MULTIMORBIDITY PATTERNS AMONG FUNCTIONALLY DEPENDENT ELDERLY ADULTS IN THE UNITED STATES: A LATENT CLASS ANALYSIS
Author(s)
Jiawei Chen, PharmD1, Richard H. Stanford, PharmD, MS1, Carrie M. Blanchard, PharmD, MPH1, Joshua M. Thorpe, PhD, MPH2;
1AESARA, Inc., Chapel Hill, NC, USA, 2UNC Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC, USA
1AESARA, Inc., Chapel Hill, NC, USA, 2UNC Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC, USA
OBJECTIVES: To identify empirically derived multimorbidity patterns among functionally dependent older adults in the United States and examine differences in healthcare expenditures and perceived health across identified clusters
METHODS: Cross-sectional retrospective analysis of the Medical Expenditure Panel Survey was conducted using data from 2017-2023, including adults >= 65 years who required help with at least one activity of daily living or instrumental activity of daily living. Comorbid conditions were identified using ICD-10-CM diagnoses mapped to CCSR condition groups. Latent class analysis (LCA) was performed in LatentGold using comorbidities to identify comorbidity clusters. Comparative fit statistics determined optimal number of classes. Predictors of class membership were guided by the Andersen Behavioral Model and outcomes were total annual healthcare expenditures and perceived health status.
RESULTS: An eight-class model provided the best fit for the study population of 2,146 dependent older adults (weighted N = 21,448,094; average annual weighted N = 5,362,023) revealing a low-complexity cardiometabolic class; diabetes, hypertension, and arthritis-dominant classes with added heart failure or mental health conditions; cardiovascular disease-focused classes; and alcohol-related classes with increasing neurologic and cardiometabolic involvement. Mean annual total healthcare expenditures across classes increased non-linearly with comorbidity burden (range, $18,745 - $46,529) with alcohol and neuropathy dominant classes incurring disproportionately higher expenditures relative to their condition counts. Prescription drug spending closely tracked total expenditures. Perceived poor health generally increased with comorbidity burden, however; one high-comorbidity class characterized by peripheral neuropathy and alcohol use disorder reported perceived health similar to the lowest-complexity group characterized by mainly hypertension.
CONCLUSIONS: Multimorbidity patterns in dependent older adults were associated with substantial variation in healthcare expenditures and perceived health, suggesting meaningful heterogeneity in health experience beyond condition counts. These findings support moving beyond condition counts toward actionable, patient-centered stratification and targeted interventions in functionally dependent populations.
METHODS: Cross-sectional retrospective analysis of the Medical Expenditure Panel Survey was conducted using data from 2017-2023, including adults >= 65 years who required help with at least one activity of daily living or instrumental activity of daily living. Comorbid conditions were identified using ICD-10-CM diagnoses mapped to CCSR condition groups. Latent class analysis (LCA) was performed in LatentGold using comorbidities to identify comorbidity clusters. Comparative fit statistics determined optimal number of classes. Predictors of class membership were guided by the Andersen Behavioral Model and outcomes were total annual healthcare expenditures and perceived health status.
RESULTS: An eight-class model provided the best fit for the study population of 2,146 dependent older adults (weighted N = 21,448,094; average annual weighted N = 5,362,023) revealing a low-complexity cardiometabolic class; diabetes, hypertension, and arthritis-dominant classes with added heart failure or mental health conditions; cardiovascular disease-focused classes; and alcohol-related classes with increasing neurologic and cardiometabolic involvement. Mean annual total healthcare expenditures across classes increased non-linearly with comorbidity burden (range, $18,745 - $46,529) with alcohol and neuropathy dominant classes incurring disproportionately higher expenditures relative to their condition counts. Prescription drug spending closely tracked total expenditures. Perceived poor health generally increased with comorbidity burden, however; one high-comorbidity class characterized by peripheral neuropathy and alcohol use disorder reported perceived health similar to the lowest-complexity group characterized by mainly hypertension.
CONCLUSIONS: Multimorbidity patterns in dependent older adults were associated with substantial variation in healthcare expenditures and perceived health, suggesting meaningful heterogeneity in health experience beyond condition counts. These findings support moving beyond condition counts toward actionable, patient-centered stratification and targeted interventions in functionally dependent populations.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EPH134
Topic
Epidemiology & Public Health
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Geriatrics