title: Comparing the population health impacts of medical conditions using routinely collected health care utilization data: nature and sources of variability.
abstract: Prevention activities are designed and resourced based on perceptions of the relative population health impacts of various conditions. We examined the nature and variability of rankings of "conditions" based on how they are defined and how their population health impacts are measured. The first listed diagnosis from all hospitalizations and ambulatory visits of U.S. service members during 2002 was used to rank conditions (as defined by two standard classification systems) using five different measures of population health impacts. Less than 10% of all conditions accounted for more than one-half of total population health impact, regardless of how conditions were defined or impacts measured. However, specific conditions with the largest impacts varied depending on the classification system and impact measure. Four groups of related conditions--acute musculoskeletal injuries, pregnancy-related conditions, respiratory infections, and mental disorders (including substance abuse)--accounted for disproportionately large impacts regardless of the measure. The identification of conditions with the largest population health impacts depends on the nature and degree of aggregation in defining conditions and the measure of impact. The findings are relevant to prevention planning and resourcing.
authors.affiliation: Army Medical Surveillance Activity, Epidemiology and Disease Surveillance Directorate, U.S. Army Center for Health Promotion and Preventive Medicine, Washington, DC 20307, USA.
authors.forename: John F
authors.initials: JF
authors.lastname: Brundage
authors.forename: Karen E
authors.initials: KE
authors.lastname: Johnson
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Lange
authors.forename: Mark V
authors.initials: MV
authors.lastname: Rubertone
mesh_terms: D000208:Acute Disease; D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D002908:Chronic Disease; D005260:Female; D006306:Health Surveys; D006772:Hospitals, Military / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008887:Military Medicine / Q000706:statistics & numerical data*; D008889:Military Personnel / Q000706:statistics & numerical data*; D018482:Muscle, Skeletal / Q000293:injuries; D011159:Population Surveillance; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D012141:Respiratory Tract Infections / Q000453:epidemiology; D014481:United States / Q000453:epidemiology