Chronic Disease Rates and Management Strain the US Healthcare System

Defining Chronic Diseases

Researchers from the RAND Corporation define a chronic disease as “a physical or mental health condition that lasts more than one year and causes functional restrictions or requires ongoing monitoring or treatment.”

Chronic diseases may include diabetes, cancer, hypertension, and stroke.

Chronic Disease Prevalence

Based on data from the International Journal of Environmental Research and Public Health (IJEPH), approximately 25% of adults in the US have two or more chronic conditions.

The prevalence of chronic diseases changes with age, with older people statistically more likely to have multiple chronic conditions. It is thought that both lifestyle changes and aging contribute to the increased risks.

“More than half of older adults have three or more chronic conditions. And the likelihood of these types of comorbidities occurring goes up as we age. Given America’s current demographics, wherein 10,000 Americans will turn 65 each day from now through the end of 2029, it is reasonable to expect that the overall number of patients with comorbidities will increase greatly,” stated researchers in IJEPH.

Additionally, 70% of deaths in the United States result from chronic disease.

Physical Strain of Chronic Disease

“Chronic diseases — including cancer, diabetes, hypertension, stroke, heart disease, respiratory diseases, arthritis, obesity, and oral diseases — can lead to hospitalization, long-term disability, reduced quality of life, and death. In fact, persistent conditions are the nation’s leading cause of death and disability,” wrote researchers in an article published in IJEPH.

The physical burdens of chronic disease can vary from pain to mental health issues surrounding the illness. Depending on the type of chronic disease, these physical burdens may be addressed through medications, therapies, and lifestyle changes.

According to the RAND Corporation, “when a patient has more than one chronic condition — for example, diabetes, hypertension, and mood disorders — treatment can be difficult to manage. Treatment strategies or drug regimens may be similar — but can be very different — and one chronic condition may be better managed than the others.”

Financial Strain of Chronic Disease

An average of 75% of all healthcare spending in the US is allotted to chronic illnesses.

According to a research article published in the American Action Forum (AAF), “the costs associated with chronic disease in the United States, both direct and indirect, are immense. Direct costs are those attributed to the prescriptions, procedures, and other health care products and services needed to treat individuals with chronic diseases. Indirect costs are those associated with the impacts of chronic disease in other realms of life, such as effects on employment, mobility, and other factors associated with well-being.”

The overall cost of chronic disease — both direct and indirect — amounts to an average of $37 trillion per year, about 19.6% of the US gross domestic product.

Direct healthcare costs for individuals with chronic diseases amount to an average of $6,032 annually. This number is five times greater than their counterparts without chronic disease.

In 2016, approximately $1.1 trillion was spent on direct costs of chronic disease, with the most significant proportion, 26.7%, being spent on heart disease and cardiovascular conditions.

According to the Milken Institute, “the most expensive conditions in terms of direct healthcare costs are diabetes ($189.6 billion in annual direct healthcare expenditures), Alzheimer’s disease ($185.9 billion), and osteoarthritis ($115.5 billion). When the indirect costs of lost economic productivity are included, the total costs of chronic diseases in the US increase to $3.7 trillion. This is equivalent to 19.6% of the US. GDP — in other words, nearly one-fifth of the US economy.”

Risk Factors of Chronic Disease Development

According to the CDC, multiple risk factors contribute to the development of chronic diseases. One significant contributor is lifestyle. Tobacco use, poor nutrition, lack of physical activity, and excessive alcohol use increase the risk of chronic disease development.

According to the CDC, there are multiple ways to reduce the risk of chronic disease development. The first way is to reduce or eliminate risky behaviors such as smoking and excessive drinking.

Additionally, “Eating healthy helps prevent, delay, and manage heart disease, type 2 diabetes, and other chronic diseases. A balanced, healthy dietary pattern includes a variety of fruits, vegetables, whole grains, lean protein, and low-fat dairy products and limits added sugars, saturated fats, and sodium. Healthy eating can work for everyone’s tastes, traditions, culture, and budget. If you are overweight, losing 5–7% of your starting weight can help prevent or delay type 2 diabetes.”

Three Most Common Chronic Diseases

The top three most common chronic diseases are heart disease, cancer, and diabetes. While genetics may play some role in the risk of developing these illnesses, lifestyle changes can prevent a portion of cases.

Heart Disease

Heart disease, an overarching term for a series of conditions, is widely accepted as the leading cause of death in the United States.

The most common type of heart disease is coronary artery disease. According to the CDC, in 2020, 382,820 people died from coronary artery disease.

The CDC estimates that 877,500 people in the US die of heart disease or stroke yearly, amounting to approximately 33% of all deaths. In addition to the high mortality risk, heart disease places a $216 billion economic burden on the healthcare system each year.

Cancer

The second leading cause of death in the US, cancer, kills an average of 600,000 people annually.

According to the CDC’s Cancer Data and Statistics, in 2019, there were 1,752,735 new cancer cases in the US. Additionally, the number of cancer-related deaths for that year was approximately 599,589. There are multiple kinds of cancer with varying symptoms, risks, and outcomes.

Regular screenings, available vaccinations — such as the one for HPV, and a healthy lifestyle are thought to reduce the risk of cancer or allow for better outcomes if cancer is detected.  

The Mayo Clinic identifies multiple side effects of cancer and its treatment, including the following:

• fatigue 
• weight fluctuations 
• abdominal pain 
• difficulty swallowing  
• skin changes 

The American Cancer Society also states that a cancer diagnosis could lead to anxiety, depression, or feelings of distress.

The burden of cancer is not just physical or mental, but it is also economical. The CDC states, “the cost of cancer care continues to rise and is expected to reach more than $240 billion by 2030.

Diabetes

Currently, there are 34.2 million diabetic people in the US and 88 million prediabetic people. There are two kinds of diabetes: type 1 and type 2.

Type 1 diabetes, sometimes referred to as juvenile diabetes, is the less common of the two and occurs when the pancreas produces little to no insulin. Conversely, type 2 diabetes accounts for up to 95% of all diabetes cases and is characterized by the inability to use insulin well.

Symptoms of diabetes include dry skin, weight changes, excessive hunger or thirst, and fatigue.

According to the CDC, in 2017, the estimated cost associated with diabetes was $327 billion. Simply put, diabetes is costly and can lead to heart failure, kidney failure, visual impairments, and more.

The Future of Chronic Diseases

As the understanding of chronic disease, its management, and potential risk factors grow, many health officials and public health experts are advocating for campaigns to reduce chronic disease risk. These campaigns include antismoking, food and exercise education, and regular screening efforts.

“As the number of individuals with chronic disease grows, this burden will grow as well. Low-income individuals are more likely to suffer from chronic disease and may be disproportionately burdened by the costs and associated social and economic consequences. Interventions to prevent and better manage existing chronic disease can reduce direct costs and prevent many indirect costs from ever emerging, thus improving the economic well-being of individuals and the country as a whole,” stated the RAND Institute.