It’s unfortunate that if there’s one thing common to all ethnic groups in the United States, regardless of race, it’s their exposure to the risk of chronic diseases, the country’s leading cause of death and disability. In its 2011 report on Health in the United States, the Centers for Disease Control and Prevention (CDC) states that:
7 out of 10 deaths among Americans each year are from chronic diseases. Heart disease, cancer and stroke account for more than 50% of all deaths each year.
In 2005, 133 million Americans – almost 1 out of every 2 adults – had at least one chronic illness.
Four modifiable health risk behaviors—lack of physical activity, poor nutrition, tobacco use, and excessive alcohol consumption—are responsible for much of the illness, suffering, and early death related to chronic diseases.
Health disparities in chronic disease incidence and mortality are widespread among members of racial and ethnic minority populations. For example, cancer death rates are higher among Asians than whites, and diabetes rates are substantially higher among American Indians and Alaska Natives than whites.
The picture painted by statistics from the CDC is clear. Diseases of the heart and malignant neoplasms (cancer) are the leading chronic diseases in the United States across all ethnic groups. Chronic lower respiratory diseases (e.g. asthma and bronchitis) and cerebrovascular diseases (e.g. stroke and hypertension) are the next leading causes of death with diabetes and Alzheimer’s now proving to be a major cause of concern for all groups.
In the following sections we’ll take a closer look at these chronic diseases – trends, prevalence, disparities among ethnic groups, and costs to individuals and the nation as a whole.
The good news is that since 1999, death rates for coronary heart disease and stroke have declined 20.8% and 24.4%, respectively. In addition, the percentage of adults with high cholesterol, a major risk factor for heart disease, has been cut by almost half since the early 1960s.
However, heart disease and stroke remain the first and third leading causes of death, accounting for more than 30% of all mortality, and are among the leading causes of disability. There are 1 million Americans are disabled from strokes, many of whom can no longer perform daily tasks, such as walking or bathing, without help.
In 2003, approximately 37% of adults reported having two or more of the major risk factors for heart disease and stroke (high blood pressure, high cholesterol, diabetes, current smoking, physical inactivity, and obesity).10
Many disparities persist. For example, age-adjusted stroke death rates for 2005 were 31% higher for African Americans than for whites, and heart disease death rates were 23% higher. The risk of having a first-ever stroke is nearly two times higher among African Americans than among whites. Recent studies show that the prevalence of heart disease and the percentage of associated premature deaths are higher among American Indians and Alaska Natives than among any other U.S. racial or ethnic group.
Treating heart disease is very expensive. The American Heart Association (AHA) estimates that annual U.S. medical costs of cardiovascular disease will reach $800 billion by 2030 – nearly triple the $272 billion spent in 2010. Heart disease also costs the nation billions in lost productivity due to missed days of work from illness. CDC enumerates these costs:
More than 1 of 3 (83 million) U.S. adults currently lives with one or more types of cardiovascular disease.
An estimated 935,000 heart attacks and 795,000 strokes occur each year.
Nearly 68 million adults have high blood pressure, and about half do not have this condition under control.
An estimated 71 million adults have high cholesterol (i.e., high levels of low-density lipoprotein cholesterol). Nearly 2 of 3 do not have this condition under control.
Tremendous progress has been made in cancer prevention strategies, early detection interventions, and cancer treatments. Breast cancer deaths among women decreased by 2% per year from 1998 to 2005. Deaths from colorectal cancer decreased among both men and women by 4% per year from 1995 to 2005.
However, cancer continues to claim more than half a million lives each year and remains the second leading cause of death. As with other leading chronic diseases, disparities exist. African Americans are more likely to die of cancer than people of any other racial or ethnic group.
Of the nation’s 10 most expensive medical conditions, cancer has the highest per-person price. The total cost of treating cancer in the U.S. rose from about $95.5 billion in 2000 to $124.6 billion in 2010, the National Cancer Institute estimates. For individual patients, costs can vary widely even for the same drug. New drugs often cost $100,000 or more a year. Patients are being put on them sooner in the course of their illness and for a longer time — sometimes for the rest of their lives. Radiation treatment is becoming more high-tech, and each leap in technology has brought a quantum leap in expense. Medical bills are a leading cause of bankruptcies.
Tremendous progress has been made in managing diabetes and its complications. Because of public health efforts, higher percentages of people with diabetes are monitoring their blood sugar daily and receiving exams.
However, Nearly 24 million Americans have diabetes. An estimated 57 million American adults have pre-diabetes, placing them at increased risk for developing type 2 diabetes. Diabetes is becoming more common every day. If current trends continue, 1 in 3 Americans born in 2000 will develop diabetes during their lifetime.
In terms of racial disparity, American Indian and Alaska Native adults are twice as likely as white adults to have diabetes. Compared to non-Hispanic white adults, the risk of diagnosed diabetes was 18% higher among Asian Americans, 66% higher among Hispanics, and 77% higher among non-Hispanic blacks.
Diabetes patients spend an average of $6,000 annually on costs for treating their disease, according to a recent survey conducted by Consumer Reports Health. That figure includes monitoring supplies, medicines, doctor visits, annual eye exams and other routine costs. But the total doesn’t include the costs of medical complications that often result from Type 2 diabetes, such as heart disease, strokes, liver and kidney damage, eye damage and a susceptibility to infections and poor healing that can lead to amputations. The CDC estimates that diabetic patients on average pay twice as much as those without the illness for health care.
Alzheimer’s disease is one of the top ten leading causes of death in the United States. It is the 6th leading cause of death among American adults, and the 5th leading cause of death for adults aged 65 years and older. Mortality rates for Alzheimer’s disease are on the rise, unlike heart disease and cancer death rates which are continuing to decline.
An estimated 5.4 million Americans have Alzheimer’s disease. This number has doubled since 1980, and is expected to be as high as 16 million by 2050. It is interesting to note that of the leading causes of death, this is one area where non-Hispanic whites show greater risk than other ethnic groups, and prevalence is higher among whites than the national average.
In 2013, the direct costs of caring for those with Alzheimer’s to American society will total an estimated $203 billion, including $142 billion in costs to Medicare and Medicaid. Total payments for health care, long-term care and hospice for people with Alzheimer’s and other dementias are projected to increase from $203 billion in 2013 to $1.2 trillion in 2050 (in current dollars). This dramatic rise includes a 500% increase in combined Medicare and Medicaid spending. The average per person Medicare payments for those with Alzheimer’s and other dementias are three times higher than for those without these conditions. Medicaid spending for older adults with Alzheimer’s disease and other dementias is nine times higher.
The average lifetime cost of care for someone with Alzheimer’s disease is $174,000. The yearly cost of caring for someone with Alzheimer’s depends on the stage of the disease. $18,400 for someone with mild symptoms, $30,100 for moderate symptoms, and $36,132 for severe symptoms.
Smoking is the primary risk factor for chronic respiratory diseases, such as emphysema and chronic bronchitis, both of which are major conditions of chronic obstructive pulmonary disease (COPD). COPD, as well as lung cancer, could become relatively uncommon in future generations if smoking rates were substantially reduced.
COPD remains the third leading cause of smoking-related deaths, killing about 93,000 adults annually.
From 1980 to 2000, the nation’s COPD death rates increased from 20.1 to 56.7 per 100,000 women and from 73.0 to 82.6 per 100,000 men.
Almost 60% of children—or 22 million children aged 3 to 11 years old—are exposed to secondhand smoke, which slows lung growth and increases risk for acute respiratory diseases and for more severe asthma.
The mortality of chronic lung disease is predicted to decrease at a rate of 1.5% a year until 2030, and yet the cost of treating it is predicted to more than double from $176.8 billion in 2006 to $389.2 billion in 2011 and to reach $832.9 billion in 2021. The reason for this skyrocketing increase is a 31.1% increase in the number of diagnoses.
Because of the burden placed on society and the economy by chronic diseases, it was natural for the Affordable Care Act to devote a whole section to “Prevention of Chronic Disease and Improving Public Health.” Prevention is the operative word here, and the focus of government efforts are in the areas of physical activity, poor nutrition, tobacco use, and excessive alcohol consumption.
The solutions being proposed are informed by the realization that these four factors are largely influenced by ethnicity and socio-economic status. Health disparities are now mainstream talking points in discussions about the health of the nation. The financial burden, both on the nation and its citizens, will always be a central topic.
Obesity and other new challenges will intersect with and compound the problem of chronic diseases and until Obamacare comes into full effect the whole nation is on tenterhooks. It has to work, and the benefits to be gained should far outweigh its heavy cost.
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