The Burden of Chronic Diseases in Missouri: Opportunities and Challenges for Public Health Shumei Yun, MD, PhD Chronic Disease Public Health Epidemiologist.

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

Chronic Neurologic Disorders– Alzheimer’s Disease– Parkinson’s Disease

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

Source: DHSS-MICA

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

Heart disease

Cancer

Cerebrovascular disease

Chronic lower respiratory diseases

Unintentional injury

Diabetes

Pneumonia & influenza

Alzheimer's disease

Kidney disease

Suicide

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, 1994-2004

*Age Adjustment Uses 2000 Standard US PopulationSource: DHSS-MICA. * CVD as the principal diagnosis

0

50

100

150

200

250

300

350

400

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

Ra

tes

pe

r 1

0,0

00

White

Black

Overall

CVD Inpatient Hospitalization Charges* in Missouri, by Pay Sources, 1994-2004

Source: DHSS-MICA. * CVD as the principal diagnosis

0

500

1000

1500

2000

2500

3000

3500

4000

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

Mil

lio

n d

oll

ars

Medicare

Medicaid

All pay sources

CVD Inpatient Hospitalization Charges* in Missouri, by Pay Sources, 1994-2004

Source: DHSS-MICA. * CVD the principal diagnosisTaking into account population change and CPI medical component

0

500

1000

1500

2000

2500

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

Mill

ion

Do

llars

Medicare

Medicaid

All pay sources

CVD Mortality Rates* in Missouri, 1990-2004

Age Adjustment Uses 2000 Standard US PopulationSource: DHSS-MICA. * CVD as the underlying cause

0

100

200

300

400

500

600

1990

1992

1994

1996

1998

2000

2002

2004

Rat

es p

er 1

00,0

00

White

Black

Overall

US

CVD Death Rates in the US , 1999

Source: http://www.cdc.gov/nccdphp/bb_heartdisease/index.htmAge-adjusted Death Rates per 100,000 Population

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, 1996-2002

*Age Adjustment Uses 2000 Standard US Population

Data Source: Missouri Cancer Registry

0

100

200

300

400

500

600

1996 1997 1998 1999 2000 2001 2002

Rat

es p

er 1

00,0

00

White

Black

Overall

All Cancer Hospitalization Rates* in Missouri, 1994-2004

*Age Adjustment Uses 2000 Standard US PopulationData Source: DHSS-MICA

0

10

20

30

40

50

60

70

Ra

tes

pe

r 1

0,0

00

White

Black

Overall

All Cancer Inpatient Hospitalization Charges* in Missouri, by Pay Sources

Source: DHSS-MICA. * Cancer as the principal diagnosisTaking into account population change and CPI medical component

0

100

200

300

400

500

600

Mil

lio

n D

oll

ars

Medicare

Medicaid

All paysources

All Cancer Mortality Rates* in Missouri, 1990-2004

* Age Adjustment Uses 2000 Standard US PopulationData Source: DHSS-MICA

0

50

100

150

200

250

300

350

Rate

s p

er

100,0

00

White

Black

Overall

US

Breast Cancer Mortality Rates* Among Women in Missouri, 1990-2004

* Age Adjustment Uses 2000 Standard US PopulationData Source: DHSS-MICA

05

1015

2025

3035

4045

50

Rate

s p

er

100,0

00

White

Black

Overall

US

Breast Cancer Mortality Rates* in Missouri, 1990-2004

* Age Adjustment Uses 2000 Standard US PopulationData Source: DHSS-MICA

05

1015

2025

3035

4045

50

Rate

s p

er

100,0

00

White

Black

Overall

US

Lung Cancer Mortality Rates* in Missouri, 1990-2004

* Age Adjustment Uses 2000 Standard US PopulationData Source: DHSS-MICA

010

2030

4050

6070

8090

100

Rate

s p

er

100,0

00

White

Black

Overall

US

Lung Cancer Mortality Rates* in Missouri, by Sex, 1990-2004

* Age Adjustment Uses 2000 Standard US PopulationData Source: DHSS-MICA

0

20

40

60

80

100

120

Rate

s p

er

100,0

00

Male

Female

Overall

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

0

2

4

6

8

10

12

14

Pre

vale

nce (

%)

White

Black

Overall

Data Source: Missouri BRFSS

Diabetes Inpatient Hospitalization Rates* in Missouri, 1993-2001

Age Adjustment Uses 2000 Standard US PopulationSource: DHSS-MICA. * Diabetes as the principal diagnosis

05

10152025

303540

4550

Rate

s 1

0,0

00

White

Black

Overall

Diabetes* Emergency Room Visit Rates in Missouri, 1994 - 2004

Age Adjustment Uses 2000 Standard US PopulationSource: DHSS-MICA. * Diabetes as the principal diagnosis

00.5

11.5

22.5

33.5

44.5

5

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

Rat

es p

er 1

,000

White

Black

Overall

Diabetes Inpatient Hospitalization Charges* in Missouri, by Pay Sources, 1994-2004

0

20

40

60

80

100

120

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

Mil

lio

n D

oll

ars

Medicare

Medicaid

Total

* Diabetes as the principal diagnosisTaking into account population change and CPI medical component

Diabetes Mortality Rates* in Missouri, 1990-2004

*Age Adjustment Uses 2000 Standard US PopulationSource: DHSS-MICA. * Diabetes as the underlying cause

0

10

20

30

40

50

60

1990

1992

1994

1996

1998

2000

2002

2004

Rat

es p

er 1

00,0

00

White

Black

Overall

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

*Age Adjustment Uses 2000 Standard US PopulationSource: DHSS-Community Data Profile

0

5

10

15

20

25

30

35

40

1993-5

1994-6

1995-7

1996-8

1997-9

1998-2000

1999-2001

2000-2

2001-3

Rate

s p

er

10,0

00

White

Black

Overall

Osteoarthritis Inpatient Hospital Charges* in Missouri, by Pay Sources, 1994-2004

Source: DHSS-MICA. * Osteoarthritis as the principal diagnosisTaking into account population change and CPI medical component

0

50

100

150

200

250

300

1992 1994 1996 1998 2000 2002 2004 2006

Mil

lio

ns D

oll

ars

Medicare

Medicaid

All PaySources

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

0

5

10

15

20

25

30

35

40

45

Rate

s p

er

10,0

00

White

Black

Overall

*Age Adjustment Uses 2000 Standard US PopulationSource: DHSS-Community Data Profile

Asthma Inpatient Hospitalization Charges* in Missouri, by Pay Sources

Source: DHSS-MICA. * Asthma as the principal diagnosisTaking into account population change and CPI medical component

0

5

10

15

20

25

30

35

40

45

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

Mil

lio

ns D

oll

ars

Medicare

Medicaid

All Pay Sources

Asthma ER Rates in Missouri, 1994-2004

02

46

810

1214

1618

20

Rate

s p

er

1,0

00

White

Black

Overall

Age Adjustment Uses 2000 Standard US PopulationSource: 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

Become Involved Send comments and

suggestions

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%

Tobacco use prevalence– High school students 24.8%– Middle school students 8.8%

Not meeting CDC physical activity recommendations– High school students 28.4%– Middle school students 26.1%

No vigorous or moderate physical activity– High school students 8%– Middle school students 7.3%

Prevalence of Smoking among Adults in Missouri

Obesity Prevalence among Adults in Missouri, 1990 - 2002

0

5

10

15

20

25

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Pre

va

len

ce

(%

)

Prevalence of No Leisure-time Physical Activity among Missouri Adults, 1990-2002

0

10

20

30

40

50

60

1988 1990 1992 1994 1996 1998 2000 2002 2004

Pre

va

len

ce

(%

)

Aging population

Thank You