Economic and Humanistic Burden of Multimorbidity in the United States: A Longitudinal Study of Expenditure and Quality of Life Trajectories, 2019–2022

Highlights: Public health relevance—How does this work relate to a public health issue? Multimorbidity is an increasing public health challenge associated with rising health care utilization and declining quality of life. This longitudinal study leverages nationally representative data (2019–2022) to determine how specific combinations of discordant diseases (e.g., cancer co-occurring with respiratory disease) drive divergent trajectories in healthcare expenditures and quality of life. Public health significance—Why is this work of significance to public health? This study provides longitudinal evidence of persistent disparities in healthcare expenditures and quality of life among multimorbid individuals. Findings identify population groups experiencing disproportionately high costs and poorer health-related quality of life. Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health? Health systems and payers should adopt cluster-based risk segmentation to target high-volatility profiles (such as the cancer + respiratory cluster) for proactive case management and admission prevention. Findings support the need for integrated, patient-centered approaches to managing chronic disease in adults. This study examines the economic and humanistic burden associated with multimorbidity among adults in the United States. Using data from the 2019–2022 Medical Expenditure Panel Survey (MEPS), we identified individuals with two or more chronic conditions and assessed trends in healthcare expenditures, out-of-pocket costs, inpatient stays, and health-related quality of life (HRQL). Weighted analyses were conducted to estimate national patterns and annual changes across survey years. Outcomes were analyzed using generalized estimating equation (GEE) models with AR(1) working correlation to compare adjusted mean total and out-of-pocket expenditures, inpatient utilization, and mental and physical HRQL across multimorbidity profiles while controlling for sociodemographic and health factors. Findings showed that multimorbidity was associated with substantial economic burden, reflected in higher healthcare costs and out-of-pocket spending over time. HRQL consistently declined throughout the study years, highlighting the growing humanistic toll of chronic disease clustering. These findings provide longitudinal evidence of persistent disparities associated with multimorbidity and may inform future research and health system planning strategies. The results provide timely evidence for health policymakers and practitioners seeking to improve health system efficiency and equity in managing multimorbidity.