Disability, health, and multiple chronic conditions among people eligible for both Medicare and Medicaid, 2005-2010

Abstract

Introduction: People who are eligible for both Medicare and Medicaid (dual eligibles) and who have disabilities and multiple chronic conditions (MCC) present challenges for treatment, preventive services, and cost-effective access to care within the US health system. We sought to better understand dual eligibles and their association with MCC, accounting for sociodemographic factors inclusive of functional disability category.

Methods: Medical Expenditure Panel Survey (MEPS) data for 2005 through 2010 were stratified by ages 18 to 64 and 65 or older to account for unique subsets of dual eligibles. Prevalence of MCC was calculated for those with physical disabilities, physical plus cognitive disabilities, and all others, accounting for sociodemographic and health-related factors. Adjusted odds for having MCC were calculated by using logistic regression.

Results: Of dual eligibles aged 18 to 64, 53% had MCC compared with 73.5% of those aged 65 or older. Sixty-five percent of all dual eligibles had 2 or more chronic conditions, and among dual eligibles aged 65 or older with physical disabilities and cognitive limitations, 35% had 4 or more, with hypertension and arthritis the most common conditions. Dual eligibles aged 18 to 64 who had a usual source of medical care had a 127% increased likelihood of having MCC compared with those who did not have a usual source of care.

Conclusion: Attention to disability can be a component to helping further understand the relationship between health and chronic conditions for dual eligible populations and other segments of our society with complex health and medical needs.

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; CL, cognitive limitation. The PD category includes those with functional limitations or those who use assistive devices. It includes anyone who reported having long-term walking limitations, long-term need for assistive device, or long-term need for assistance with activities of daily living but did not report cognitive limitation. CL includes those who reported confusion or memory loss, having problems making decisions, or requiring supervision for their own safety. The category “no PD or CL” includes those who did not identify as having either a PD or CL. For chronic conditions, the full-year consolidated files for MEPS include only questions related to heart attack, coronary heart disease, angina, angina pectoris, other heart disease (these 5 grouped as cardiovascular disease), stroke, emphysema, hypertension, diabetes, arthritis and asthma. [Table: see text]