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Journal of General Internal Medicine

, 22:403

First Online: 16 November 2007


BackgroundAmong patients with multiple chronic conditions, there is increasing appreciation of the complex interrelatedness of diseases. Previous studies have focused on the prevalence and economic burden associated with multiple chronic conditions, much less is known about the mortality rate associated with specific combinations of multiple diseases.

ObjectiveMeasure the mortality rate in combinations of 11 chronic conditions.

DesignCohort study of veteran health care users.

ParticipantsVeterans between 55 and 64 years that used Veterans Health Administration health care services between October 1999 and September 2000.

MeasurementsPatients were identified as having one or more of the following: COPD, diabetes, hypertension, rheumatoid arthritis, osteoarthritis, asthma, depression, ischemic heart disease, dementia, stroke, and cancer. Mutually exclusive combinations of disease based on these conditions were created, and 5-year mortality rates were determined.

ResultsThere were 741,847 persons included. The number in each group by a count of conditions was: none = 217,944 29.34%; 1 = 221,111 29.8%; 2 = 175,228 23.6%; 3 = 86,447 11.7%; and 4+ = 41,117 5.5%. The 5-year mortality rate by the number of conditions was: none = 4.1%; 1 = 6.0%; 2 = 7.8%; 3 = 11.2%; 4+ = 16.7%. Among combinations with the same number of conditions, there was significant variability in mortality rates.

ConclusionsPatients with multiple chronic conditions have higher mortality rates. Because there was significant variation in mortality across clusters with the same number of conditions, when studying patients with multiple coexisting illnesses, it is important to understand not only that several conditions may be present but that specific conditions can differentially impact the risk of mortality.

KEY WORDSchronic conditions coexistant conditions mortality veterans  Download fulltext PDF

Autor: Todd A. Lee - Alexandra E. Shields - Christine Vogeli - Teresa B. Gibson - Min Woong-Sohn - William D. Marder - David B


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