Patients' body mass index and blood pressure over time: diagnoses, treatments, and the effects of comorbidities

Med Care. 2014 Mar:52 Suppl 3:S110-7. doi: 10.1097/MLR.0000000000000023.

Abstract

Background: A national strategic framework to address multiple chronic conditions has called for further research on disease trajectories of patients with comorbidities.

Methods: An observational study using multilevel models to analyze electronic health record data from a multispecialty practice from 2003 to 2010 to examine disease trajectories of patients with at least 2 of 3 common chronic conditions: overweight/obese, hypertension, and depression. Using longitudinal data on up to 110,000 patients, the effects of comorbidities on the probability of having a diagnosis for overweight/obesity or hypertension and on the trajectories of body mass index (BMI) and blood pressure (BP) over time were examined.

Results: From 2003 to 2010, the percentage of patients with high BMI receiving an overweight/obesity diagnosis grew from 5.0% to 18.7%, and the percentage of patients with high BP having a hypertension diagnosis rose from 39.9% to 51.7%. The effect of time for patients with high BMI and depression was less than the effect of time for high BMI only patients (P<0.01) in receiving overweight/obesity diagnoses. Co-occurring depression and high BMI was positively associated with BMI trajectory (coefficient=0.06, P<0.01), whereas high BP and high BMI (coefficient=-0.07, P<0.01) or high BP and high BMI and depression (coefficient=-0.05, P<0.01) were negatively associated with BMI trajectories.

Conclusions: Although physicians' recording of diagnoses for patients with high BMI and high BP has improved, significant gaps remain. Some co-occurrence patterns of these 3 conditions not only affected the recognition of overweight/obesity and hypertension over time, but also BMI trajectories over time. Quality improvement efforts should target patients with co-occurring depression and overweight/obesity.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Body Mass Index*
  • Causality
  • Comorbidity
  • Depression / diagnosis*
  • Depression / epidemiology*
  • Epidemiologic Research Design
  • Female
  • Health Status
  • Humans
  • Hypertension / diagnosis*
  • Hypertension / epidemiology*
  • Hypertension / therapy
  • Male
  • Middle Aged
  • Obesity / diagnosis*
  • Obesity / epidemiology*
  • Obesity / therapy
  • Prevalence
  • Risk Factors
  • United States / epidemiology