NCHS Data Brief ■ No. 275 ■ March 2017

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Barriers to Health Care for Adults With Multiple Chronic 

Conditions: United States, 2012–2015

Brian W. Ward, Ph.D.

Key findings 

Data from the National 

Health Interview Survey

● In 2015, the percentage of 

adults aged 18–64 who delayed 

or did not obtain needed 

medical care due to cost in the 

past 12 months was highest 

among those diagnosed with 2 

or more of 10 selected chronic 

conditions (16.9%), and it 

was lowest among those with 

none of the selected conditions 

(8.5%).

● The percentage of adults 

who delayed needed medical 

care for a non-cost reason in the 

past 12 months increased as the 

number of conditions increased.

● The percentage of adults 

who had seen or talked to a 

health professional in the past 

12 months increased as the 

number of conditions increased. 

● For 2012–2015, the 

percentage of adults aged 

18–64 with two or more 

conditions who delayed or did 

not obtain needed medical care 

due to cost decreased, while 

the percentage who delayed 

medical care for a non-cost 

reason increased.

In 2014, 25.7% of adults had been diagnosed with multiple chronic 

conditions (MCC), or 2 or more of 10 selected chronic conditions, including 

hypertension, cancer, stroke, coronary heart disease, diabetes, arthritis, 

hepatitis, current asthma, weak or failing kidneys, and chronic obstructive 

pulmonary disease (1). As the number of chronic conditions increases, so do 

the health care costs for those diagnosed with MCC (2). In addition, the costs 

of managing these conditions further increases with advancing age (3). This 

report examines health care access and utilization among adults with MCC 

compared with those with one or no diagnosed chronic conditions.

Keywords: unmet medical needs • National Health Interview Survey

In 2015, the percentage of adults who had seen or talked to a 

health care professional in the past 12 months increased as 

the number of diagnosed chronic conditions increased.

Figure 1. Percentage of adults who had seen or talked to a health care professional in the past

12 months, by number of diagnosed chronic conditions among 10 selected conditions and age: 

United States, 2015 

1

Among adults with the same number of chronic conditions, significantly different from those aged 65 and over based on a 

two-tailed significance test (p < 0.05). 2

Significant increasing linear trend.

NOTES: The 10 selected conditions include hypertension, cancer, stroke, coronary heart disease, diabetes, arthritis, hepatitis, 

current asthma, weak or failing kidneys, and chronic obstructive pulmonary disease. Access data table for Figure 1 at: 

https://www.cdc.gov/nchs/data/databriefs/db275_table.pdf#1. 

SOURCE: NCHS, National Health Interview Survey, 2015. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
NCHS Data Brief ■ No. 275 ■ March 2017

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● For adults aged 18–64, 73.1% of those without a chronic condition had seen or talked to a 

health care professional in the past 12 months. This percentage increased to 95.4% among 

those with two or more chronic conditions (Figure 1).

● The percentage of adults aged 65 and over who had seen or talked to a health care 

professional in the past 12 months was lowest among those without a chronic condition 

(80.7%) and highest among those with two or more chronic conditions (98.3%).

● Among adults with the same number of diagnosed chronic conditions, those aged 18–64 

were less likely than adults aged 65 and over to have seen or talked to a health care 

professional in the past 12 months.

In 2015, the percentage of adults who delayed or did not obtain needed 

medical care due to cost in the past 12 months increased as the number of 

diagnosed chronic conditions increased.

● The percentage of adults aged 18–64 who delayed or did not obtain needed medical care due 

to cost in the past 12 months was lowest among those without a chronic condition (8.5%) 

and highest among those with two or more chronic conditions (16.9%) (Figure 2).

Figure 2. Percentage of adults who delayed or did not obtain needed medical care due to cost in the past 12 months, by 

number of diagnosed chronic conditions among 10 selected conditions and age: United States, 2015 

1

Among adults with the same number of chronic conditions, significantly different from those aged 65 and over based on a two-tailed significance test (p < 0.05). 2

Significant increasing linear trend. 

NOTES: The 10 selected conditions include hypertension, cancer, stroke, coronary heart disease, diabetes, arthritis, hepatitis, current asthma, weak or failing 

kidneys, and chronic obstructive pulmonary disease. Access data table for Figure 2 at: https://www.cdc.gov/nchs/data/databriefs/db275_table.pdf#2.

SOURCE: NCHS, National Health Interview Survey, 2015.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
NCHS Data Brief ■ No. 275 ■ March 2017

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● Among adults aged 65 and over, those with two or more chronic conditions were more 

likely to have delayed or not obtained needed medical care due to cost in the past 12 months 

(5.2%) compared with adults without a chronic condition (2.7%) and those with one chronic 

condition (2.9%).

● Among adults with the same number of diagnosed chronic conditions, the percentage of 

adults who delayed or did not obtain needed medical care due to cost in the past 12 months 

was higher among those aged 18–64 compared with those aged 65 and over.

In 2015, the percentage of adults who delayed needed medical care for 

a non-cost reason in the past 12 months increased as the number of 

diagnosed chronic conditions increased.

● For adults aged 18–64, 7.9% of those without a chronic condition delayed needed medical 

care due to a non-cost reason in the past 12 months compared with 19.7% of those with two 

or more chronic conditions (Figure 3).

 

 

 

 

 

Figure 3. Percentage of adults who delayed needed medical care due to a non-cost reason in the past 12 months, by 

number of diagnosed chronic conditions among 10 selected conditions and age: United States, 2015 

1

Among adults with the same number of chronic conditions, significantly different from those aged 65 and over based on a two-tailed significance test (p < 0.05). 2

Significant increasing linear trend. 

NOTES: The 10 selected conditions include hypertension, cancer, stroke, coronary heart disease, diabetes, arthritis, hepatitis, current asthma, weak or failing 

kidneys, and chronic obstructive pulmonary disease. Access data table for Figure 3 at: https://www.cdc.gov/nchs/data/databriefs/db275_table.pdf#3.

SOURCE: NCHS, National Health Interview Survey, 2015.

 

 

 

 

 

 

 

 

 
NCHS Data Brief ■ No. 275 ■ March 2017

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● The percentage of adults aged 65 and over who delayed needed medical care due to a 

non-cost reason in the past 12 months was lowest among those without a chronic condition 

(3.4%) and highest among those with two or more chronic conditions (11.4%).

● Among adults with the same number of diagnosed chronic conditions, those aged 18–64 

were more likely than those aged 65 and over to have delayed needed medical care for a 

non-cost reason in the past 12 months.

For 2012–2015, the percentage of adults with two or more chronic 

conditions who delayed or did not obtain needed medical care for any 

reason decreased for adults aged 18–64, but the percentage increased for 

adults aged 65 and over.

● There was a decreasing trend in the percentage of adults aged 18–64 with two or more 

chronic conditions who delayed or did not obtain needed medical care for any reason in the 

past 12 months, from 34.3% in 2012 to 31.4% in 2015 (Figure 4).

Figure 4. Percentage of adults diagnosed with 2 or more chronic conditions among 10 selected conditions who had not 

received or had delayed needed medical care in the past 12 months, by reason for delay or nonreceipt and age: United 

States, 2012–2015 

 

1

Significant decreasing linear trend.

2

Significant increasing linear trend.

NOTES: The 10 selected conditions include hypertension, cancer, stroke, coronary heart disease, diabetes, arthritis, hepatitis, current asthma, weak or failing 

kidneys, and chronic obstructive pulmonary disease. Percentage distributions may not add up to 100.0% due to rounding. Access data table for Figure 4 at: 

https://www.cdc.gov/nchs/data/databriefs/db275_table.pdf#4.

SOURCE: NCHS, National Health Interview Survey, 2012–2015.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
NCHS Data Brief ■ No. 275 ■ March 2017

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● There was an increasing trend in the percentage of adults aged 65 and over with two or more 

chronic conditions who delayed or did not obtain needed medical care for any reason in the 

past 12 months, from 13.5% in 2012 to 15.0% in 2015.

● The percentage of adults aged 18–64 with two or more chronic conditions who delayed or 

did not obtain needed medical care due only to cost in the past 12 months decreased, from 

16.5% in 2012 to 11.7% in 2015.

● There was an increasing trend in the percentage of adults aged 18–64 with two or more 

chronic conditions who delayed needed medical care due only to a non-cost reason in the 

past 12 months, from 12.4% in 2012 to 14.6% in 2015.

● Among adults aged 65 and over with two or more chronic conditions, there was no 

significant change in the percentage who delayed or did not obtain needed medical care in 

the past 12 months due only to cost or only for a non-cost reason. 

Summary

This report compares national estimates of health care access and utilization among adults 

diagnosed with 2 or more of 10 selected chronic conditions and adults diagnosed with 1 or none 

of the selected conditions. In 2015, adults with two or more conditions were more likely to use 

health care services in the past 12 months compared with those with one chronic condition or 

those without a chronic condition. However, adults with two or more conditions were more likely 

to delay or not obtain needed medical care due to cost and non-cost related reasons compared 

with those with less than two conditions.

Regardless of the number of diagnosed chronic conditions, adults aged 18–64 were less likely to 

use health services in the past 12 months compared with those aged 65 and over, and they were 

more likely to delay or not obtain needed medical care due to cost and non-cost related reasons. 

For 2012–2015, no significant changes were found in the prevalence of delay or non-receipt of 

care due only to cost or only for a non-cost reason among adults aged 65 and over with two or 

more chronic conditions. However, there was an increase in the percentage of adults aged 65 and 

over who delayed or did not obtain care for any reason. For adults aged 18–64 with two or more 

chronic conditions, there was a decrease in the percentage who delayed or did not receive needed 

medical care in the past 12 months due only to cost during this same time period. By 2015, a 

higher percentage of adults delayed care for a non-cost reason (14.6%) compared with a cost 

reason (11.7%).

In summary, adults with two or more chronic conditions may be more likely than those with one 

or no chronic conditions to use health care services, but they also experience more barriers to 

health care. For 2012–2015, the reasons for these barriers have changed for adults aged 18–64 

with two or more chronic conditions.
NCHS Data Brief ■ No. 275 ■ March 2017

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Definitions

Delayed needed medical care due to a non-cost reason: Adults were asked, “Have you delayed 

getting care for any of the following reasons in the past 12 months?” Reasons provided included 

being unable to get through on the telephone, being unable to get an appointment soon enough, 

having to wait too long to see the doctor after arriving, not having the clinic or doctor’s office 

open when the adult was able to get there, or not having transportation. An affirmative answer 

to any one of these questions indicated that needed medical care was delayed due to a non-cost 

reason.

Delayed or did not obtain needed medical care due to cost in the past 12 months: Respondents 

were asked, “During the past 12 months, has medical care been delayed for [the adult] because of 

worry about the cost?” and “During the past 12 months, was there a time when [the adult] needed 

medical care, but did not get it because the adult could not afford it?” An affirmative response to 

either one of these questions indicated that needed medical care was delayed or not obtained.

Multiple chronic conditions: Having been diagnosed with 2 or more of 10 selected chronic 

conditions. The conditions selected were based on previous research (1,4). These 10 conditions 

included whether an adult had ever been diagnosed by a doctor or other health care professional 

with hypertension, cancer, stroke, coronary heart disease, diabetes, arthritis (including rheumatoid 

arthritis, gout, lupus, and fibromyalgia), and hepatitis. Also included was a current diagnosis of 

asthma, a diagnosis of weak or failing kidneys in the past 12 months, and a diagnosis of chronic 

obstructive pulmonary disease (COPD) (indicated by having ever been diagnosed with COPD or 

emphysema or having been diagnosed with chronic bronchitis in the past 12 months). Of note, 

2012 was the first year a survey question asking adults if they had ever been diagnosed with 

COPD was included on the National Health Interview Survey (NHIS) (5).

Seen or talked to a health care professional in the past 12 months: Adults were asked, “About how 

long has it been since you last saw or talked to a doctor or other health care professional about 

your own health? Include doctors seen while a patient in a hospital.” Responses of “6 months or 

less” and “more than 6 months, but not more than 1 year ago” were combined.
NCHS Data Brief ■ No. 275 ■ March 2017

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Data source and methods

Data from 139,451 adults who responded to the 2012–2015 NHIS were used for this analysis, 

including 33,672 respondents from the 2015 survey. NHIS is a multipurpose health survey 

conducted continuously throughout the year by the National Center for Health Statistics (NCHS). 

Interviews are conducted in person in respondents’ homes, but follow-ups to complete interviews 

may be conducted over the telephone. Questions about delaying and not receiving needed medical 

care due to cost are from the survey’s Family Core component, while all remaining questions 

used in this analysis are from the Sample Adult component. The Family Core component collects 

information on all family members, and the Sample Adult component collects additional data 

from one randomly selected adult (“sample adult”). The final Sample Adult response rates for the 

2012–2015 NHIS ranged from 61.2% in 2012 to 55.2% in 2015. For further information about 

NHIS, including the questionnaire, visit the NHIS website at: https://www.cdc.gov/nchs/nhis/

index.htm.

All analyses used weights to produce national estimates. Data weighting procedures are described 

elsewhere (6). Point estimates and their estimated variances were calculated using SUDAAN 

software (7) and the Taylor series linearization method to account for the complex design of 

NHIS. Two-sided significance tests at the 0.05 level were used to compare estimates. Logistic 

regression was used to assess linear trends. All estimates shown in this report meet the NCHS 

standard of reliability (relative standard error less than or equal to 30%).

About the author

Brian W. Ward is with the National Center for Health Statistics, Division of Health Interview 

Statistics.
NCHS Data Brief ■ No. 275 ■ March 2017

References

1. Ward BW, Black LI. State and regional prevalence of diagnosed multiple 

chronic conditions among adults aged ≥18 years—United States, 2014. 

MMWR Morb Mortal Wkly Rep 65(29):735–8. 2016.

2. Lehnert T, Heider D, Leicht H, Heinrich S, Corrieri S, Luppa M, et al. 

Review: Health care utilization and costs of elderly persons with multiple 

chronic conditions. Med Care Res Rev 68(4):387–420. 2011.

3. Paez KA, Zhao L, Hwang W. Rising out-of-pocket spending for chronic 

conditions: A ten-year trend. Health Aff (Millwood) 28(1):15–25. 2009.

4. Goodman RA, Posner SF, Huang ES, Parekh AK, Koh HK. Defining and 

measuring chronic conditions: Imperatives for research, policy, program, and 

practice. Prev Chronic Dis 10:120239. 2013.

5. Ward BW, Nugent CN, Blumberg SJ, Vahratian A. Measuring the 

prevalence of diagnosed chronic obstructive pulmonary disease in the United 

States using data from the 2012–2014 National Health Interview Survey. 

Public Health Rep 132(2). 2017.

6. Parsons VL, Moriarity C, Jonas K. Design and estimation for the 

National Health Interview Survey, 2006–2015. National Center for Health 

Statistics. Vital Health Stat 2(165). 2014.

7. RTI International. SUDAAN (Release 11.0.0) [computer software]. 2012.

Suggested citation

Ward BW. Barriers to health care for adults 

with multiple chronic conditions: United 

States, 2012–2015. NCHS data brief, no 

275. Hyattsville, MD: National Center for 

Health Statistics. 2017.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health Interview Statistics 

Marcie L. Cynamon, Director

Stephen J. Blumberg, Ph.D., Associate 

Director for Science

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