Fifty-three percent of dual eligibles aged 18 to 64 had MCC compared with 73.5% of those 65 or older (). Among these dual eligibles with MCC, mean ages and total annual expenditures were 51 and $18,137 for those aged 18 to 64 and 75 and $14,364 for those aged 65 or older, respectively. Among dual eligibles with MCC who had a physical disability alone, 68% had MCC among those aged 18 to 64 and 86% had MCC among those 65 or older, comparable to prevalence for those with both physical disabilities and cognitive limitations but higher than prevalence for these age groups for those not reporting a physical disability or having only a cognitive limitation or other disability (30% and 52%, respectively). The number of chronic conditions included in our definition of MCC ranged from 2 (24%) to 7 (<1%), with variation by disability and age categories (). Sixty-six percent of all dual eligibles had 2 or more chronic conditions. Among dual eligibles aged 65 or older with physical disabilities and cognitive limitations, 35% had 4 or more chronic conditions. Dual eligibles aged 18 to 64 in each disability category had higher rates of 1 or fewer chronic conditions than did older dual eligibles.
Prevalence of Multiple Chronic Conditionsa (MCC) Among of Medicare- and Medicaid-Eligible, Noninstitutionalized Adults in the United States, Overall and by Disability type, Medical Expenditure Panel Survey (MEPS), 2005–2010b
Figure Multiple chronic conditions among Medicare- and Medicaid-eligible noninstitutionalized adults, by disability category and age, Medical Expenditure Panel Survey (MEPS), 2005–2010 (N = 3,398,940 [weighted]). Abbreviations: PD, physical disability; (more ...)
For dual eligibles aged 18 to 64 with MCC, 59% were female, 60% non-Hispanic white, and 10% Hispanic; 76% lived in an urban area, 50% lived below federal poverty guidelines, 31% lacked a high school diploma, and 29% reported poor health status (). Additionally, 59% were obese, 94% reported having a usual source of medical care, 74% were not married, and a greater percentage lived in the South (32%) than in other parts of the country. For dual eligibles with MCC who were aged 65 or older, 71% were female, 45% were non-Hispanic white, 22% were Hispanic, 81% lived in urban area, 35% lived below federal poverty guidelines, 61% lacked a high school diploma, and 17% reported poor health status. Thirty-nine percent were obese, with usual sources of care, married status, and residence in the South comparable to those aged less than 65 years.
Sociodemographic and Health Characteristics of Medicare- and Medicaid-Eligible, Noninstitutionalized Adults with Multiple Chronic Conditionsa in the United States, by Disability and Age, Medical Expenditure Panel Survey (MEPS), 2005–2010b
The leading chronic conditions among those measured for both those aged 18 to 64 and those 65 or older were hypertension and arthritis, respectively. Among each disability category and the total, the greatest differences between those aged 18 to 64 years and those aged 65 or older were for having asthma and cardiovascular disease, with 36% of all those aged 18 to 64 reporting asthma compared with 20% of those 65 or older and 41% of those 18 to 64 reporting cardiovascular conditions compared with 51% of those 65 or older.
Variation in prevalence was evident in other sociodemographic or health-related factors. Among Hispanics, there was far greater prevalence of MCC among those 65 or older compared with those 18 to 64, regardless of disability category, markedly different from that seen in other racial or ethnic groupings. Far higher percentages of men had MCC among dual eligibles aged 18 to 64 than among those aged 65 or older, but the opposite was seen for women, with higher percentages among dual eligibles aged 65 or older compared with those aged 18 to 64, regardless of disability category. Differences also existed in education, with higher percentages of MCC among those dual eligibles aged 65 or older and having less than a high school education compared with those aged 18 to 64. This relationship was reversed for dual eligibles with a high school education. Dual eligibles aged 18 to 64 in each disability category had high obesity rates, as high as 60% among those with physical disabilities. High percentages of poor health status were reported by those aged 18 to 64, with the highest rate (39%) among dual eligibles with both physical disabilities and cognitive limitations; among those aged 65 or older, poor health status was highest among those with physical disabilities and cognitive limitations. The South showed the highest rates of dual eligibles with MCC compared with other regions of the country, with this difference being especially high for people aged 65 or older.
Several factors were significantly associated with MCC. Among all dual eligibles aged 18 to 64 having MCC, men aged 18 to 64 were 25% less likely to have MCC than women (). With each year of age within this age category, the odds of MCC increased by 9%, and Hispanics were significantly less likely than non-Hispanic whites to have MCC. In this age group for all dual eligibles, there was a 59% or 69% greater likelihood of having MCC among those living in the Midwest or South, respectively, compared with those in the West, a 31% greater likelihood among nonurban dwellers, and a 127% increased odds among those with a usual source of medical care. Fair or poor health status and obesity or underweight were associated with MCC in this age category, as they were for those aged 65 or older. Significant odds ratios for dual eligibles among those aged 65 or older suggested a greater likelihood of MCC for age, being non-Hispanic black, having a high school or lower education, having a usual source of medical care, obesity or underweight, and fair or poor health status.
Adjusted Odds Ratios of Having Multiple Chronic Conditionsa Among Medicare- and Medicaid-Eligible Noninstitutionalized Adults, by Disability and Age Categories, Medical Expenditure Panel Survey (MEPS), 2005–2010b
Among dual eligibles with only physical disabilities, significant odds ratios associated with having MCC were found among those aged 18 to 64 for age, being married, living in the Midwest compared with the West, reporting fair or poor health, or not having a healthy weight. Except for health status and healthy weight, all of these significant associations disappeared for dual eligibles with physical disabilities who were 65 or older, with only non-Hispanic ethnicity being significant. Among people with both physical and cognitive disabilities, significant odds of having MCC were found, again among those aged 18 to 64 years first, for age, being black, being a high school graduate, being married, living in the South, reporting fair or poor health status, or unhealthy weight. For those 65 or older with both physical and cognitive limitations, significant odds were found for women, other race/ethnicity (this includes Asian, American Indian, and persons from the Pacific Rim), reporting fair or poor health status, or unhealthy weight. For all other dual eligibles (“other disabilities” category), age, fair or poor health status, and unhealthy weight were significant among those aged 18 to 64 years, with Midwest residence replacing age as significant also among those 65 or older.