Chronic conditions, disability and health service use among U.S. working age adults with chronic health care needs: Adapting the non-categorical approach to population identification and measurement

Adults with chronic conditions and people with disabilities are overlapping population groups with many shared healthcare concerns. Yet, rarely have these two groups been considered together. While population-level measurement based on a non-categorical approach has been successfully used to bridge these groups among children with special healthcare needs, this approach has not been implemented for the working aged. In order to provide a preliminary profile of Adults with Chronic Health Care Needs (ACHCN), we pooled data from the 2006-2008 Medical Expenditure Panel Survey. We identified ACHCN on the basis of having one or more health / mental health conditions expected to last at least 12 months and known to require ongoing medical intervention and/or result in some degree of disability. Overall, we found that potentially half of working aged adults have a chronic health care need. On average, ACHCN reported over two chronic conditions and over two acute conditions during each year. When compared to adults without chronic health care needs, total annual medical expenditures for ACHCN were over four times as high. In multivariate models, we found that ACHCN have higher rates of access problems, significantly elevated use of most ambulatory services and substantially higher risk of hospitalization compared to adults without chronic health care needs. Among ACHCN, health conditions, access problems, service use and expenditures were most heavily concentrated among people with disabilities, particularly individuals with ADL/IADL limitations. These findings suggest the need for new population-level measurement and surveillance approaches that transcend medical diagnosis.