title: Geographic and racial/ethnic variations in patterns of multimorbidity burden in patients with type 2 diabetes.
abstract: BACKGROUND
  Multimorbidity presents a significant public health challenge, but regional, rural/urban, and racial/ethnic differences in patterns of multimorbidity in diabetes are poorly understood.
  
  
  OBJECTIVE
  To describe patterns of multimorbidity in medical and mental health by regional, rural/urban, and racial/ethnic variation in patients with type 2 diabetes mellitus.
  
  
  METHODS
  Retrospective cohort study from 2002 through 2006 PARTICIPANTS: A national cohort of 892,223 veterans with diabetes
  
  
  METHODS
  Multimorbidity was the main outcome defined as: the measure of multimorbidity and two categorical outcomes, with pattern of medical and mental health comorbidities combined and separately.
  
  
  RESULTS
  Among patients, 52% had 2+ comorbidities, 33% had a single comorbidity, and 14% had no comorbidity; 13.9% had both medical and mental health comorbidities, 70.3% had medical only, and 1.5% had mental health only. The odds of having 3+ comorbidities were nearly fourfold greater in patients 75 years and older relative to patients younger than 50 years (OR=3.95 [95% CI: 3.84, 4.06]). Compared to non-Hispanic whites, the odds of 3+ comorbidities among non-Hispanic blacks were 1.67 times greater (95% CI: 1.63, 1.71). Hispanics were more likely to have a mental health comorbidity alone (OR=1.20 [95% CI: 1.13, 1.28]) than non-Hispanic whites. For patients living in rural areas, the odds were higher of having 3+ comorbidities (OR=1.21 [95% CI: 1.19, 1.23]) and of having both medical and mental health comorbidities (OR=1.15 [95% CI: 1.13, 1.17]) compared to urban dwellers.
  
  
  CONCLUSIONS
  Among individuals with diabetes, traditionally disadvantaged groups, including non-Hispanic blacks and rural patients, appear to bear the greatest burden and risk of multimorbidity. Significantly greater odds with increasing number of comorbidities were seen by race/ethnicity, rural residence, and geographic region.
authors.affiliation: Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC, USA.
authors.forename: Cheryl P
authors.initials: CP
authors.lastname: Lynch
authors.forename: Mulugeta
authors.initials: M
authors.lastname: Gebregziabher
authors.forename: R Neal
authors.initials: RN
authors.lastname: Axon
authors.forename: Kelly E
authors.initials: KE
authors.lastname: Hunt
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Payne
authors.forename: Leonard E
authors.initials: LE
authors.lastname: Egede
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012423:Rural Health / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014504:Urban Health / Q000706:statistics & numerical data; D014728:Veterans / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data