• Mary Jo V Pugh, Erin P Finley, Laurel A Copeland, Chen-Pin Wang, Polly H Noel, Megan E Amuan, Helen M Parsons, Margaret Wells, Barbara Elizondo, and Jacqueline A Pugh.
• *South Texas Veterans Health Care System †Department of Epidemiology and Biostatistics, University of Texas Health Science Center San Antonio, San Antonio ‡Texas A&M Health Science Center, Bryan §Department of Medicine, Division of Clinical Epidemiology, University of Texas Health Science Center San Antonio, San Antonio ∥Center for Applied Health Research, jointly sponsored by Central Texas Veterans Health Care System, and Scott and White Healthcare System, Temple, TX ¶Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA #Department of Medicine, Division of Hospital Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX.
• Med Care. 2014 Feb 1;52(2):172-81.

BackgroundA growing body of research on US Veterans from Afghanistan and Iraq [Operations Enduring and Iraqi Freedom, and Operation New Dawn (OEF/OIF)] has described the polytrauma clinical triad (PCT): traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and pain. Extant research has not explored comorbidity clusters in this population more broadly, particularly co-occurring chronic diseases.ObjectivesThe aim of the study was to identify comorbidity clusters among diagnoses of deployment-specific (TBI, PTSD, pain) and chronic (eg, hypertension, diabetes) conditions, and to examine the association of these clusters with health care utilization and adverse outcomes.Research DesignThis was a retrospective cohort study.SubjectsThe cohort comprised OEF/OIF Veterans who received care in the Veterans Health Administration in fiscal years (FY) 2008-2010.MeasuresWe identified comorbidity using validated ICD-9-CM code-based algorithms and FY08-09 data, followed by which we applied latent class analysis to identify the most statistically distinct and clinically meaningful patterns of comorbidity. We examined the association of these clusters with process measures/outcomes using logistic regression to correlate medication use, acute health care utilization, and adverse outcomes in FY10.ResultsIn this cohort (N=191,797), we found 6 comorbidity clusters. Cluster 1: PCT+Chronic Disease (5%); Cluster 2: PCT (9%); Cluster 3: Mental Health+Substance Abuse (24%); Cluster 4: Sleep, Amputation, Chronic Disease (4%); Cluster 5: Pain, Moderate PTSD (6%); and Cluster 6: Relatively Healthy (53%). Subsequent health care utilization patterns and adverse events were consistent with disease patterns.ConclusionsThese comorbidity clusters extend beyond the PCT and may be used as a foundation to examine coordination/quality of care and outcomes for OEF/OIF Veterans with different patterns of comorbidity.

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