Estimating prevalence of multiple chronic conditions based on health behaviors and its regional differences in the United State, Behavioral Risk Factor Surveillance System, 2009
Henry Carretta, Florida State University, College of Medicine/Division of Health Affairs 
*Jihyung Shin, Florida State University, Department of Statistics 

Keywords: Multiple chronic conditions, Chronic disease, BRFSS, Hierarchical logistic regression, Health behaviors

Chronic disease prevalence is increasing in the United States and is associated with significant morbidity and health care costs. The purpose of this study was to examine regional differences in the prevalence of persons with a single chronic condition, multiple chronic conditions, and good or excellent self-reported health status among adults in the U.S. The 2009 Behavioral Risk Factor Surveillance System (BRFSS) data (n=304,982) were used for the analyses. Among U.S. adults (age>=18), about 83% of them said that they are in good or better health. However, about 71% of adults reported at least one of following chronic conditions, diabetes, hypertension, heart attack, angina or coronary heart disease, stroke, high cholesterol, asthma, arthritis, or cancer. Among those, approximately 64% reported more than one condition. Chronic disease prevalence was concentrated in southern states. States were grouped by the 9 U.S. Census divisions. Hierarchical logistic regression models were fitted and the odds ratios compared among the 9 divisions controlling for reported health enhancing behaviors, behaviors detrimental to health, and demographic characteristics. Behavioral health factors were found to have a significant relationship with reported health status, prevalence of a chronic disease and multiple chronic conditions. Significant regional differences were observed as well. Compared to the national average, adults living in the East North Central(IL,IN,MI,OH, and WI), South Atlantic (DE,DC,FL,GA, MD,NC,SC,VA, and WV), East South Central (AL,KY,MS, and TN), and West South Central (AR,LA,OK, and TX) divisions, had higher odds of any single chronic condition, (OR = 1.057,1.035,1.071, and 1.074 respectively) and multiple chronic conditions (OR =1.054,1.047,1.150, and 1.080 respectively). In contrast, respondents from the West North Central (IA, KS, MN, MO, NE, ND, and SD) and Mountain (AZ,CO,ID,MT,NV,NM,UT, and WY) divisions had lower odds of having both a single chronic condition (OR=0.828 and 0.933) and multiple chronic conditions (OR=0.874 and 0.935). Residents in the New England (CT, ME, MA, NH, RI, and VT) division also had lower odds of having multiple chronic conditions (OR=0.934). Significant regional differences in health behaviors, health status, and chronic disease prevalence suggest target areas for policies and programs that enhance adoption of healthy behaviors and cessation of detrimental behaviors as a means to reduce these health disparities.