Chronic Disease  /  Human Burden

While medical innovations and public health gains in the past century have been measurable in leaps and bounds, significant progress against acute disease has revealed an equally enormous challenge—chronic disease on an unprecedented scale. Close to half of Americans have chronic conditions and 1 in 4 have more than one. They cause 7 out of every 10 deaths and cost our country 75 cents of every health care dollar. With chronic disease prevalence growing at a faster rate than the population as a whole, the forecast is daunting.

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    • Caregivers cut back on own preventive health
      One in 4 family caregivers cut back on spending for their own preventive health or dental care when caring for a loved one.  
    • Impact of family caregiving on individual health
      Family caregivers commonly experience poor health and are at increased risk for heart disease, poor immune function, fatigue, depression, and more.  
    • More than 60 million new family caregivers each year
      Every year, 61.6 million family caregivers take on the roll of unpaid caregiver to a family member or loved one.  
    • Chronic diseases limit activities of daily living
      One in 4 Americans living with a chronic illness are limited in their activities of daily living.  
    • In 2011, the leading causes of death in the U.S. were chronic diseases: heart disease, cancer, chronic lower respiratory diseases, and stroke (cerebrovascular diseases).  
    • Among those aged 65-74, 13% of men and 22% of women reported an inability to perform at least one of five activites, compared to those 85 and over, of which,…  
    • In 2007, 42% of people over 65 reported a functional limitation, while 14% had trouble performing one or more instrumental activity of daily living but had no limitations on regular…  
    • Death rates for selected leading causes of death among people age 65 and over, 1981-2006  
    • Percentage of noninstitutionalized Medicare enrollees age 65 and over who have limitations in instrumental activities of daily living (IADLs) and who receive personal assistance, by age group, selected years 1992-2007  
    • Percentage of Medicare enrollees age 65 and over who have limitations in activities of daily living (ADLs) or instrumental activities of daily living (IADLs), or who are in a facility,…  
    • Adults 45 years of age and over reporting prescription drug use in the past month for selected drug categories, by age and sex: United States, 1988-1994 and 2003-2006  
    • Limitation of activity caused by selected chronic health conditions among older adults, by age: United States, 2006-2007  
    • Hypertension, diabetes, and serious heart conditions among adults 45-64 years of age, by percent of poverty level: United States, 2007  
    • Arthritis and other musculoskeletal conditions were the most frequently reported chronic conditions causing limitation of activity. Heart and circulatory conditions were the second leading cause of activity limitation.  
    • In 2006, 42% of Americans age 75 years and over living in the community reported having a limitation in their usual activity due to a chronic condition, compared with 13%…  
    • From 2004-2005, 25% of 65-74 year olds and 60% of adults aged 85 and older reported a limitation of activity due to chronic conditions.  
    • People with 5 or more chronic conditions see an average of close to 14 different physicians and fill 50 prescriptions per year.  
    • Based on preliminary data from 2004, the top 15 causes of death in the United States in 2004 were: 1. Disease of the heart – 654,092 deaths 2. Malignant neoplasms – 550-270…  
    • Family Caregivers are a Critical Source of Support for Americans with Chronic Illnesses  
    • Chronic Diseases are the Leading Causes of Death in the U.S.  
    • Medicare-covered hospital and skilled nursing facility stays per 1,000 Medicare enrollees age 65 and over in fee-for-service, 1992-2005  
    • Percentage of Medicare enrollees age 65 and over with functional limitations, by residential setting, 2005  
    • Death rates for selected leading causes of death among people age 65 and over, 1981-2004  
    • Percentage of Medicare enrollees age 65 and over who have limitations in activities of daily living (ADLs) or instrumental activities of daily living (IADLs), or who are in a facility,…  
    • The hospitalization rate for Medicare enrollees increased between 1992 and 1999 from 306 stays per 1,000 enrollees to 350 per 1,000. The rate then decreased to 350 per 1,000 in…  
    • More than 42% of Americans aged 65 and older reported a functional limitation in 2005.  
    • Among Americans aged 65 and older, heart disease and cancer are the top two leading causes of death.  
    • The Gallup Healthways Well-Being Index found that 24% of those surveyed were not able to perform their usual activities on 1 or more days during the previous month because of…  
    • In 2002, the healthy life expectancy at birth was 69 years in the U.S. – 67 years for men and 71 years for women.  
    • Almost 37% of older persons reported a severe disability in 2006 and 16% reported that they needed some type of assistance as a result.  
    • In 2005, over 13.2 million persons aged 65 and older were discharged from short stay hospitals. This is a rate of 3,596 for every 10,000 persons aged 65+ which…  
    • Percent of Persons with Limitations in Activities of Daily Living by Age Group: 2005  
    • One in Four Americans Has Multiple Chronic Conditions  
    • Older Adults are More Likely to Have Multiple Chronic Conditions  
    • Physician and Home Health Care Visits Increase with the Number of Chronic Conditions  
    • Seniors with Chronic Conditions Rarely Have a Single Condition  
    • Women Are More Likely Than Men to Have a Chronic Condition Primarily Because They Live Longer  
    • In 2003, more than 13.2 million people age 65 and older were discharged from short stay hospitals. This is a rate of 3,679 for every 10,000 people age 65 and…  
    • In 2006, 43.2 million Americans were covered by Medicare– 7 million disabled.  
    • Chronically ill patients receive only about 55% of all clinically recommended care.  
    • Only 3 of 5 U.S. adults with chronic disease report having a self-management plan. This type of plan encourages patients to take steps to control their conditions.  
    • The percentage of recommended care received by Medicare beneficiaries was 3.2% higher than those who did not have health insurance.  
    • Quality-of-care scores were found to decline with age. The percentage of recommended care received by individuals age 18-30 was 57.5%, compared to 52.1% for those 65 and older.  
    • Trends in Chronic Disability Among Persons Age 65 or Older, 1984-1999  
    • Older Persons with Disability, Their Family Availability and Care Arrangements, 1994 and 1999  
    • Trends in Informal and Formal Care Among Older Community Residents Receiving Care, 1984-1999  
    • In 1999, nearly 40% of caregiving children were assisting parents who were age 85 or older, compared to about 34% in 1994. Nearly 13% of caregiving children were age 65…  
    • 11% of caregiving spouses were age 85 or older, up from 8.6% in 1994.  
    • More than 1/2 of family caregivers were providing help to spouses or parents with 3 or more activities of daily living (ADL) disabilities in 1999, up about 5% from 1994.  
    • Older persons with a spouse and a child, and older persons living with others were most likely to rely entirely on informal care (about 62% for both groups).  
    • 1/3 of older people without a spouse or child received no care in 1999, compared to 1/4 of older people with a spouse and a child (or children).  
    • A larger proportion of older community residents who received personal assistance were relying entirely on their informal caregivers in 1991 than in 1994 (2/3 compared to 57% in 1994) as…  
    • Among older persons in the community with disability who did receive personal assistance, the proportion receiving any informal care (informal care or informal/formal combination of care) fell somewhat, from 94.9%…  
    • Increased use of multiple prescription medications has been shown to raise the risk of adverse drug interactions for older adults. The risk of injury is associated with the use of…  
    • Each year, older adults who have 5 or more chronic illnesses visit, on average, 14 different physicians, make 37 physician office visits, and have 50 prescriptions filled.  
    • American adults age 65 and older use 1/3 of all prescription medications.  
    • In 2003, 28.6% of Americans 75 years and older made 1 – 3 health care visits (visits to doctor’s offices, emergency departments, and home visits); 36% made 4 – 9;…  
    • In 2003, 45.8% of the American population (civilian, noninstitutionalized) made 1 – 3 health care visits (visits to doctor’s offices, emergency departments, or home visits); 24.8% made 4 – 9;…  
    • In 2003, 34% of the population age 65 – 74 years (civilian, noninstitutionalized) made 1 – 3 health care visits (visits to doctor’s offices, emergency departments, and home visits); 35.7%…  
    • The typical caregiver is a 46-year-old woman with at least some college experience, providing more than 20 hours of weekly care to her mother. However, nearly 4 in 10 caregivers…  
    • Medicare beneficiaries with 4 or more chronic conditions are 99 times more likely to be admitted to the hospital for ambulatory sensitive conditions, than Medicare beneficiaries without chronic conditions.  
    • Medicare beneficiaries with 5 or more chronic conditions see an average of 14 different physicians a year.  
    • The average 75-year-old suffers from 3 chronic conditions and takes 5 prescription medications.  
    • 5 chronic diseases–heart disease, cancer, stroke, chronic obstructive pulmonary disease (COPD), and diabetes–account for more than 2/3 of all deaths.  
    • Percent Change in Selected Leading Causes of Death from 2000 to 2004  
    • Distribution of Medicare enrollees age 65 and over receiving personal care for a chronic disability, by type of care, 1984, 1989, 1994, and 1999  
    • 1.7 million Americans die from a chronic disease each year–7 out of 10 deaths in the United States.  
    • Chronic diseases are the leading cause of death and disability in the United States–accounting for 70% of all deaths.  
    • Age-adjusted Percentage of Medicare Enrollees Age 65 and Over Who are Chronically Disabled, by Level and Category of Disability, 1984, 1989, 1994, and 1999  
    • Distribution of Medicare Enrollees Age 65 and Over Using Assistive Devices and/or Receiving Personal Care for a Chronic Disability, 1984, 1989, 1994, and 1999  
    • Among older Americans, 6 of the 7 leading causes of death are chronic diseases.  
    • Over 2/5 of Americans age 65 and older who had health care expenses paid at least $1,000 out-of-pocket in 2003.  
    • In 2002, 61% of all deaths of those age 65 and older were caused by heart disease (32%), cancer (22%), and stroke (8%).  
    • “The United States spends more on health per capita than any other country, and health spending continues to increase rapidy. Much of this spending is for care that controls or…  
    • In 2000, there were more than 1.3 million home health care patients.  
    • In 2000, there were 105,496 hospice patients.  
    • 12.1% of noninstitutionalized Americans in 2003 had activity limitations caused by chronic conditions.  
    • There are an estimated 44 million American adult caregivers (21% of the adult population) who provide unpaid care to an adult. These caregivers are present in 22.9 million households (21%…  
    • People with Multiple Chronic Illnesses Are More Likely to Have Activity Limitations  
    • One Quarter of Individuals with Chronic Illness Also Have Activity Limitations  
    • Individuals with Chronic Illnesses and Activity Limitations Have More Home Health Care Visits  
    • People with Chronic Illnesses and Activity Limitations Have More Inpatient Stays  
    • People with Multiple Chronic Conditions Are Much More Likely to be Hospitalized  
    • People with Chronic Illnesses and Activity Limitations Fill More Prescriptions  
    • People with Chronic Illnesses and Activity Limitations Have More Physician Visits