Learning Objectives
By the end of this section, you will be able to:
- Define comorbidity and its financial impacts
- Explore common examples of comorbid chronic diseases
- Discuss unique health care needs and health care coverage for comorbid chronic diseases
If it is difficult to live with one chronic disease, imagine the challenges facing patients with multiple chronic diseases simultaneously. In fact, more than 25 percent of individuals with chronic illness are diagnosed with two or more chronic conditions (Boersma et al., 2020). This is significant considering that individuals with chronic illness report lower health-related quality of life and have higher health care costs and a substantially increased risk of morbidity and mortality.
Comorbidity
The simultaneous presence of two or more medical conditions is referred to as comorbidity. It has a profound impact on disease burden, the total effects of a disease on an individual or a society. This burden of disease, especially when it involves chronic conditions, affects many aspects of health care, including finances and health insurance coverage, both of which are discussed in more detail in the following sections.
Financial Impacts from Comorbid Chronic Diseases
As noted in the previous module, nearly 90% of health care costs in the United States are related to chronic illness (CDC, 2023b). This highlights the importance of chronic disease burden on both the economy and personal finances. As the number of diagnosed chronic conditions increases for an individual, so do the number of emergency room visits, patient readmissions, prescriptions, and outpatient clinic visits, as well as the length of inpatient hospital stays. These increases in required health care services result in higher out-of-pocket costs and health care spending by insurance companies and health care institutions. Americans diagnosed with five or more chronic conditions account for only 12% of the population but make up nearly half of total health care spending, again highlighting the significance of the relationship between chronic illness and increased health care expenditures (Buttorff et al., 2017). This places an extra financial burden on the patients themselves as well as on the health care system and the overall economy.
Health Care Coverage for Comorbid Chronic Diseases
Health insurance coverage is a topic that has been debated and discussed at length by politicians, legislators, and individual health care consumers. Although consensus about the best course of action for the provision of health insurance remains elusive, it is clear that health insurance coverage becomes more complex with the presence of chronic comorbidities.
Coverage for chronic conditions varies depending on the type of health insurance acquired. Two of the most common health insurance plans for patients with chronic disease are offered through federal programs such as Medicare and Medicaid, both of which are administered by the Centers for Medicare and Medicaid Services (CMS). However, these programs have specific eligibility requirements that may not allow all individuals with chronic illness to obtain coverage. Table 9.1 lists the eligibility requirements for each program and some of the services covered (CMS, 2023).
| Characteristic | Medicare | Medicaid |
|---|---|---|
| Eligibility requirements |
|
|
| Covered services |
|
|
Examples of Comorbid Chronic Diseases
There are a multitude of common chronic diseases, several of which tend to occur as comorbid comorbidities. This is often due to certain characteristics of the disease, such as anatomic location or underlying pathophysiology, which can manifest as multiple disorders with similar etiologies. For example, one of the most common pairs of comorbidities is hypertension (i.e., elevated blood pressure in the blood vessels) and hyperlipidemia (i.e., elevated cholesterol in the blood vessels). This is likely because hyperlipidemia results in the deposition of fatty plaques in the vasculature, which increases the force of blood through the vessels, resulting in hypertension (Healthmatch, 2022). In this case, the presence of one chronic condition (hyperlipidemia) results in the development of another (hypertension). Other chronic conditions that often exist as comorbidities include:
- atherosclerosis and CVD
- cerebral vascular disease and carotid stenosis
- COPD and other upper respiratory disorders (e.g., chronic laryngitis, chronic sinusitis)
- diabetes mellitus and CVD
- mood disorders (e.g., depression, anxiety, bipolar disorder) and substance use disorders
- osteoarthritis and other autoimmune disorders
Comorbidity Management with Polypharmacy
With an increased prevalence in diagnosed comorbid chronic conditions, there is often an associated increase in the number of medications prescribed to treat each condition. The simultaneous use of multiple medications by a single patient is called polypharmacy (Figure 9.2). Polypharmacy can result in negative outcomes, including adverse medication reactions and overdoses, so it is important for nurses to be aware of the risks associated with polypharmacy when caring for patients with multiple comorbidities. Nurses should be prepared to advocate for clear communication between providers and patients to mitigate these associated risks.
Link to Learning
Read this article to learn about efforts to reduce the effects of polypharmacy in older adults.