Treatment burden across multimorbidity combinations among middle-aged and older adults in the U.S.
5 affiliations
- 1Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
- 2Portland State University (PSU) Joint School of Public Health, Oregon Health & Science University (OHSU), Portland, OR, USA
- 3Department of Health and Human Services, University of Michigan at Dearborn, Dearborn, MI, USA
- 4CRESS, INSERM, INRAE, Université Paris Cité, Paris, France
- 5Department of Family Medicine, OHSU, Portland, OR, USA
Abstract
Background: The workload of accessing and using healthcare can be substantial for middle-aged and older adults with multimorbidity (≥2 chronic conditions) and may reduce quality of life. However, how treatment burden varies across clinically meaningful multimorbidity combinations in U.S. adults remains poorly understood.
Methods: We conducted a cross-sectional analysis of the 2022 Health and Retirement Study Treatment Burden Questionnaire (TBQ) module in a nationally representative sample of U.S. adults aged ≥51 years (N=1,551). Treatment burden was assessed using the 15-item TBQ (range 0–150), with scores ≥59 indicating unsustainable burden. Multimorbidity was characterized using nine chronic condition categories and mutually exclusive, a priori, literature-informed combinations: cardiovascular, metabolic, cardiometabolic, and other multimorbidity. Survey-weighted analyses estimated burden and unsustainable burden prevalence, and logistic regression examined associations between multimorbidity patterns and unsustainable burden.
Results: Mean treatment burden was modest (TBQ 21; 95% CI, 19–23) but varied across multimorbidity combinations. Cardiometabolic multimorbidity had the highest mean burden (27; 95% CI, 23–30). Among respondents with unsustainable treatment burden, the largest proportions had cardiometabolic multimorbidity (44%) or cardiovascular multimorbidity (34%). In adjusted analyses, cardiometabolic multimorbidity was associated with higher odds of unsustainable burden compared with no multimorbidity (OR 4.9; 95% CI, 1.9–12.7). The most burdensome items were administrative complexity, financial strain, lifestyle demands, and ongoing care reminders.
Conclusions: Treatment burden varied across multimorbidity combinations, with cardiometabolic multimorbidity associated with the highest mean burden and greater odds of unsustainable burden. These combinations may complement condition counts but, because they were derived from a limited set of chronic conditions, should be interpreted alongside patient capacity, resources, and social context.
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BibTeX
@article{zahidy2026treatment,
title = {{Treatment burden across multimorbidity combinations among middle-aged and older adults in the U.S.}},
author = {Misk Al Zahidy and Sheila Markwardt and Anda Botoseneanu and Viet-Thi Tran and Victor M. Montori and Ana R. Quiñones},
journal = {Journal of Multimorbidity and Comorbidity},
year = {2026},
month = sep,
doi = {10.1177/26335565261490113},
url = {https://doi.org/10.1177/26335565261490113},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Treatment burden across multimorbidity combinations among middle-aged and older adults in the U.S.
AU - Misk Al Zahidy
AU - Sheila Markwardt
AU - Anda Botoseneanu
AU - Viet-Thi Tran
AU - Victor M. Montori
AU - Ana R. Quiñones
PY - 2026
DA - 2026/09/15
JO - Journal of Multimorbidity and Comorbidity
DO - 10.1177/26335565261490113
UR - https://doi.org/10.1177/26335565261490113
AB - Background: The workload of accessing and using healthcare can be substantial for middle-aged and older adults with multimorbidity (≥2 chronic conditions) and may reduce quality of life. However, how treatment burden varies across clinically meaningful multimorbidity combinations in U.S. adults remains poorly understood. Methods: We conducted a cross-sectional analysis of the 2022 Health and Retirement Study Treatment Burden Questionnaire (TBQ) module in a nationally representative sample of U.S. adults aged ≥51 years (N=1,551). Treatment burden was assessed using the 15-item TBQ (range 0–150), with scores ≥59 indicating unsustainable burden. Multimorbidity was characterized using nine chronic condition categories and mutually exclusive, a priori, literature-informed combinations: cardiovascular, metabolic, cardiometabolic, and other multimorbidity. Survey-weighted analyses estimated burden and unsustainable burden prevalence, and logistic regression examined associations between multimorbidity patterns and unsustainable burden. Results: Mean treatment burden was modest (TBQ 21; 95% CI, 19–23) but varied across multimorbidity combinations. Cardiometabolic multimorbidity had the highest mean burden (27; 95% CI, 23–30). Among respondents with unsustainable treatment burden, the largest proportions had cardiometabolic multimorbidity (44%) or cardiovascular multimorbidity (34%). In adjusted analyses, cardiometabolic multimorbidity was associated with higher odds of unsustainable burden compared with no multimorbidity (OR 4.9; 95% CI, 1.9–12.7). The most burdensome items were administrative complexity, financial strain, lifestyle demands, and ongoing care reminders. Conclusions: Treatment burden varied across multimorbidity combinations, with cardiometabolic multimorbidity associated with the highest mean burden and greater odds of unsustainable burden. These combinations may complement condition counts but, because they were derived from a limited set of chronic conditions, should be interpreted alongside patient capacity, resources, and social context.
SN - 2633-5565
ER -