Burden of Chronic Diseases

The Burden of Chronic Diseases in Missouri: Opportunities and Challenges for Public Health Shumei Yun, MD, PhD Chronic Disease Public Health Epidemiologist Office of Epidemiology Chronic Diseases  Chronic diseases can be defined as diseases that have a prolonged course, that do not resolve spontaneously, and which a complete cure is rarely achieved. Chronic disease epidemiology and control, 2nd Edition Chronic Diseases  Characteristics of Chronic Diseases – – – – Uncertain etiology Multiple risk factors A long latency period A prolonged course of illness Chronic disease epidemiology and control, 2nd Edition Major Chronic Diseases   Cardiovascular Disease Cancer – – – – – Lung Cancer Colorectal Cancer Breast Cancer Cervical Cancer Prostate Cancer Major Chronic Diseases  Chronic Lung Diseases – – Asthma Chronic Obstructive Pulmonary Disease   Diabetes Arthritis and Other Musculoskeletal Diseases – – – Osteoarthritis Rheumatoid Arthritis Osteoporosis Alzheimer’s Disease Parkinson’s Disease  Chronic Neurologic Disorders – – Chronic Diseases in the U.S.  According to CDC, more than 90 million people in the U.S. live with a chronic illness. Chronic diseases—such as heart disease, cancer, and diabetes —are the leading causes of death and disability. Chronic diseases account for 7 out of every 10 deaths. The treatment of chronic diseases accounts for 75% of total health care cost each year.    Leading Causes of Death in Missouri, 2004 Septicemia Heart dis eas e Cancer 15,432 12,429 3,483 2,738 2,639 1,466 1,406 1,384 1,080 728 0 5,000 10,000 15,000 20,000 Cerebrovas cular dis eas e Chronic lower res piratory dis eas es Unintentional injury Diabetes Pneumonia & influenza Alzheimer's dis eas e Kidney dis eas e Suicide Source: DHSS-MICA Source: DHSS-MICA Missouri is among the States with Highest CVD Deaths in the Nation    More than 1 in 5 Missourians have some form of CVD. More than 21,000 CVD deaths occur each year. CVD deaths remained high compared to other states. CVD Hospitalization Rates* in Missouri, 19942004 400 350 Rates per 10,000 300 250 200 150 100 50 0 White Black Overall *Age Adjustment Uses 2000 Standard US Population Source: DHSS-MICA. * CVD as the principal diagnosis 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 CVD Inpatient Hospitalization Charges* in Missouri, by Pay Sources, 1994-2004 4000 3500 Million dollars 3000 2500 2000 1500 1000 500 0 Medicare Medicaid All pay sources Source: DHSS-MICA. * CVD as the principal diagnosis 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 CVD Inpatient Hospitalization Charges* in Missouri, by Pay Sources, 1994-2004 2500 2000 Million Dollars 1500 1000 500 0 Medicare Medicaid All pay sources 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 Source: DHSS-MICA. * CVD the principal diagnosis Taking into account population change and CPI medical component 20 04 CVD Mortality Rates* in Missouri, 1990-2004 600 500 Rates per 100,000 400 300 200 100 0 White Black Overall US 19 90 19 92 19 94 19 96 19 98 20 00 20 02 Age Adjustment Uses 2000 Standard US Population Source: DHSS-MICA. * CVD as the underlying cause 20 04 CVD Death Rates in the US , 1999 Age-adjusted Death Rates per 100,000 Population Source: http://www.cdc.gov/nccdphp/bb_heartdisease/index.htm Cancer- Missourians Most Concerned Diseases    Cancer affects three out of four Missouri families. More than 28,000 new cases are diagnosed each year in Missouri. Over 12,000 cancer deaths occur each year. All Cancer Incidence Rates* in Missouri, 19962002 600 500 Rates per 100,000 400 300 200 100 0 1996 1997 1998 1999 2000 2001 2002 White Black Overall *Age Adjustment Uses 2000 Standard US Population Data Source: Missouri Cancer Registry All Cancer Hospitalization Rates* in Missouri, 1994-2004 70 60 Rates per 10,000 50 40 30 20 10 0 White Black Overall 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 *Age Adjustment Uses 2000 Standard US Population Data Source: DHSS-MICA All Cancer Inpatient Hospitalization Charges* in Missouri, by Pay Sources 600 500 Million Dollars 400 300 200 100 0 Medicare Medicaid All pay sources 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 Source: DHSS-MICA. * Cancer as the principal diagnosis Taking into account population change and CPI medical component All Cancer Mortality Rates* in Missouri, 19902004 350 300 Rates per 100,000 250 200 150 100 50 0 White Black Overall US 19 90 19 92 19 94 19 96 19 98 20 00 20 02 * Age Adjustment Uses 2000 Standard US Population Data Source: DHSS-MICA 20 04 Breast Cancer Mortality Rates* Among Women in Missouri, 1990-2004 50 45 40 35 30 25 20 15 10 5 0 Rates per 100,000 White Black Overall US 19 90 19 92 19 94 19 96 19 98 20 00 20 02 * Age Adjustment Uses 2000 Standard US Population Data Source: DHSS-MICA 20 04 Breast Cancer Mortality Rates* in Missouri, 1990-2004 50 45 40 35 30 25 20 15 10 5 0 Rates per 100,000 White Black Overall US 19 90 19 92 19 94 19 96 19 98 20 00 20 02 * Age Adjustment Uses 2000 Standard US Population Data Source: DHSS-MICA 20 04 Lung Cancer Mortality Rates* in Missouri, 1990-2004 100 90 80 70 60 50 40 30 20 10 0 Rates per 100,000 White Black Overall US 19 90 19 92 19 94 19 96 19 98 20 00 20 02 * Age Adjustment Uses 2000 Standard US Population Data Source: DHSS-MICA 20 04 Lung Cancer Mortality Rates* in Missouri, by Sex, 1990-2004 120 100 Rates per 100,000 80 60 40 20 0 Male Female Overall 19 90 19 92 19 94 19 96 19 98 20 00 20 02 * Age Adjustment Uses 2000 Standard US Population Data Source: DHSS-MICA 20 04 Diabetes is on the rise in Missouri  In 2005, 7.7% of adults aged 18 or older have physician diagnosed diabetes.  About 1/3 of all persons with diabetes are unaware of their condition. The number of children with type 2 diabetes is increasing.   Minorities and people with low SES are disproportionately affected. Diabetes is a severe illness  Without appropriate management, diabetes can lead to – – – – – Kidney failure Blindness Amputations Cardiovascular diseases Death due to flu and pneumonia complications. Prevalence of Self-reported Physician Diagnosed Diabetes in Missouri, 1990-2005 14 12 Prevalence (%) 10 8 6 4 2 0 White Black Overall 19 90 19 92 19 94 19 96 19 98 20 00 20 02 Data Source: Missouri BRFSS 20 04 Diabetes Inpatient Hospitalization Rates* in Missouri, 1993-2001 50 45 40 35 30 25 20 15 10 5 0 Rates 10,000 White Black Overall Age Adjustment Uses 2000 Standard US Population Source: DHSS-MICA. * Diabetes as the principal diagnosis 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 Diabetes* Emergency Room Visit Rates in Missouri, 1994 - 2004 5 4.5 4 3.5 3 2.5 2 1.5 1 0.5 0 Rates per 1,000 White Black Overall Age Adjustment Uses 2000 Standard US Population Source: DHSS-MICA. * Diabetes as the principal diagnosis 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 Diabetes Inpatient Hospitalization Charges* in Missouri, by Pay Sources, 1994-2004 120 100 80 60 40 20 0 Medicare Medicaid Total Million Dollars * Diabetes as the principal diagnosis Taking into account population change and CPI medical component 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 Diabetes Mortality Rates* in Missouri, 19902004 60 50 Rates per 100,000 40 30 20 10 0 White Black Overall 19 90 19 92 19 94 19 96 19 98 20 00 20 02 *Age Adjustment Uses 2000 Standard US Population Source: DHSS-MICA. * Diabetes as the underlying cause 20 04 Arthritis: the Leading Cause of Disability   In 2005, 32.1% of Missourians have physician diagnosed arthritis. About 15.5% of Missourians have certain activity limitation due to arthritis or joint symptoms. Prevalence of Physician-diagnosed Arthritis, 2005 Arthritis Hospitalization Rates* in Missouri, 1993-2003 40 35 Rates per 10,000 30 25 20 15 10 5 0 1993- 1994- 1995- 1996- 1997- 1998- 1999- 2000- 20015 6 7 8 9 2000 2001 2 3 White Black Overall *Age Adjustment Uses 2000 Standard US Population Source: DHSS-Community Data Profile Osteoarthritis Inpatient Hospital Charges* in Missouri, by Pay Sources, 1994-2004 300 Millions Dollars 250 200 150 100 50 0 1992 All Pay Sources Medicare Medicaid 1994 1996 1998 2000 2002 2004 2006 Source: DHSS-MICA. * Osteoarthritis as the principal diagnosis Taking into account population change and CPI medical component Asthma: Leading Cause of Hospitalization among Children <15 Yrs  More than 30,000 ER visits each year in Missouri – More than 1/3 by children < 15 yrs   More than 7,000 hospitalizations each year – More than 1/3 by children < 15 yrs Adults with current asthma in 2005: 9% Asthma Inpatient Hospitalization Rates* in Missouri, 1994-2004 45 40 35 30 25 20 15 10 5 0 White Black Overall Rates per 10,000 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 *Age Adjustment Uses 2000 Standard US Population Source: DHSS-Community Data Profile Asthma Inpatient Hospitalization Charges* in Missouri, by Pay Sources Millions Dollars 45 40 35 30 25 20 15 10 5 0 Medicare Medicaid All Pay Sources 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Source: DHSS-MICA. * Asthma as the principal diagnosis Taking into account population change and CPI medical component 2004 Asthma ER Rates in Missouri, 1994-2004 20 18 16 14 12 10 8 6 4 2 0 Rates per 1,000 White Black Overall 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 Age Adjustment Uses 2000 Standard US Population Source: DHSS-MICA. * Asthma as the principal diagnosis Opportunities     Chronic diseases are preventable. Prevention is cost-effective. Public health interventions work. Infrastructure for chronic disease prevention and control exists. Evidence-Based Interventions B e c o m e In v o l v e d S e n d c o m m e n ts a n d s u g g e s t io n s Topics Alcohol Cancer Diabetes Mental Health Motor Vehicle Nutrition Oral Health Physical Activity Pregnancy Sexual Behavior Social Environment Substance Abuse Tobacco Vaccines Violence http://www.thecommunityguide.org/alcohol/default.htm Challenges       High prevalence of risk factors Lack of support for prevention Lack of funding for prevention Sustained multi-sectoral commitments needed Social determinants of chronic diseases Aging Population Risk Factors among Missouri Youth, 2003  Overweight prevalence – – High school students 12.1 Middle school students 15.9% High school students 24.8% Middle school students 8.8% High school students 28.4% Middle school students 26.1% High school students 8% Middle school students 7.3%  Tobacco use prevalence – –  Not meeting CDC physical activity recommendations – –  No vigorous or moderate physical activity – – Prevalence of Smoking among Adults in Missouri Obesity Prevalence among Adults in Missouri, 1990 - 2002 25 20 Prevalen ce (% ) 15 10 5 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Prevalence of No Leisure-time Physical Activity among Missouri Adults, 1990-2002 60 50 P re v a le n c e ( % ) 40 30 20 10 0 1988 1990 1992 1994 1996 1998 2000 2002 2004 Aging population Thank You