1. Prevalence of Chronic Disease & Comorbid Conditions in the CHAIN Cohort CHAIN Report 2007-4 Peter Messeri, Gunjeong Lee, Sara Berk Mailman School of Public Health Needs Assessment Committee Meeting December 16, 2008

2. Background As a consequence of increased life expectancy and complications from HIV medication, people living with HIV/AIDS are increasingly vulnerable to a broad spectrum of nonHIV comorbidities. This study presents data on the prevalence of 9 chronic conditions in the CHAIN cohort and estimates of medical care service utilization associated with management of these conditions. 12/13/20082NYC Presentation

3. Study Questions What is the lifetime prevalence of selected nonHIV chronic conditions in the CHAIN cohorts? Do rates of chronic conditions differ by sociodemographic characteristics, lifestyle behaviors or HIV disease progression? To what extent do chronic conditions impair physical and mental health? How much of CHAIN cohort utilization of medical care services is tied to management of nonHIV chronic conditions? 12/13/20083NYC Presentation

4. How Were the Data Obtained? Self reported information on 9 chronic conditions was collected for NYC Cohort members at all four rounds of interviews conducted between 2002 and 2008. Cohort members were asked “has a doctor ever told you that you had any of the following conditions” asthma, hypertension, heart problems, diabetes, arthritis/ rheumatism, high cholesterol, chronic sinusitis, hepatitis, cervical abnormalities (for women). 12/13/20084NYC Presentation

5. How Were the Data Obtained? At each interview, we further confirmed whether participants were currently experiencing problems with each condition and whether they were receiving medical care for the condition. As a measure of the overall burden of nonHIV chronic conditions, we created a count of the total number of conditions reported. 12/13/20085NYC Presentation

6. Percentage of CHAIN Cohort Reporting Any or 3 or More Chronic Conditions at Baseline and Round 4 Interviews NYCTri County Source: CHAIN Report 2007-4: Table 2 12/13/2008 6NYC Presentation

7. Lifetime Prevalence of nonHIV Chronic Conditions NYC Tri County Source: CHAIN Report 2007-4: Table 2, Round 4 Prevalence 12/13/20087NYC Presentation

8. NYC CHAIN and NYC Lifetime Prevalence* for Selected Chronic Conditions *NYC prevalence adjusted to match the age, gender and ethnic composition of the NYC CHAIN cohort. Source: CHAIN Report 2007-4.: Table 4 12/13/20088NYC Presentation

9. Participant Attributes Associated Increased Vulnerability to Chronic Conditions Advanced age Being a female History of substance abuse or injecting drug use Source: CHAIN Report 2007-4: Tables 5-1,5-2,6-1,6-2 12/13/20089NYC Presentation

10. Chronic Conditions and Quality of Life For the NYC CHAIN cohort, each additional chronic condition is associated with a 1.5 point decline on a general physical health scale and.77 decline in mental health This compares – with similar declines, 1.9 and.57, in physical and mental health, for the Tri-County cohort. – 3.1 and 2.0 point declines in physical and mental health associated with a fall in CD4 T-Cell counts from above 500 to below 200 Source: CHAIN Report 2004-7: Table 7 12/13/200810NYC Presentation

11. Additional Days/Visits of Medical Services Attributable to Presence of NonHIV Chronic Conditions NYCTri County Source: CHAIN Report 2007-4: Table 9 12/13/200811NYC Presentation

12. Conclusions Comorbid health conditions are ubiquitous among CHAIN cohort members. Cohort members are at increased risk for several common chronic conditions compared to the general populations of similar age, gender and ethnicity. They contribute to significant declines in both physical and mental well being of cohort members. Experiencing these conditions appears to substantially increase use of medical services. – A very large proportion of members who ever have these conditions, report current treatment at time of interviews. – Comorbid conditions contribute to a significant increased use of medical services. 12/13/200812NYC Presentation

13. Conclusions New York City findings are generally in line with those for Tri-County. The findings of this report directly confirm that individuals with increasing number of chronic conditions make more use of medical services, but further research is needed for more precise assessment of increased medical utilization directly related to medical management of these conditions. Both professional and patient education should be considered to manage comorbid conditions in a more efficient and effective manner among PLWHA. 12/13/200813NYC Presentation