in the U.S. Armed Forces.
The HHS Interagency Workgroup on
chronic conditions in the United States in order to provide a consistent framework for analyses.9 This includes 20 chronic conditions (hypertension, congestive heart failure, coronary artery disease,
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