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ORIGINAL RESEARCH
than the national prevalence in seven states (Texas [43.6%], North Dakota [43.1%], California [42.1%], Colorado [41.6%], Alaska [39.8%], Virginia [39.5%], and Hawaii [38.1%]) and the District of Columbia (36.9%). (Table 2)
The most prevalent MCC dyad and triad combinations in U.S. veterans were arthritis and being obese was the most commonly occurring dyad. By sex, high cholesterol and arthritis were the most common amongst both male and female common dyads by sex and age is listed in Table 3.
Overall and for male veterans, angina/ heart attack/high cholesterol was the most prevalent triad. This was also the most common triad in male veterans and the age group 65 and older. Arthritis/asthma/ obesity was the most common triad in triads were listed by sex and age group.
DISCUSSION
Nearly one in two veterans reported MCC. In the absence of a standardized taxonomy for MCCs, particularly
in the number and types of chronic conditions, there is variation in reported prevalence. Yoon et al.7 analyzed VA
data using 28 chronic conditions, with
conditions, and reported almost one third of nonelderly and slightly more than a third of elderly veterans with comorbid chronic conditions. The CDC’s analyses of National Health Interview Survey (NHIS) data8 to describe the health status of community-dwelling male veterans aged 25–64 reported a prevalence slightly over 20% in an analysis of nine chronic conditions. Another study on MCC among the non-institutionalized, civilian U.S. adult population with 10 chronic
conditions reported 25% prevalence of MCC.17,18 My prior research with the same 12 chronic conditions as in this study showed an MCC prevalence of 36.8% among non-institutionalized adults in Delaware.14 These MCC numbers are considerably lower than our results of 47.8% and underscore the high burden
of MCC in veterans as compared to non- veterans. Disturbingly, more veterans veterans (17.1%). Prior studies focusing
on single chronic conditions do show higher risk for cardiovascular disease (CVD),19 more obesity,20 higher prevalence of smoking,21 higher rates of diabetes,22 and substance abuse and mental illness23 amongst veterans compared to non- veterans. MCC prevalence showed a consisted increase with age for both veterans and non-veterans. However, prevalence across almost all age groups was higher in veterans. Besides higher risk, veterans are more likely to have their access to health care and the likelihood of being diagnosed with various conditions.
Female veterans showed a lower burden of MCC as compared to non-veteran females. Prior studies on civilian populations have consistently shown a higher burden of MCC among females.17,18 One reason for this disparity could be the age distribution. Female veterans in the study sample were predominantly young, with over 46% being less than 45 years of age, in contrast to male veterans, where over 46% were
in the 65 years and older category. Age distribution by sex was relatively uniform in the non-veteran sample. Female veterans reported arthritis, asthma, and obesity, whereas male veterans reported angina, heart attack, and high cholesterol as the most common MCC triad. Future research including age-adjusted analyses could further explore MCC differences by gender amongst veterans. Research using VA
health services shows the most common MCC combination as that of diabetes, hyperlipidemia, and hypertension.7
MCC disparities by race were also evident in this study. White veterans had a
higher prevalence of MCC than Hispanic veterans. Age group differences could again explain this disparity. Nearly 65% of the Hispanic sample in this study was less than 55 years of age. In contrast, nearly 64% of the white veterans in this sample were 55 years or older. More work is required to further elaborate on racial differences in MCC among veterans.
CONCLUSIONS
the burden of MCC amongst veterans by state. Several state prevalence estimates prevalence. State level disparities in MCC prevalence among veterans can inform targeted program planning and resource allocation. Exploring the type of nearby military and VA health facilities available within states bearing the greatest burden of MCC might inform practitioners
and researchers where to implement prevention strategies.
This study has limitations. BRFSS is a telephone survey that excludes people living in institutions, nursing homes, long-term care facilities, and correctional institutions, which excludes some severely ill people (veterans and non- veterans) from our analysis. Second, BRFSS data are self-reported and subject to recall and social desirability bias
(e.g., underreporting of actual weight). Also, BRFSS captures data only on by a doctor or health professional, potentially leading to the underreporting of conditions that were undiagnosed
or were not recalled by the respondent during the BRFSS interview. In addition,
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