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Methods
The NHIS is a multistage health survey of the US civilian, noninstitutionalized population. Information from the NHIS Family Core questionnaire (Family Core) on sex, race/ethnicity, age, and health insurance coverage was used in this analysis. In the Family Core, 1 adult from the family self-reports and acts as a proxy for other family members. Data on chronic conditions are collected by using the Sample Adult Core questionnaire. The respondent (ie, "sample adult") is randomly selected from all adults in the family aged 18 years or older. A proxy is used for the sample adult only if a health condition makes it impossible for the sample adult to respond for himself or herself. Our analyses include 34,525 sample adults from the 2012 NHIS (final response rate: 61.2%).
Adults were identified as having 0, 1, 2, or 3 or more chronic conditions. The chronic conditions included in this study were 10 physical conditions from a list of 20 conditions identified by the US Department of Health and Human Services (HHS) to foster a more consistent and standardized approach to measuring the occurrence of chronic conditions in the United States. Participants were identified as having 1 of the 10 conditions if they had ever been told by a doctor or health care provider that they had hypertension, coronary heart disease, stroke, diabetes, cancer, arthritis, or hepatitis; had experienced weak or failing kidneys during the past 12 months; currently had asthma; or had COPD. COPD was assessed by using responses from 2 survey questions asking adults if they had ever had emphysema or had had chronic bronchitis in the past 12 months; adults answering yes to either question were identified as having COPD. SUDAAN software 10.0.1 (RTI International, Research Triangle Park, North Carolina) was used to account for the complex sample design of the NHIS when generating estimates and confidence intervals. Estimates were calculated for subgroups defined by age, sex, race/ethnicity, and health insurance coverage to show prevalence of single conditions and MCC among these subgroups. Two-tailed significance tests were used to test for differences in prevalence between population subgroups; all differences reported are significant (P < .05).
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