Original article
Why Patients Visit Their Doctors: Assessing the Most Prevalent Conditions in a Defined American Population

https://doi.org/10.1016/j.mayocp.2012.08.020Get rights and content

Abstract

Objective

To describe the prevalence of nonacute conditions among patients seeking health care in a defined US population, emphasizing age, sex, and ethnic differences.

Patients and Methods

The Rochester Epidemiology Project (REP) medical records linkage system was used to identify all residents of Olmsted County, Minnesota, on April 1, 2009, who had consented to review of their medical records for research (142,377 patients). We then electronically extracted all International Classification of Diseases, Ninth Revision codes noted in the records of these patients by any health care institution between January 1, 2005, and December 31, 2009. We grouped International Classification of Diseases, Ninth Revision codes into clinical classification codes and then into 47 broader disease groups associated with health-related quality of life. Age- and sex-specific prevalence was estimated by dividing the number of individuals within each group by the corresponding age- and sex-specific population. Patients within a group who had multiple codes were counted only once.

Results

We included a total of 142,377 patients, 75,512 (53%) of whom were female. Skin disorders (42.7%), osteoarthritis and joint disorders (33.6%), back problems (23.9%), disorders of lipid metabolism (22.4%), and upper respiratory tract disease (22.1%, excluding asthma) were the most prevalent disease groups in this population. Ten of the 15 most prevalent disease groups were more common in women in almost all age groups, whereas disorders of lipid metabolism, hypertension, and diabetes were more common in men. Additionally, the prevalence of 7 of the 10 most common groups increased with advancing age. Prevalence also varied across ethnic groups (whites, blacks, and Asians).

Conclusion

Our findings suggest areas for focused research that may lead to better health care delivery and improved population health.

Section snippets

Study Population

The REP links data on medical care delivered to the population of Olmsted County, Minnesota.7, 8, 9 The vast majority of medical care in this community is currently provided by a few health care institutions: the Mayo Clinic and its 2 affiliated hospitals, Olmsted Medical Center and its affiliated hospital, and the Rochester Family Medicine Clinic. The health care records from these institutions are linked together through the REP records linkage system.8, 9 Patients are categorized as

Description of the Olmsted County Population

Overall, the REP infrastructure captured 146,687 Olmsted County residents in 2009 compared with 143,962 individuals predicted by the US Census.17 Therefore, the REP captured slightly more people than the US Census (101.9%). These results are consistent with a previous study that examined REP capture rates between 1970 and 2000.8

Of 146,687 residents, 142,377 gave permission for use of their medical records for research (97.1%). The population included 75,512 females (53%). Age and sex

Principal Findings

Using the REP medical records linkage system, we described the prevalence of the most common medical conditions in a defined US population across all ages, for men and women separately, and across ethnic groups. Surprisingly, the most prevalent nonacute conditions in our community were not chronic conditions related to aging such as diabetes and heart disease but rather conditions that affect both sexes and all age groups: skin disorders, osteoarthritis and joint disorders, back problems,

Conclusion

In this article, we report the prevalence of 47 broad categories of nonacute conditions across all age groups, in men and women separately, and across ethnic groups in the Olmsted County population. The data provide insight into current health care use in a defined US population and may predict future health care service and work force needs as well as opportunities for prevention. Finding that skin and back problems are major drivers of health care utilization affirms the importance of moving

Acknowledgements

We thank Lori Klein for assistance with manuscript preparation.

References (47)

  • C. Vogeli et al.

    Multiple chronic conditions: prevalence, health consequences, and implications for quality, care management, and costs

    J Gen Intern Med

    (2007)
  • W. Katon et al.

    Cost-effectiveness of a multicondition collaborative care intervention: a randomized controlled trial

    Arch Gen Psychiatry

    (2012)
  • P.S. Hussey et al.

    The PROMETHEUS bundled payment experiment: slow start shows problems in implementing new payment models

    Health Aff (Millwood)

    (2011)
  • D.W. Bates et al.

    The future of health information technology in the patient-centered medical home

    Health Aff (Millwood)

    (2010)
  • J.L. St Sauver et al.

    Use of a medical records linkage system to enumerate a dynamic population over time: the Rochester Epidemiology Project

    Am J Epidemiol

    (2011)
  • Agency for Healthcare Research and Quality. Medical Expenditure Panel Survey HC-120, Appendix 3: Clinical...
  • Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project: Clinical Classifications Software...
  • M.S. Porta et al.

    A Dictionary of Epidemiology

    (2008)
  • D.W. Anderson et al.

    On epidemiologic surveys

    Am J Epidemiol

    (1983)
  • W.E. Deming

    Boundaries of statistical inference

  • W.A. Rocca et al.

    Incidence of dementia and Alzheimer's disease: a reanalysis of data from Rochester, Minnesota, 1975-1984

    Am J Epidemiol

    (1998)
  • Small area income and poverty estimates: state and county estimates for 2009. United States Census Bureau website....
  • US Census Bureau. 2010 Demographic Profile Data, Olmsted County, MN....
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    Grant Support: This study was made possible by the Rochester Epidemiology Project (grant number R01-AG034676; Principal Investigators: Walter A. Rocca, MD, MPH, and Barbara P. Yawn, MD, MSc). This project was also supported by funding from the Mayo Clinic Center for Translational Science Activities (UL1 RR024150).

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