title: Clusters of Multiple Complex Chronic Conditions: A Latent Class Analysis of Children at End of Life.
abstract: Children at end of life often experience multiple complex chronic conditions with more than 50% of children reportedly having two or more conditions. These complex chronic conditions are unlikely to occur in an entirely uniform manner in children at end of life. Previous work has not fully accounted for patterns of multiple conditions when evaluating care among these children.
  
  
  
  The objective of the study was to understand the clusters of complex chronic conditions present among children in the last year of life.
  
  
  
  Participants were 1423 pediatric decedents from the 2007 to 2008 California Medicaid data. A latent class analysis was used to identify clusters of children with multiple complex chronic conditions (neurological, cardiovascular, respiratory, renal, gastrointestinal, hematologic, metabolic, congenital, cancer). Multinomial logistic regression analysis was used to examine the relationship between demographic characteristics and class membership.
  
  
  
  Four latent classes were yielded: medically fragile (31%); neurological (32%); cancer (25%); and cardiovascular (12%). Three classes were characterized by a 100% likelihood of having a complex chronic condition coupled with a low or moderate likelihood of having the other eight conditions. The four classes exhibited unique demographic profiles.
  
  
  
  This analysis presented a novel way of understanding patterns of multiple complex chronic conditions among children that may inform tailored and targeted end-of-life care for different clusters.
authors.affiliation: College of Nursing, University of Tennessee-Knoxville, Knoxville, Tennessee, USA. Electronic address: llindley@utk.edu.
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Lindley
authors.affiliation: Department of Pediatric Oncology and the Division of Population Sciences' Center for Outcomes and Policy Research Harvard Medical School, Boston, Massachusetts, USA; Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Division of Pediatric Hematology/Oncology, Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Jennifer W
authors.initials: JW
authors.lastname: Mack
authors.affiliation: Center for Business & Economic Research, University of Tennessee, Knoxville, Tennessee, USA; Department of Economics, University of Tennessee, Knoxville, Tennessee, USA.
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Bruce
mesh_terms: D000293:Adolescent; D002140:California; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016013:Likelihood Functions; D008297:Male; D008484:Medicaid; D000071069:Multiple Chronic Conditions / Q000401:mortality*; D013727:Terminal Care; D014481:United States; D055815:Young Adult
keywords: Complex chronic conditions; children; end of life; latent class analysis; pediatric