Differences Between Younger and Older US Adults With Multiple Chronic Conditions

Mary L. Adams, MS, MPH


Prev Chronic Dis. 2017;14(9) 

In This Article

Abstract and Introduction


Introduction Adults with multiple (≥2) chronic conditions (MCCs) account for a large portion of US health care costs. Despite the increase in MCC rates with age, most people with MCCs are working age. The study objective was to compare adults with MCCs who were younger than 65 years with those aged 65 years or older on selected measures to better understand the differences between groups and inform interventions that could lower health care costs.

Methods Data from respondents to the 2015 Behavioral Risk Factor Surveillance System data (N = 201,711) were used to compare adults aged 65 or older with MCCs with those younger than 65 with MCCs in unadjusted and adjusted analyses on chronic conditions, quality of life measures, disability status, access to health care, and modifiable risk factors. MCCs were based on up to 12 chronic conditions (heart disease, stroke, asthma, arthritis, chronic obstructive pulmonary disease, high cholesterol, cognitive impairment, diabetes, depression, chronic kidney disease, cancer other than skin, and hypertension).

Results Consistent with 80% of all adults being younger than 65, more than 60% of adults with MCCs were younger than 65 years. Compared with adults aged 65 or older with MCCs, those younger than 65 were more likely to report asthma, cognitive impairment, depression, smoking, obesity, poorer access to health care, disability, and worse quality of life in both unadjusted and adjusted analysis.

Conclusion To decrease the burden of chronic diseases, adults younger than 65 with MCCs should get the treatment they need to reduce the chance of developing more chronic conditions as they age. The ultimate goal is to improve health status and reduce health care costs for everyone with MCCs.


Rates of multiple chronic conditions (MCCs), defined as having 2 or more co-occurring chronic conditions, tend to increase with age,[1] resulting in increasing Medicare costs.[2] As a consequence, considerable information on MCCs comes from Medicare claims data[3,4] for adults aged 65 years or older. A recent review of 163 studies[5] that included adults of all ages noted that despite the increase in MCC rates with age, most people with MCCs are working age. Other studies found that medical expenditures for chronic conditions among nonelderly adults and adults aged 65 or older were similar, averaging approximately $3,700 for those with 2 or 3 chronic conditions and $8,900 for those with 4 or more.[6] Another study[7] found larger relative increases in MCCs over time among those aged 25 to 44 years compared with older adults and different chronic conditions by age group.

Lifestyle factors such as smoking and obesity[8–10] increase the risk of many chronic conditions included in measures of MCCs. Some chronic conditions, such as diabetes, depression, high blood pressure, and high cholesterol, are also risk factors for MCCs.[5] Any of these risk factors can increase the likelihood of developing additional chronic conditions in adults of any age. When considered collectively, these findings suggest the need for a better understanding of MCCs among younger adults to develop effective strategies to prevent more chronic conditions from developing and better manage existing ones. This understanding in turn could mitigate any increase in future health care costs.

The objective of this study was to compare adults younger than 65 with MCCs with those aged 65 years or older with MCCs on selected measures. Measures included disability status, quality of life measures, chronic conditions, risk factors, and access to health care to add to information that is known about adults younger than 65 with MCCs. Because there is no standard list of chronic conditions to include, the study used different definitions of MCCs: one that considers diabetes, high blood pressure, high cholesterol, and depression as chronic conditions, and one that does not.