Multiple chronic conditions and healthcare access disparities for people with disabilities

The Institute of Medicine recently published a Call for Public Health Action to address chronic disease. This Call is especially pertinent to people with disabilities because, as a group, not only do people with disabilities experience worse health than the general population, but they also have a greater prevalence and more complex mix of comorbidities and multiple chronic conditions (MCC). People with disabilities have diminished access to healthcare and this fact is especially troubling given that, with each additional chronic condition, an individual's risk for many adverse outcomes increases, including the risk for unnecessary hospitalizations, duplicative tests, impaired functional status, adverse drug events, conflicting medical advice, and mortality. Moreover, for people with disabilities, each additional chronic condition and/or failure to properly manage existing conditions increases the likelihood that they will require greater assistance with activities of daily living, have to reduce their community participation or need to move into more restrictive settings that severely limit community participation.. Using 5 years of nationally representative Medical Expenditures Panel Survey (MEPS) data, in this project we identify predictors of comorbidity of chronic diseases in each of four disability subgroups: cognitive limitations, physical disabilities, sensory disabilities, and the aged. In addition, we identify the common dyads and triads of chronic disease within the four subgroups. Finally, we conduct exploratory analysis on differences and similarities across dyads/triads as related to elements of the Anderson behavioral model. These have important implications for next steps in research and policy.