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The prevalence of selected chronic diseases and conditions and associated risk factors is typically assessed through separate state surveillance systems. Similarly, public health program planning typically is not integrated across program content areas. The population is aging, and the prevalence of risk factors, such as overweight and obesity, is increasing nationally. The prevalence of persons with multiple chronic conditions (MCC, ≥2 conditions) likely will continue increasing as a function of these trends. The objective of this study was to provide Colorado-specific estimates on the burden of MCC and risk factors in terms of prevalence and costs and to determine the implications for public health programming at the state health department.
METHODS:
We gathered data from Centers for Medicare and Medicaid Services 2012 Chartbook to determine the national- and Colorado-level burdens of MCC and associated costs among Medicare Fee for Service (FFS) beneficiaries. We also analyzed 2007–2011 Colorado Behavioral Risk Factor Surveillance System (BRFSS) data to determine the prevalence of chronic conditions and risk factors among all adults and to analyze disparities by age, race/ethnicity, sex, federal poverty level (FPL), and other factors.
RESULTS:
In the United States, 67% of Medicare FFS beneficiaries had ≥2 of 15 selected chronic conditions in 2011, and the corresponding estimate in Colorado was 56%. In Colorado, 26% of Medicare FFS beneficiaries had ≥4 chronic conditions and yet incurred 63% of Medicare costs. Costs per beneficiary increased as the number of chronic conditions increased from $2,230 for beneficiaries with 0–1 condition to $31,524 for those with ≥6 conditions. BRFSS data indicate that among adult Coloradans aged 45–84 years, 69% had ≥1 of 6 selected chronic conditions, and this prevalence was greater among those aged 65+ years versus 45–54 years, Hispanics versus White non-Hispanics, females versus males, and those with incomes within 0–250% FPL versus 250%+ FPL. Forty four percent of adult Coloradans reported ≥3 selected modifiable risk factors for chronic diseases, and 8% reported no risk factors. Thirty three percent of adults with high blood pressure were obese, and 65% of adults with diabetes had high blood pressure.
CONCLUSIONS:
When conducting an evidence-based approach to public health program planning, consideration must be placed on the most effective interventions for patients with or at-risk for MCC. The state health department in Colorado has made evidence-based primary and secondary prevention initiatives, including the Diabetes Prevention Program and chronic disease self-management, a priority.