Disease Chronicity and Mortality in Young Military-Connected Children With Medical Complexity

OBJECTIVE Although health conditions experienced by children with medical complexity (CMC) are often conceptualized as chronic or lifelong, rapid development during early childhood can result in changing health status. This is particularly relevant for military-connected children, who may experience challenges with health care access and coordination. This study assessed mortality and the duration of observable CMC-qualifying diagnoses among young military-connected CMC and identified factors associated with these outcomes. METHODS This retrospective, longitudinal cohort study analyzed 2005–2020 TRICARE data. Children diagnosed with at least 1 CMC-qualifying condition by 36 months were stratified into 3 mutually exclusive groups: CMC who died within 12 months of diagnosis, children with CMC-qualifying conditions observed 12 months or more after diagnosis, and children with CMC-qualifying conditions observed less than 12 months after diagnosis. Poisson regression was used to identify factors associated with these outcomes. RESULTS Among 73 602 CMC, 43 261 (58.8%) were male, 19 279 (26.1%) were born preterm, and 20 546 (27.9%) had progressive conditions. CMC experienced a mean of 61.5 (SD, 81.7) days with clinical encounters in the 2 years following diagnosis. During this period, 3093 (4.2%) died within 12 months of diagnosis, 40 664 (55.2%) had CMC-qualifying conditions observed for at least 12 months, and 29 845 (40.5%) had CMC-qualifying conditions observed less than 12 months. Preterm birth, chronic conditions affecting 3 or more body systems, and technology dependence were associated with both mortality and CMC-qualifying diagnoses observed after 12 months or more. CONCLUSIONS Among young military-connected CMC, mortality was high. Among survivors, more than 40% did not have any CMC-qualifying conditions observed 12 months or more after diagnosis, indicating the dynamic nature of these conditions or limited documentation in clinical encounters.