Stone Carol L
Institute for Families in Society, University of South Carolina, Columbia, SC, USA.
AIMS Public Health. 2020 Feb 4;7(1):44-65. doi: 10.3934/publichealth.2020006. eCollection 2020.
In the healthcare sector, patients can be categorized into clinical risk groups, which are based, in part, on multiple chronic conditions. Population-based measures of clinical risk groups for population health planning, however, are not available. Using responses of working-age adults (19-64 years old) from the Behavioral Risk Factor Surveillance System for survey years 2015-2017, a population-based measure of chronic disease severity (CDS) was developed as a proxy for clinical risk groups. Four categories of CDS were developed: low, medium-low, medium-high, and high, based on self-reported diagnoses of multiple chronic conditions, weighted by hospitalization costs. Prevalence estimates of CDS were prepared, by population demographics and state characteristics, and CDS association with perceived health-related quality of life (HRQOL) was evaluated. Age-adjusted CDS varied from 72.9% (95% CI: 72.7-73.1%) for low CDS, to 21.0% (95% CI: 20.8-21.2%), 4.4% (95% CI: 4.3-4.5%) and 1.7% (95% CI: 1.6-1.8%) for medium-low, medium-high, and high CDS, respectively. The prevalence of high CDS was significantly greater (p < 0.05) among older adults, those living below the federal poverty level, and those with disabilities. The adjusted odds of fair/poor perceived HRQOL among adults with medium-low or medium-high/high CDS were 2.39 times (95% CI: 2.30-2.48) or 6.53 times (95% CI: 6.22-6.86) higher, respectively, than adults with low CDS. Elevated odds of fair/poor HRQOL with increasing CDS coincided with less prevalence of high CDS among men, minority race/ethnicities, and adults without insurance, suggesting a link between CDS and risk of mortality. Prevalence of high CDS was significantly higher (p < 0.05) in states with lower population density, lower per capita income, and in states that did not adopt the ACA. These results demonstrate the relevance of a single continuous population-based measure of chronic disease severity for health planning at the state, regional, and national levels.
在医疗保健领域，患者可被分为临床风险组，这部分基于多种慢性病情况。然而，目前尚无用于人群健康规划的基于人群的临床风险组衡量指标。利用行为风险因素监测系统中2015 - 2017年调查年份19 - 64岁劳动年龄成年人的回答，开发了一种基于人群的慢性病严重程度（CDS）衡量指标，作为临床风险组的替代指标。根据自我报告的多种慢性病诊断情况，并按住院费用加权，将CDS分为四类：低、中低、中高和高。按人群人口统计学特征和州特征编制了CDS患病率估计值，并评估了CDS与自我感知的健康相关生活质量（HRQOL）之间的关联。年龄调整后的CDS从低CDS的72.9%（95%置信区间：72.7 - 73.1%），到中低、中高和高CDS的21.0%（95%置信区间：20.8 - 21.2%）、4.4%（95%置信区间：4.3 - 4.5%）和1.7%（95%置信区间：1.6 - 1.8%）。高CDS患病率在老年人、生活在联邦贫困线以下的人群以及残疾人群中显著更高（p < 0.05）。中低或中高/高CDS成年人自我感知的HRQOL为一般/较差的调整后比值分别比低CDS成年人高2.39倍（95%置信区间：2.30 - 2.48）或6.53倍（95%置信区间：6.22 - 6.86）。随着CDS升高，一般/较差HRQOL的比值升高，同时男性、少数族裔/种族以及无保险成年人中高CDS患病率较低，这表明CDS与死亡风险之间存在联系。在人口密度较低、人均收入较低以及未采用《平价医疗法案》（ACA）的州，高CDS患病率显著更高（p < 0.05）。这些结果表明，一种单一的基于人群的连续慢性病严重程度衡量指标对于州、地区和国家层面的健康规划具有重要意义。
