title: Hypertension, diabetes, hypercholesterolemia, and their combinations increased health care utilization and decreased health status.
abstract: OBJECTIVE
  For individuals with hypertension, diabetes, or hypercholesterolemia, the relative magnitude of cardiovascular risk factors and the effect of multiple risk factors remains controversial and both treatment practices and health care usage vary. We sought to determine the effect of hypertension, diabetes, hypercholesterolemia, and their combinations on health care utilization and health status through analysis of data from a large national survey.
  
  
  METHODS
  We applied the Anderson model to a cross-sectional representative sample (n=15,107) of the U.S. civilian, noninstitutionalized population (the 1996 Medical Expenditure Panel Survey).
  
  
  RESULTS
  For diabetes, additional risk factors did not increase the likelihood of emergency room (ER) visits or hospitalizations but were associated with increased outpatient visits and poorer health status. For hypertension, additional risk factors increased the likelihood of hospitalization (but not ER visits), the number of outpatient visits, and poorer health status. For hypercholesterolemia, additional risk factors were associated with increased likelihood of ER visits, hospitalizations, and poorer health status but not more outpatient visits. Diabetes had the largest effect on health care utilization and health status.
  
  
  CONCLUSIONS
  These findings re-emphasize the magnitude of diabetes as a major risk factor associated with increased ER visits, hospitalizations, outpatients visits, and lower health status.
authors.affiliation: Center for Health Care Research, Division of General Internal Medicine, Medical University of South Carolina, 135 Cannon Street, Suite 403, P.O. Box 250837, Charleston, SC 29425-0837, USA. nataraja@musc.edu
authors.forename: Sundar
authors.initials: S
authors.lastname: Natarajan
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Nietert
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006304:Health Status; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D006973:Hypertension / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology