Objective: To determine the prevalence and impact of multiple chronic conditions on children's health status and utilization of health services.
Design: Analysis of the 1988 National Health Interview Survey on Child Health.
Setting: Nationally representative sample of the U.S. civilian, noninstitutionalized population.
Participants: A total of 17,710 children less than 18 years of age selected in a stratified cluster sampling of U.S. households.
Results: We estimated that fewer than 5% of children have multiple (two or more) chronic conditions and that less than 1% of children had three or more such conditions. However, despite this low overall prevalence, some notable features of multiple chronic conditions stand out. Many of the most prevalent condition-pairs were allergy related, and the rates of co-occurrence of these disorders were generally higher than would be predicted on the basis of prevalence rates for the individual conditions. Children with multiple chronic conditions had more mental and physical health problems and used substantially more health services than other children. For example, the prevalence of developmental delay, learning disabilities, and emotional and behavioral problems increased sharply with the number of chronic conditions reported. Notable deterioration in such health status measures as days in bed, school absences, and activity limitation was also observed with increasing numbers of chronic conditions. Similarly, utilization of hospital and physician services increased in tandem with increasing numbers of chronic conditions.
Conclusions: Children who have multiple conditions of a chronic nature, even if few in number, have increased morbidity across a variety of measures.