NCHS Data Brief ■ No. 100 ■ July 2012

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Multiple Chronic Conditions Among Adults Aged 45 and 

Over: Trends Over the Past 10 Years

Virginia M. Freid, M.S.; Amy B. Bernstein, Sc.D.; and Mary Ann Bush, M.S.

Key findings 

Data from the National 

Health Interview Survey, 

1999–2000 and 2009–2010

• Between 1999–2000 and 

2009–2010, the percentage of 

adults aged 45–64 and 65 and 

over with two or more of nine 

selected chronic conditions 

increased for both men and 

women, all racial and ethnic 

groups examined, and most 

income groups.

• During the 10-year period, 

the percentage of adults 

aged 65 and over with both 

hypertension and diabetes 

increased from 9% to 15%; 

prevalence of hypertension and 

heart disease increased from 

18% to 21%; and prevalence 

of hypertension and cancer 

increased from 8% to 11%. 

• The percentage of adults 

aged 45–64 with two or more 

of nine selected chronic 

conditions who did not receive 

or delayed needed medical care 

due to cost increased from 17% 

to 23%, and the percentage 

who did not receive needed 

prescription drugs due to cost 

increased from 14% to 22%. 

Studies suggest that the presence of multiple chronic conditions (MCC) 

adds a layer of complexity to disease management (1–6); recently the U.S. 

Department of Health and Human Services established a strategic framework 

for improving the health of this population (2). This report presents estimates 

of the population aged 45 and over with two or more of nine self-reported 

chronic conditions, using a definition of MCC that was consistent in the 

National Health Interview Survey (NHIS) over the recent 10-year period: 

hypertension, heart disease, diabetes, cancer, stroke, chronic bronchitis, 

emphysema, current asthma, and kidney disease. Examining trends in the 

prevalence of MCC informs policy on chronic disease management and 

prevention, and helps to predict future health care needs and use for Medicare 

and other payers. 

Keywords: hypertension • diabetes • cancer • prevalence 

The percentage of adults aged 45–64 and 65 and over with 

two or more of nine selected chronic conditions increased 

between 1999–2000 and 2009–2010.

Figure 1. Prevalence of two or more of nine selected chronic conditions among adults aged 45

and over, by age and sex: United States, 1999–2000 and 2009–2010

1999–2000 2009–2010

0

10

20

30

40

50

60

65 and over

Age in years

45–64

Total Men Women Total Men Women

16.1 16.9 15.2

1

20.6 1

21.3

37.2

1

45.3

39.2

1

49.0

35.8

1

42.5

1

Percent

21.0

1

Significantly different from 1999–2000, p < 0.05.

NOTE: Access data table for Figure 1 at: http://www.cdc.gov/nchs/data/databriefs/db100_tables.pdf#1.

SOURCE: CDC/NCHS, National Health Interview Survey.
NCHS Data Brief ■ No. 100 ■ July 2012

■  2  ■

• The percentage of adults with two or more chronic conditions increased for men and women 

in both age groups during the 10-year period (Figure 1).

• In 2009–2010, 21% of adults aged 45–64 and 45% of adults aged 65 and over had been 

diagnosed with two or more chronic conditions.

The percentage of adults aged 45 and over with two or more of nine 

selected chronic conditions increased for all racial and ethnic groups 

between 1999–2000 and 2009–2010.

1

Significantly different from 1999–2000, p < 0.05.

NOTE: Access data table for Figure 2 at: http://www.cdc.gov/nchs/data/databriefs/db100_tables.pdf#2.

SOURCE: CDC/NCHS, National Health Interview Survey. 

Figure 2. Prevalence of two or more of nine selected chronic conditions among adults aged 45 and over, by age and race 

and Hispanic origin: United States, 1999–2000 and 2009–2010

0

10

20

30

40

50

60

Percent

1999–2000 2009–2010

45–64 65 and over

Age in years

Black only,

not Hispanic

White only,

not Hispanic

Hispanic Black only,

not Hispanic

White only,

not Hispanic

Hispanic

23.2

15.3 14.5

1

19.0

43.8

37.1

1

45.1

32.2

1

42.4

1

51.6

1

20.6

1

27.9

• Between 1999–2000 and 2009–2010, the percentage of adults aged 45–64 with two or more 

chronic conditions increased 20% for non-Hispanic black, 35% for non-Hispanic white, and 

31% for Hispanic adults (Figure 2).

• During this period, the prevalence of two or more chronic conditions among those aged 65 

and over increased 18% for non-Hispanic black, 22% for non-Hispanic white, and 32% for 

Hispanic adults. 

• In both time periods, the prevalence of two or more chronic conditions was higher among 

non-Hispanic black adults than among adults in other racial and ethnic groups. 
NCHS Data Brief ■ No. 100 ■ July 2012

■  3  ■

During the 10-year period, the prevalence of two or more of nine selected 

chronic conditions increased for adults aged 45 and over in most family 

income groups. 

Figure 3. Prevalence of two or more of nine selected chronic conditions among adults aged 45 and over, by age and 

percentage of poverty level: United States, 1999–2000 and 2009–2010

0

10

20

30

40

50

60

400% or

more

200%–

399%

100%–

199%

Below

100%

400% or

more

200%–

399%

100%–

199%

Below

100%

65 and over

Age in years

45–64

Percent

1999–2000 2009–2010

1

Significantly different from 1999–2000, p < 0.05.

NOTE: Access data table for Figure 3 at: http://www.cdc.gov/nchs/data/databriefs/db100_tables.pdf#3.

SOURCE: CDC/NCHS, National Health Interview Survey. 

30.6

33.4

23.8

1

29.8

16.9

1

21.2

11.5

1

15.7

42.5

1

50.9

41.4

1

49.5

35.5

1

46.3

32.7

1

39.0

• In both 1999–2000 and 2009–2010, the prevalence of two or more chronic conditions for 

adults aged 45–64 decreased with rising family income and was more than twice as high 

among those living in poverty as among those at 400% or more of the poverty level (Figure 

3). 

• Among those aged 65 and over, the percentage with two or more chronic conditions also 

decreased with increasing family income, but the percentage varied less by family income 

than among those aged 45–64. 
NCHS Data Brief ■ No. 100 ■ July 2012

■  4  ■

The percentage of adults aged 45 and over with the three most common 

combinations of the nine selected chronic conditions increased over the 

10-year period. 

Figure 4. Prevalence of the three most common combinations of the nine selected chronic conditions, by age and type of 

chronic condition: United States, 1999–2000 and 2009–2010

1

Significantly different from 1999–2000, p < 0.05.

NOTES: Parts may not sum to total due to rounding. Access data table for Figure 4 at: http://www.cdc.gov/nchs/data/databriefs/db100_tables.pdf#4.

SOURCE: CDC/NCHS, National Health Interview Survey. 

0

5

10

15

Percent

20

25 Specified conditions in addition

to at least one other of nine

selected chronic conditions

Only specified conditions

1.8

1

2.9

1

1.6

1

1.3

9.4

6.3

3.1

1

15.2

1

10.2

1

5.0

17.7

10.4

7.3

1

21.2

1

13.5

7.6

0.9

0.9 2.2

2.6

4.8

3.1

3.3

6.4

3.2

1

4.3

1

7.5

3.0

4.9

7.9

3.5

1

7.2

1

10.7

1

4.0

1

4.1

1

8.1

1999–

2000

2009–

2010

1999–

2000

2009–

2010

1999–

2000

2009–

2010

1999–

2000

2009–

2010

1999–

2000

2009–

2010

1999–

2000

2009–

2010

45–64

Age in years

65 and over

Hypertension

and diabetes

Hypertension

and heart

disease

Hypertension

and cancer

Hypertension

and diabetes

Hypertension

and heart

disease

Hypertension

and cancer

• Between 1999–2000 and 2009–2010, the percentage of adults aged 45–64 with both 

hypertension and diabetes increased from 5% to 8% because of an increase in the share 

with hypertension and diabetes only, as well as an increase in the share with hypertension, 

diabetes, and additional chronic condition(s) (Figure 4). 

• During the 10-year period, the percentage of adults aged 65 and over with both hypertension 

and diabetes rose from 9% to 15%; prevalence of hypertension and heart disease increased 

from 18% to 21%; and prevalence of hypertension and cancer increased from 8% to 11%. 
NCHS Data Brief ■ No. 100 ■ July 2012

■  5  ■

The percentage of adults aged 45–64 with two or more of nine selected 

chronic conditions who did not receive or delayed needed medical care in 

the past year due to cost, or who did not receive needed prescription drugs 

in the past year due to cost, increased over the 10-year period.

0

10

20

30

40

50

60

Did not get 

prescription drugs in 

past year due to cost

Did not get or delayed 

medical care in past

year due to cost

Did not get

prescription drugs in

past year due to cost

Did not get or delayed

medical care in past

year due to cost

1999–2000 2009–2010

45–64 65 and over

Age in years

Figure 5. Adults aged 45 and over with two or more of nine selected chronic conditions who did not get or delayed needed 

medical care due to cost in the past year or did not get needed prescription drugs due to cost in the past year, by age: 

United States, 1999–2000 and 2009–2010

1

Significantly different from 1999–2000, p < 0.05.

NOTE: Access data table for Figure 5 at: http://www.cdc.gov/nchs/data/databriefs/db100_tables.pdf#5.

SOURCE: CDC/NCHS, National Health Interview Survey. Percent

17.2

1

23.4

14.2

1

21.5

6.5 6.9 5.1 1

6.3

• In 2009–2010, 23% of adults aged 45–64 with two or more chronic conditions did not 

receive or delayed needed medical care in the past year due to cost, and 22% did not receive 

needed prescription drugs due to cost (Figure 5). 

• For adults aged 65 and over with two or more chronic conditions, there was no change in the 

percentage who did not receive or delayed needed medical care in the past year due to cost, 

while the percentage who did not receive needed prescription drugs in the past year due to 

cost increased over the 10-year period. 
NCHS Data Brief ■ No. 100 ■ July 2012

■  6  ■

Summary 

These findings demonstrate the widespread rise in the prevalence of two or more of nine 

selected chronic conditions over a 10-year period. The most common combinations of chronic 

conditions––hypertension and diabetes, hypertension and heart disease, and hypertension and 

cancer––increased during this time. Between 1999–2000 and 2009–2010, adults aged 45–64 

with two or more chronic conditions had increasing difficulty obtaining needed medical care and 

prescription drugs because of cost. 

Growth in the prevalence of MCC was driven primarily by increases in three of the nine 

individual conditions. During this 10-year period, prevalence of hypertension increased from 35% 

to 41%, diabetes from 10% to 15%, and cancer from 9% to 11%, among those aged 45 and over. 

A limitation of this report is that it includes only respondent-reported information of a physician 

diagnosis; thus, estimates may be understated because they do not include undiagnosed chronic 

conditions. 

Increases in the prevalence of MCC may be due to a rise in new cases (incidence) or longer 

duration with chronic conditions. The prevalence of obesity—a risk factor for certain types of 

heart disease and cancer, hypertension, stroke, and diabetes—increased in the United States over 

the past 30 years, but has leveled off in recent years (7–9). Advances in medical treatments and 

drugs are contributing to increased survival for persons with some chronic conditions. During 

this 10-year period, death rates for heart disease, cancer, and stroke declined (9). In recent years, 

the percentage of Americans who were aware of their hypertension, and the use of hypertension 

medications, has increased (8). 

The rising prevalence of MCC has implications for the financing and delivery of health care. 

Persons with MCC are more likely to be hospitalized, fill more prescriptions and have higher 

annual prescription drug costs, and have more physician visits (3). Out-of-pocket spending is 

higher for persons with multiple chronic conditions and has increased in recent years (5). 

Chronic disease, and combinations of chronic diseases, affects individuals to varying degrees and 

may impact an individual’s life in different ways. The increasing prevalence of MCC presents a 

complex challenge to the U.S. health care system, both in terms of quality of life and expenditures 

for an aging population. 

Definition

Multiple chronic conditions: Based on respondent’s reports to the following set of individual 

questions that were consistent over the 10-year period examined: “Have you ever been told 

by a doctor or other health professional that you had hypertension...coronary heart disease...

angina...a heart attack...any kind of heart condition or heart disease (other than the ones I just 

asked about)...diabetes...stroke...emphysema...cancer?” Respondents were also asked these 

questions about the past year: “During the past 12 months, have you had an episode of asthma, 

or were you told by a doctor or other health professional that you had chronic bronchitis or 

weak kidneys?” For hypertension, respondents had to have been told on two or more different 

visits. Adults who responded “borderline diabetes” were recoded as “no” to diabetes. Adults 

who responded in the affirmative to only “non-melanoma” skin cancer were recoded as “no” for 

cancer. The four heart disease questions were combined into one variable and considered as one 
NCHS Data Brief ■ No. 100 ■ July 2012

■  7  ■

chronic condition. Other definitions of MCC are used in the literature and differ based on analytic 

objectives and the data sources used in the analyses (2,3).

Data sources and methods

Estimates in this report are based on NHIS data, which provide information on the health status 

of the civilian noninstitutionalized population of the United States. Questions about all nine of 

the selected chronic conditions were answered by 30,682 respondents in 1999–2000 and 29,523 

respondents in 2009–2010. For more information about NHIS, including the questionnaires used, 

visit the NHIS website: http://www.cdc.gov/nchs/nhis.htm.

Differences between subgroups were evaluated using the univariate t statistic. All significance 

tests were two sided, using p < 0.05 as the level of significance. All comparisons reported in 

the text are statistically significant unless otherwise indicated. Data analyses were performed 

using SAS version 9.1 (SAS Institute, Cary, N.C.) and SUDAAN version 9.0 (RTI International, 

Research Triangle Park, N.C.).

About the authors

Virginia M. Freid, Amy B. Bernstein, and Mary Ann Bush are with the Centers for Disease 

Control and Prevention’s National Center for Health Statistics, Office of Analysis and 

Epidemiology.

References

1. Benjamin RM. Multiple chronic conditions: A public health challenge. Public Health Rep 

125(5):626–7. 2010. 

2. Department of Health and Human Services. HHS initiative on multiple chronic conditions. 

Available from: http://www.hhs.gov/ash/initiatives/mcc/.

3. Anderson G. Chronic care: Making the case for ongoing care. Princeton, NJ: Robert Wood 

Johnson Foundation. 2010. Available from: http://www.rwjf.org/files/research/50968chronic.care.

chartbook.pdf. 

4. Wolff JL, Starfield B, Anderson G. Prevalence, expenditures, and complications of multiple 

chronic conditions in the elderly. Arch Intern Med 162(20):2269–76. 2002.

5. Paez KA, Zhao L, Hwang W. Rising out-of-pocket spending for chronic conditions: A tenyear trend. Health Aff 28(1):15–25. 2009.

6. Vogeli C, Shields AE, Lee TA, Gibson TB, Marder WD, Weiss KB, Blumenthal D. 

Multiple chronic conditions: Prevalence, health consequences, and implications for quality, care 

management, and costs. J Gen Intern Med 22(Suppl 3):391–5. 2007.

7. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US 

adults, 1999–2008. JAMA 303(3):235–41. 2010.
NCHS Data Brief ■ No. 100 ■ July 2012

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8. Yoon S, Ostchega Y, Louis T. Recent trends in the prevalence of high 

blood pressure and its treatment and control, 1999–2008. NCHS data brief, 

no 48. Hyattsville, MD: National Center for Health Statistics. 2010. Available 

from: http://www.cdc.gov/nchs/data/databriefs/db48.htm.

9. National Center for Health Statistics. Health, United States, 2011: With 

special feature on socioeconomic status and health. Hyattsville, MD. 2012. 

Available from: http://www.cdc.gov/nchs/hus.htm.

Suggested citation

Freid VM, Bernstein AB, Bush MA. 

Multiple chronic conditions among adults 

aged 45 and over: Trends over the past 10 

years. NCHS data brief, no 100. Hyattsville, 

MD: National Center for Health Statistics. 

2012.

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the public domain and may be reproduced 

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source, however, is appreciated.

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Statistics

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Jennifer H. Madans, Ph.D., Associate 

Director for Science

Office of Analysis and Epidemiology

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