Linear association between number of modifiable risk factors and multiple chronic conditions: Results from the Behavioral Risk Factor Surveillance System

- We defined multiple (≥ 2) chronic conditions (MCCs) with 8 or 12 chronic conditions.
- We studied associations of MCCs with composite measures of up to 9 risk factors.
- Linear increase in MCC rates with each added risk factor, starting with one.
- All 9 risk factors are important.
- Results suggest potential for primary prevention of a wide range of conditions.

Multiple (≥ 2) chronic conditions (MCCs) are responsible for a large fraction of healthcare costs. Our aim was to examine possible associations between MCCs and composite measures of behavioral risk factors (RFs). Data were publicly available 2013 Behavioral Risk Factor Surveillance System and included 483,865 non-institutionalized US adults ages ≥ 18 years. Chronic conditions included asthma, arthritis, chronic obstructive pulmonary disease, cognitive impairment, heart disease, stroke, cancer, and kidney disease. RFs included obesity, current smoking, sedentary lifestyle, inadequate fruit and vegetable consumption, and sleeping other than 7-8 h, while depression, hypertension, high cholesterol, and diabetes were considered in each category. Stata was used to study associations between 2 different MCCs and 2 composite measures of RFs in both unadjusted and adjusted analysis. Over 96% of respondents reported ≥ 1 of the 9 RFs and 71.5% reported ≥ 1 of the chronic conditions. For each combination there was a linear increase (with similar slopes) in MCC rate with more RFs and a statistically significant increase in adjusted odds ratios (ORs) for the MCC with each additional RF. For the MCC based on 8 chronic conditions, ORs were 1.3 (95% CI 1.1, 1.6) for 1 RF, 2.3 (1.9, 2.7) for 2, 3.7 (3.1, 4.4) for 3, 5.7 (4.8, 6.8) for 4, 9.1 (7.6, 10.8) for 5, 14.6 (12.2, 17.4) for 6, 24.0 (19.7, 29.2) for 7, 38.1 (29.6, 48.9) for 8, and 100.0 (56.3, 177.8) for all 9, each vs. zero RFs. Findings highlight the need for effective integrated programs to address multiple RFs and chronic conditions.