OBJECTIVES: Multiple chronic conditions (MCC), defined as the co-occurrence of two or more chronic diseases, may adversely affect quality of life. This study aimed to determine the association of MCC with health-related quality of life (HRQoL) and physical functioning.
METHODS: This retrospective cross-sectional study used 2011-2012 Medical Expenditure Panel Survey data, a nationally representative US survey of the civilian noninstitutionalized population of all ages in the US, and included adult patients (age ≥ 18 years). MCC was assessed based on the Center for Medicare and Medicaid Services’ list of 17 chronic conditions. Physical and mental HRQoL was measured using short form heath survey (SF-12); physical functioning was measured using Activities of Daily Living (ADL) and instrumental ADL (IADL). Covariates included age, sex, body mass index, smoking status, education and insurance. Multiple linear (for mental and physical HRQoL) and multivariable logistic (for ADL and IADL) regression models were constructed to determine the association of MCC with outcomes while adjusting for covariates.
RESULTS: The study cohort included 47,087 patients: 51.9% (no MCC), 19.9% (1 MCC), 12.1% (2 MCC [dyads]), 8.4% (3 MCC [triads]), 4.5% (4 MCC) and 3.2% (5+ MCC). Patients with no MCC had mean physical HRQoL of 49.2 and mental HRQoL of 51.0. Two most frequent dyads were hypertension+hyperlipidemia (physical HRQoL: 40.9; mental HRQoL: 49.3) and hypretension+diabetes (physical HRQoL: 38.6; mental HRQoL: 48.1). Two most frequent triads were diabetes+hypertension+hyperlipidemia (physical HRQoL: 37.9; mental HRQoL: 48.1) and hypertension+hyperlipidemia+ischemic heart disease (physical HRQoL: 35.7; mental HRQoL: 48.1). Risk-adjusted regression models showed that each additional chronic condition reduced the physical HRQoL (β: -3.02) and the mental HRQoL(β: -1.76) and increased the odds of ADL (odds ratio [OR]: 1.66, 95% CI:1.57-1.74) and IADL (OR: 1.68, 95% CI:1.60-1.76).
CONCLUSIONS: MCC adversely affects HRQoL and physical functioning, with significantly greater deterioration associated with increasing number of chronic conditions.
