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Abstract and Introduction
Abstract
Introduction Public health and clinical strategies for meeting the emerging challenges of multiple chronic conditions must address the high prevalence of lifestyle-related causes. Our objective was to assess prevalence and trends in the chronic conditions that are leading causes of disease and death among adults in the United States that are amenable to preventive lifestyle interventions.
Methods We used self-reported data from 196,240 adults aged 25 years or older who participated in the National Health Interview Surveys from 2002 to 2009. We included data on cardiovascular disease (coronary heart disease, angina pectoris, heart attack, and stroke), cancer, chronic obstructive pulmonary disease (emphysema and chronic bronchitis), diabetes, and arthritis.
Results In 2002, an unadjusted 63.6% of participants did not have any of the 5 chronic conditions we assessed; 23.9% had 1, 9.0% had 2, 2.9% had 3, and 0.7% had 4 or 5. By 2009, the distribution of co-occurrence of the 5 chronic conditions had shifted subtly but significantly. From 2002 to 2009, the age-adjusted percentage with 2 or more chronic conditions increased from 12.7% to 14.7% (P < .001), and the number of adults with 2 or more conditions increased from approximately 23.4 million to 30.9 million.
Conclusion The prevalence of having 1 or more or 2 or more of the leading lifestyle-related chronic conditions increased steadily from 2002 to 2009. If these increases continue, particularly among younger adults, managing patients with multiple chronic conditions in the aging population will continue to challenge public health and clinical practice.
Introduction
More than 70.0% of deaths in the United States and about 75.0% of health care spending costs are attributable to chronic diseases. The 5 leading causes of death — heart disease, cancer, chronic lower respiratory disease, cerebrovascular disease, and diabetes — accounted for more than half of all deaths in 2009 and represent a high percentage of the nation's health care costs. Other chronic conditions exact a heavy toll in terms of disease, disability, quality of life, and economic costs.
Although much is known about the descriptive epidemiology of these 5 leading causes of disease and death, less is known about how commonly these conditions occur together. Such data could inform clinicians, public health professionals, policy makers, and health insurers. In recognition of the challenges to public health and the health care system posed by people with multiple chronic conditions, the US Department of Health and Human Services (HHS) developed a strategic framework for multiple chronic conditions. This framework outlines goals, objectives, and strategies to address clinical and public health system changes to improve health: maximize use of self-care and related services; provide information to public health, social services, and clinical care providers; and promote research to address gaps in knowledge.
Because the roots of the chronic conditions that are the leading causes of morbidity and mortality can be traced to lifestyle factors — principally smoking, diet, and physical activity — it is likely that, despite significant reductions in the prevalence of smoking, the continuing erosion of a low-risk lifestyle profile could result in an increase in the incidence, prevalence, and co-occurrence of lifestyle-related chronic conditions. In response to the HHS strategic framework's recommendations for research to address the epidemiology of multiple chronic conditions, our study's main objectives were to assess the prevalence of co-occurrence of leading lifestyle-related chronic conditions and to examine trends in the prevalence of these conditions from 2002 to 2009.
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