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Chronic Disease Burden Change over Time

By March 26, 2018Commentary

Chronic diseases are the cause of much health spending and a detriment to patients’ quality of life.  As the population ages and life expectancy is extended, the burden of chronic disease gets larger, as a study in Health Affairs demonstrates.   (HA Article)   The researchers used a variety of databases to assess number of chronic conditions at the time of death in Ontario, Canada, and to examine how that number changed from 1994 to 2013, as well as the extent to which it appeared linked to demographic and socio-economic factors.  Eighteen common chronic conditions, like diabetes, asthma, hypertension, arthritis, and heart disease were included in determining the level of morbidity and multi-morbidity.  In all there were over 1.6 million adult deaths during the study period of 67% of these adults had four or more of the included chronic conditions.  Those who had four or more conditions lived six years longer on average than those who died with only 3 chronic conditions, 12 years longer than those dying with 1 or 2 conditions and 22 years longer than those who had no chronic disease at the time of death.  Seems counterintuitive, but just reflects that if you live long enough, you will likely acquire more diseases, and that for some people, a chronic disease is severe enough to kill them young.

The presence of chronic disease increased for all of the conditions over the study period, with hypertension, osteoarthritis and mood disorder having the largest rises and rheumatoid arthritis and colitis the lowest.  The growth in the presence of chronic conditions at death was much greater for the period 1994 to 2004 than the period after that.  And in that second decade, the presence of stroke and heart disease actually declined at death, which is probably due to the new drug treatments available in early years and through this period.  The percent of people who died with more than one chronic condition increased from 80% in 1994 to 95% in 2013. The percent of people who died with five or more rose from 25% to 66%.  This increase was seen in people at all ages at time of death, but particularly among the very old.  There did not appear to be significant differences between men and women or low and high-income areas in the overall rates.  But there were some diseases specific variations, with low-income areas having more respiratory disease, diabetes and mental illness.  High-income areas had more cancer, cardiac arrythmia and dementia, probably due to longer lives.

Some of the rise in chronic disease prevalence may just reflect more aggressive screening and diagnosis or better documentation, but most of it is likely real.  As life expectancy continues to rise, wellness and disease prevention efforts become more important to stave off the onset and minimize the consequences of chronic conditions.  At some point, we should all also hope that medical science finds cures for diseases like hypertension and diabetes, as opposed to treatments that merely ameliorate symptoms.

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