{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T12:15:24Z","timestamp":1784722524177,"version":"3.55.0"},"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2023,5,18]],"date-time":"2023-05-18T00:00:00Z","timestamp":1684368000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100008130","name":"Pusan National University Hospital","doi-asserted-by":"publisher","award":["2019B030"],"award-info":[{"award-number":["2019B030"]}],"id":[{"id":"10.13039\/501100008130","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\nBackground<\/jats:title>\nThe prevalence of multiple chronic conditions (MCC), defined as several coexisting chronic conditions, has increased with the aging of society. MCC is associated with poor outcomes, but most comorbid diseases in asthma patients have been evaluated as asthma-associated diseases. We investigated the morbidity of coexisting chronic diseases in asthma patients and their medical burdens.<\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\nWe analyzed data from the National Health Insurance Service-National Sample Cohort for 2002\u20132013. We defined MCC with asthma as a group of one or more chronic diseases in addition to asthma. We analyzed 20 chronic conditions, including asthma. Age was categorized into groups 1\u20135 (< 10, 10\u201329, 30\u201344, 45\u201364, and \u2265 65 years, respectively). The frequency of medical system use and associated costs were analyzed to determine the asthma-related medical burden in patients with MCC.<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nThe prevalence of asthma was 13.01%, and the prevalence of MCC in asthmatic patients was 36.55%. The prevalence of MCC with asthma was higher in females than males and increased with age. The significant comorbidities were hypertension, dyslipidemia, arthritis, and diabetes. Dyslipidemia, arthritis, depression, and osteoporosis were more common in females than males. Hypertension, diabetes, COPD, coronary artery disease, cancer, and hepatitis were more prevalent in males than females. According to age, the most prevalent chronic condition in groups 1 and 2 was depression, dyslipidemia in group 3, and hypertension in groups 4 and 5. Older age, low income, and severe disability were independent risk factors for MCC in patients with asthma. The frequency of asthma-related medical system use and asthma-associated costs increased with increasing numbers of coexisting chronic diseases.<\/jats:p>\n<\/jats:sec>\n\nConclusion<\/jats:title>\nComorbid chronic diseases in asthma patients differed according to age and sex. The asthma-related-medical burdens were highest in patients with five or more chronic conditions and groups 1 and 5.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0286004","type":"journal-article","created":{"date-parts":[[2023,5,18]],"date-time":"2023-05-18T17:44:19Z","timestamp":1684431859000},"page":"e0286004","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":17,"title":["The prevalence of multiple chronic conditions and medical burden in asthma patients"],"prefix":"10.1371","volume":"18","author":[{"given":"Eun-Jung","family":"Jo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young Uk","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahreum","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hye-Kyung","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2662-831X","authenticated-orcid":true,"given":"Changhoon","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,5,18]]},"reference":[{"issue":"9","key":"pone.0286004.ref001","doi-asserted-by":"crossref","first-page":"1844","DOI":"10.3390\/ijerph15091844","article-title":"The effect of usual source of care on the association of annual healthcare expenditure with patients\u2019 age and chronic disease duration","volume":"15","author":"S Moon","year":"2018","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0286004.ref002","doi-asserted-by":"crossref","first-page":"E66","DOI":"10.5888\/pcd10.120239","article-title":"Defining and measuring chronic conditions: imperatives for research, policy, program, and practice","volume":"10","author":"RA Goodman","year":"2013","journal-title":"Prev Chronic Dis"},{"issue":"2","key":"pone.0286004.ref003","doi-asserted-by":"crossref","first-page":"65","DOI":"10.3109\/13814789609162146","article-title":"Comorbidity or multimorbidity: what\u2019s in a name? A review of literature","volume":"2","author":"M van den Akker","year":"1996","journal-title":"Eur J Gen Pract"},{"issue":"2","key":"pone.0286004.ref004","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1370\/afm.1337","article-title":"A systematic review of prevalence studies on multimorbidity: toward a more uniform methodology","volume":"10","author":"M Fortin","year":"2012","journal-title":"Ann Fam Med"},{"issue":"Suppl 1","key":"pone.0286004.ref005","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1080\/13814780802436093","article-title":"Multimorbidity in primary care: prevalence and trend over the last 20 years","volume":"14","author":"AA Uijen","year":"2008","journal-title":"Eur J Gen Pract"},{"issue":"1","key":"pone.0286004.ref006","doi-asserted-by":"crossref","first-page":"e023919","DOI":"10.1136\/bmjopen-2018-023919","article-title":"Predicting poorer health outcomes in older community-dwelling patients with multimorbidity: prospective cohort study assessing the accuracy of different multimorbidity definitions","volume":"9","author":"M Sasseville","year":"2019","journal-title":"BMJ open"},{"issue":"26","key":"pone.0286004.ref007","doi-asserted-by":"crossref","first-page":"2635","DOI":"10.1056\/NEJMsa022615","article-title":"The quality of health care delivered to adults in the United States","volume":"348","author":"EA McGlynn","year":"2003","journal-title":"N Engl J Med"},{"issue":"3","key":"pone.0286004.ref008","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1007\/s11606-007-0322-1","article-title":"Multiple chronic conditions: prevalence, health consequences, and implications for quality, care management, and costs","volume":"22","author":"C Vogeli","year":"2007","journal-title":"J Gen Intern Med"},{"key":"pone.0286004.ref009","unstructured":"Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. Fontana, Global Initiative for Asthma, 2022."},{"issue":"2","key":"pone.0286004.ref010","doi-asserted-by":"crossref","first-page":"101","DOI":"10.5415\/apallergy.2012.2.2.101","article-title":"Asthma in the elderly","volume":"2","author":"A Gillman","year":"2012","journal-title":"Asia Pac Allergy"},{"issue":"1","key":"pone.0286004.ref011","first-page":"1","article-title":"Asthma in the elderly: what we know and what we have yet to know","volume":"7","author":"A Y\u00e1\u00f1ez","year":"2014","journal-title":"World Allergy Organ J"},{"issue":"4","key":"pone.0286004.ref012","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1111\/j.1398-9995.2012.02786.x","article-title":"Development and comorbidity of eczema, asthma and rhinitis to age 12\u2013data from the BAMSE birth cohort","volume":"67","author":"N Ballardini","year":"2012","journal-title":"Allergy"},{"issue":"4","key":"pone.0286004.ref013","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1183\/09031936.00121308","article-title":"Influence of comorbid conditions on asthma","volume":"33","author":"L. Boulet","year":"2009","journal-title":"Eur Respir J"},{"issue":"7","key":"pone.0286004.ref014","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1136\/thx.2009.131078","article-title":"Burden of comorbidity in individuals with asthma","volume":"65","author":"AS Gershon","year":"2010","journal-title":"Thorax"},{"issue":"5","key":"pone.0286004.ref015","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1053\/rmed.2002.1463","article-title":"The influence of co-morbidity on health-related quality of life in asthma and COPD patients","volume":"97","author":"H Wijnhoven","year":"2003","journal-title":"Respir Med"},{"issue":"5","key":"pone.0286004.ref016","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1513\/AnnalsATS.201302-032OC","article-title":"An examination of adverse asthma outcomes in US Adults with multiple morbidities","volume":"10","author":"MR Patel","year":"2013","journal-title":"Ann Am Thorac Soc"},{"issue":"1","key":"pone.0286004.ref017","doi-asserted-by":"crossref","first-page":"22","DOI":"10.4104\/pcrj.2013.00107","article-title":"Chronic disease co-morbidity of asthma and unscheduled asthma care among adults: results of the national telephone health interview survey German Health Update (GEDA) 2009 and 2010","volume":"23","author":"H Steppuhn","year":"2014","journal-title":"Prim Care Respir J"},{"issue":"2","key":"pone.0286004.ref018","first-page":"e15","article-title":"Cohort profile: the national health insurance service\u2013national sample cohort (NHIS-NSC), South Korea","volume":"46","author":"J Lee","year":"2017","journal-title":"Int J Epidemiol"},{"key":"pone.0286004.ref019","unstructured":"The National Bureau of Economic Research. Centers for Medicare & Medicaid Services\u2019 ICD-9-CM to and from ICD-10-CM and ICD-10-PCS Crosswalk or General Equivalence Mappings. https:\/\/www.nber.org\/research\/data\/icd-9-cm-and-icd-10-cm-and-icd-10-pcs-crosswalk-or-general-equivalence-mappings. Accessed July 7 2022."},{"issue":"10","key":"pone.0286004.ref020","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.3109\/02770900903350473","article-title":"The added burden of comorbidity in patients with asthma","volume":"46","author":"T Zhang","year":"2009","journal-title":"J Asthma"},{"issue":"1","key":"pone.0286004.ref021","first-page":"49","article-title":"Characteristics of comorbidity in adult asthma","volume":"29","author":"L. Ben-Noun","year":"2001","journal-title":"Public Health Rev"},{"issue":"3","key":"pone.0286004.ref022","doi-asserted-by":"crossref","first-page":"306","DOI":"10.3109\/02770903.2013.879881","article-title":"Coexisting chronic conditions associated with mortality and morbidity in adult patients with asthma","volume":"51","author":"K Sumino","year":"2014","journal-title":"J Asthma"},{"issue":"2","key":"pone.0286004.ref023","doi-asserted-by":"crossref","first-page":"46","DOI":"10.24095\/hpcdp.30.2.03","article-title":"The comorbidity burden of the treated asthma patient population in British Columbia","volume":"30","author":"R Prosser","year":"2010","journal-title":"Chronic Dis Can"},{"issue":"3","key":"pone.0286004.ref024","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/j.genhosppsych.2007.02.003","article-title":"Impact of anxiety and depression on functional impairment in adolescents with asthma","volume":"29","author":"E McCauley","year":"2007","journal-title":"Gen Hosp Psychiatry"},{"issue":"3","key":"pone.0286004.ref025","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1542\/peds.2006-0249","article-title":"Asthma symptom burden: relationship to asthma severity and anxiety and depression symptoms","volume":"118","author":"LP Richardson","year":"2006","journal-title":"Pediatrics"},{"issue":"4","key":"pone.0286004.ref026","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1378\/chest.130.4.1034","article-title":"Depressive symptoms and adherence to asthma therapy after hospital discharge","volume":"130","author":"A Smith","year":"2006","journal-title":"Chest"},{"issue":"5","key":"pone.0286004.ref027","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1016\/S1081-1206(10)61135-0","article-title":"Impact of depressive symptoms on adult asthma outcomes","volume":"94","author":"MD Eisner","year":"2005","journal-title":"Ann Allergy Asthma Immunol"},{"issue":"2","key":"pone.0286004.ref028","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1046\/j.1360-0443.2000.95225112.x","article-title":"Gender differences in alcohol consumption and adverse drinking consequences: cross-cultural patterns","volume":"95","author":"RW Wilsnack","year":"2000","journal-title":"Addiction"},{"issue":"9","key":"pone.0286004.ref029","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1016\/0277-9536(91)90157-8","article-title":"Patterns and causes of gender differences in smoking","volume":"32","author":"I Waldron","year":"1991","journal-title":"Soc Sci Med"},{"issue":"6","key":"pone.0286004.ref030","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1093\/geronb\/gbr106","article-title":"How does the trajectory of multimorbidity vary across Black, White, and Mexican Americans in middle and old age?","volume":"66","author":"AR Qui\u00f1ones","year":"2011","journal-title":"J Gerontol B Psychol Sci Soc Sci"},{"issue":"1","key":"pone.0286004.ref031","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12916-017-0913-6","article-title":"The contribution of risk factors to socioeconomic inequalities in multimorbidity across the lifecourse: a longitudinal analysis of the Twenty-07 cohort","volume":"15","author":"SV Katikireddi","year":"2017","journal-title":"BMC Med"},{"issue":"6","key":"pone.0286004.ref032","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1016\/j.sapharm.2018.09.006","article-title":"Medication adherence and barriers among low-income, uninsured patients with multiple chronic conditions","volume":"15","author":"CI Fernandez-Lazaro","year":"2019","journal-title":"Res Social Adm Pharm"},{"issue":"5","key":"pone.0286004.ref033","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1586\/14737167.2015.1091730","article-title":"Multiple chronic conditions and healthcare costs among adults","volume":"15","author":"U Sambamoorthi","year":"2015","journal-title":"Expert Rev Pharmacoecon Outcomes Res"},{"issue":"2","key":"pone.0286004.ref034","doi-asserted-by":"crossref","first-page":"163","DOI":"10.3109\/15412555.2013.831061","article-title":"Medical utilization and cost in patients with overlap syndrome of chronic obstructive pulmonary disease and asthma","volume":"11","author":"CK Rhee","year":"2014","journal-title":"COPD"},{"issue":"1","key":"pone.0286004.ref035","first-page":"1","article-title":"Differences in the risk of mood disorders in patients with asthma-COPD overlap and in patients with COPD alone: a nationwide population-based retrospective cohort study in Korea","volume":"20","author":"HR Kang","year":"2019","journal-title":"Respir Res"},{"key":"pone.0286004.ref036","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/j.jpsychires.2020.07.047","article-title":"Illuminating the treatment gap of mental disorders: a comparison of community survey-based and national registry-based 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