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cardiac arrhythmias, hyperlipidemia, stroke, arthritis, asthma, autism spectrum disorder, cancer, chronic kidney disease, chronic obstructive pulmonary disease, dementia, depression, diabetes, hepatitis, human schizophrenia, and substance use disorders). Despite HHS Interagency Workgroup recommendations for a standardized approach, there is no agreed taxonomy for MCCs (primarily because not all recommended 20 conditions
are accounted for in a single data source). Studies on MCC use various combinations of the 20 recommended conditions. In my previous published research on MCC,14 I had selected 12 conditions, i.e angina, arthritis, asthma, cancer, chronic kidney disease, COPD, diabetes, high blood pressure, high cholesterol, myocardial infarction (heart attack), obesity, and stroke. Obesity was as a chronic condition or disease in the 15,16
of the 12 diagnosed chronic conditions
if they had ever been told by a doctor
or other health care provider that
they had high blood pressure, high cholesterol, coronary heart disease (angina), stroke, diabetes, cancer kidney disease, COPD, asthma arthritis, or heart attack (myocardial infarction). BRFSS captures data only on conditions that professional, potentially leading to the underreporting of conditions that were undiagnosed or were not recalled by the respondent during the BRFSS interview. For obesity, data on self-reported weight and height was used to calculate body mass index (BMI). Participants were insurance categories included private coverage, public coverage (Medicaid, Medicare, other state programs), other coverage (e.g. TRICARE [formerly
CHAMPUS], VA, or military health plans, and any other), and uninsured.
For purposes of this study, the 12 selected chronic conditions were combined into four mutually exclusive categories:
zero, one, two, or three or more chronic conditions. MCC were estimated by the addition of the following categories:
two chronic conditions and three or more chronic conditions. Weighted prevalence was also calculated for the 10 most common MCC dyad and triad
and triad combinations were further presented by sex and age group. MCC prevalence estimates for veterans were also generated for 50 U.S. states and the District of Columbia.
Statistical Analyses
All analyses were conducted in SAS version 9.4 (SAS Institute, Inc.) to
account for the complex sampling design.
at p<.05. Estimates for certain population subgroups may be based on small numbers and have relatively large sampling
errors. As per BRFSS guidelines, if the
points wide, data were suppressed.
RESULTS
10.6% of respondents (n=235,683)
distribution was as follows: 18-24 (4.9%); 25-34 (11.2%); 35-44 (10.6%); 45-54 (14.5%); 55-64 (16.4%); 65 and older (42.4%). Male veterans comprised over 90% of the sample. Female veterans in the study sample were predominantly young, with over 46% being less than 45 years
of age. On the other hand, over 46% of male veterans were in the 65 years and older category. By racial categorization, the majority of the veterans in the sample were non-Hispanic whites (78.9%), followed by non-Hispanic blacks (12.8%)
and Hispanics (8.3%). Hispanic veterans tended to be younger: nearly 65% of the Hispanic veterans in this study were less than 55 years of age. In contrast, nearly 64% of the white veterans in this sample were 55 years or older.
Non-veterans (n=1,575,544) were represented by males (43.7%) and females (56.3%). Distribution across age groups was uniform: 18-24 (13.5%); 25-34 (18.1%); 35-44 (17%); 45-54 (17.1%); 55-64 (16.7%); 65 and older (17.6%). The majority of civilians were white non- Hispanic (67.4%), followed by black non- Hispanic (12.9%) and Hispanics (19.7%).
During 2015-2018, nearly 73% veterans had at least one of 12 selected chronic conditions as compared to 61.2% of non- veterans. 47.8% of veterans had MCC, whereas only 33.1% of non-veterans reported the same. Disturbingly, the prevalence of three or more chronic conditions was higher in veterans compared to non-veterans across almost all race, sex, and age group categories were observed in the two groups. Male veterans were more likely to have MCC, whereas in non-veterans, females reported a higher MCC prevalence. The majority of veterans with MCC had health care coverage as compared to non-veterans. (Table 1)
prevalence among U.S. veterans was found, with state-level estimates ranging from 58.5% in West Virginia to 38.1%
in Hawaii. Prevalence estimates of MCC in veterans were higher than the overall national percentage in 13 states (West Virginia [58.5%], Michigan [57.1%], Maine [54.4%)], Kentucky [54.3%], Indiana [53.3%], Alabama [53.1%], Pennsylvania [53.1%], Oklahoma [52.2%], Tennessee [51.9%], Rhode Island [51.4%], Arkansas [51.2%], Louisiana [50.9%)], and Massachusetts [50.9%]), and lower
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Del Med J | March/April 2021 | Vol. 93 | No. 2
