According to a recent Rand Corporation report on the impact of chronic disease, 60% of non-institutionalized adult Americans had at least one chronic condition and 40% had more than one in 2014. A pretty astounding 12% had five or more. The Report is based on MEP Surveys. (Rand Report) These numbers reflect overdiagnosis as much as anything, and many people’s lives are unaffected by these chronic “diseases”. But a relatively small number do have extensive disability and spending associated with their conditions, and they account for a very large part of total health spending. They have activity of daily living, cognitive and social limitations. The percent of spending accounted for is even higher if institutionalized adults are included, as they almost always have multiple chronic conditions. These patients also impose a care-giving burden on family and friends, which has financial and health consequences for those caregivers. Women, probably because they live longer, are more likely than men to have multiple chronic diseases. Non-hispanic Caucasians, somewhat surprisingly, have higher rates than other racial types.
The most common chronic diseases are hypertension, afflicting about one in four adult Americans (again, the guidelines for what is high blood pressure tend to shift and there is likely overdiagnosis here for sure); high cholesterol, about 21.6% prevalence; mood and anxiety disorders, 21.6% (okay, lets toughen up a bit here, life isn’t that hard); and diabetes around 10.6% prevalence. For most chronic conditions, prevalence has shown gradual increases since 2008, which again, likely reflects diagnostic changes more than true prevalence changes. ER admissions increase steadily by number of chronic conditions; going from 7% of the population with no chronic disease having at least one ER visit in a year, to 32% of people with five or more chronic conditions. Similar trends exist for other major care categories: from 3% of people with no chronic disease having an inpatient stay in a year to 32% for those with five or more conditions; 1 average prescription fill a year compared to 51 filled; and 2 outpatient visits compared to 20. While people with 5 or more chronic diseases are 12% of the adult, non-institutionalized population, they represent 41% of all spending; and if institutionalized adults were included, a lot more spending would be accounted for. This five or more condition category has noticeably higher spending, almost double, than even the 3 or 4 condition category. All this extra spending not only affects third-party payers, but leads to more out-of-pocket spending. Every time you read a report like this, you have to think about what we can do to prevent people from developing them, and much of chronic disease can be prevented.