Chronic Disease Overview

Chronic Diseases: The Leading Causes of Death and Disability in the United States

Chronic diseases and conditions—such as heart disease, stroke, cancer, type 2 diabetes, obesity, and arthritis—are among the most common, costly, and preventable of all health problems.

• As of 2012, about half of all adults—117 million people—had one or more chronic health conditions. One of four adults had two or more chronic health conditions.¹
• Seven of the top 10 causes of death in 2010 were chronic diseases. Two of these chronic diseases—heart disease and cancer—together accounted for nearly 48% of all deaths.²
• Obesity is a serious health concern. During 2009–2010, more than one-third of adults, or about 78 million people, were obese (defined as body mass index [BMI] ≥30 kg/m2). Nearly one of five youths aged 2–19 years was obese (BMI ≥95th percentile).³
• Arthritis is the most common cause of disability.⁴ Of the 53 million adults with a doctor diagnosis of arthritis, more than 22 million say they have trouble with their usual activities because of arthritis.⁵
• Diabetes is the leading cause of kidney failure, lower-limb amputations other than those caused by injury, and new cases of blindness among adults.⁶

Health Risk Behaviors that Cause Chronic Diseases

Health risk behaviors are unhealthy behaviors you can change. Four of these health risk behaviors—lack of exercise or physical activity, poor nutrition, tobacco use, and drinking too much alcohol—cause much of the illness, suffering, and early death related to chronic diseases and conditions.

• In 2011, more than half (52%) of adults aged 18 years or older did not meet recommendations for aerobic exercise or physical activity. In addition, 76% did not meet recommendations for muscle-strengthening physical activity.⁷
• About half of US adults (47%) have at least one of the following major risk factors for heart disease or stroke: uncontrolled high blood pressure, uncontrolled high LDL cholesterol, or are current smokers.⁸ Ninety percent of Americans consume too much sodium, increasing their risk of high blood pressure.⁹
• In 2011, more than one-third (36%) of adolescents and 38% of adults said they ate fruit less than once a day, while 38% of adolescents and 23% of adults said they ate vegetables less than once a day.¹⁰
• More than 42 million adults—close to 1 of every 5—said they currently smoked cigarettes in 2012.¹¹ Cigarette smoking accounts for more than 480,000 deaths each year.¹¹ Each day, more than 3,200 youth younger than 18 years smoke their first cigarette, and another 2,100 youth and young adults who smoke every now and then become daily smokers.¹¹
• Drinking too much alcohol is responsible for 88,000 deaths each year, more than half of which are due to binge drinking.^{12, 13} About 38 million US adults report binge drinking an average of 4 times a month, and have an average of 8 drinks per binge, yet most binge drinkers are not alcohol dependent.¹⁴

The Cost of Chronic Diseases and Health Risk Behaviors

In the United States, chronic diseases and conditions and the health risk behaviors that cause them account for most health care costs.

• Eighty-six percent of all health care spending in 2010 was for people with one or more chronic medical conditions.¹⁵
• The total costs of heart disease and stroke in 2010 were estimated to be $315.4 billion. Of this amount, $193.4 billion was for direct medical costs, not including costs of nursing home care.¹⁶
• Cancer care cost $157 billion in 2010 dollars.¹⁷
• The total estimated cost of diagnosed diabetes in 2012 was $245 billion, including $176 billion in direct medical costs and $69 billion in decreased productivity. Decreased productivity includes costs associated with people being absent from work, being less productive while at work, or not being able to work at all because of diabetes.¹⁸
• The total cost of arthritis and related conditions was about $128 billion in 2003. Of this amount, nearly $81 billion was for direct medical costs and $47 billion was for indirect costs associated with lost earnings.¹⁹
• Medical costs linked to obesity were estimated to be $147 billion in 2008. Annual medical costs for people who are obese were $1,429 higher than those for people of normal weight in 2006.²⁰
• For the years 2009-2012, economic cost due to smoking is estimated to be more than $289 billion a year. This cost includes at least $133 billion in direct medical care for adults and more than $156 billion for lost productivity from premature death estimated from 2005 through 2009.¹¹
• The economic costs of drinking too much alcohol were estimated to be $223.5 billion, or $1.90 a drink, in 2006. Most of these costs were due to binge drinking and resulted from losses in workplace productivity, health care expenses, and crimes related to excessive drinking.²¹

References

1. Ward BW, Schiller JS, Goodman RA. Multiple chronic conditions among US adults: a 2012 update. Prev Chronic Dis. 2014;11:130389. DOI: http://dx.doi.org/10.5888/pcd11.130389.
2. Centers for Disease Control and Prevention. Death and Mortality. NCHS FastStats Web site. http://www.cdc.gov/nchs/fastats/deaths.htm. Accessed December 20, 2013.
3. Centers for Disease Control and Prevention. NCHS Obesity Data. http://www.cdc.gov/nchs/data/factsheets/factsheet_obesity.htm. Accessed December 20, 2013.
4. Hootman JM, Brault MW, Helmick CG, Theis KA, Armour BS. Prevalence and most common causes of disability among adults—United States, 2005. MMWR. 2009;58(16):421-6. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5816a2.htm?s_cid=mm5816a2_e. Accessed December 23, 2013.
5. Barbour KE, Helmick CG, Theis KA, et al. Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation—United States, 2010-2012. MMWR. 2013;62(14):869-73. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6244a1.htm. Accessed March 13, 2014.
6. Centers for Disease Control and Prevention. National Diabetes Fact Sheet, 2011. Atlanta, GA: Centers for Disease Control and Prevention, US Dept. of Health and Human Services; 2011. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf [PDF - 2.66 MB] Accessed December 20, 2013.
7. Centers for Disease Control and Prevention. Exercise or Physical Activity. NCHS FastStats Web site. http://www.cdc.gov/nchs/fastats/exercise.htm. Accessed December 20, 2013.
8. Fryar CD, Chen T, Li X. Prevalence of uncontrolled risk factors for cardiovascular disease: United States, 1999–2010. NCHS Data Brief, No. 103. Hyattsville, MD: National Center for Health Statistics, Centers for Disease Control and Prevention, US Dept. of Health and Human Services; 2012.
9. Cogswell ME, Zhang Z, Carriquiry AL, et al. Sodium and potassium intakes among US adults: NHANES 2003–2008. Am J Clin Nutr. 2012;96:647-57.
10. Centers for Disease Control and Prevention. State Indicator Report on Fruits and Vegetables, 2013. Atlanta, GA: Centers for Disease Control and Prevention, US Dept. of Health and Human Services; 2013. http://www.cdc.gov/nutrition/downloads/State-Indicator-Report-Fruits-Vegetables-2013.pdf. [PDF - 4.51 MB] Accessed December 23, 2013.
11. US Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: US Dept. of Health and Human Services, Centers for Disease Control and Prevention; 2014. http://www.surgeongeneral.gov/library/reports/50-years-of-progress/full-report.pdf. [PDF - 28.58 MB] Accessed February 7, 2014.
12. Centers for Disease Control and Prevention. Alcohol and Public Health: Alcohol Related Disease Impact (ARDI). http://nccd.cdc.gov/DPH_ARDI/default/default.aspx. Accessed March 11, 2014.
13. Centers for Disease Control and Prevention. Alcohol-attributable deaths and years of potential life lost, United States, 2001. MMWR. 2004;53:866-70. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5337a2.htm. Accessed April 9, 2014.
14. Kanny D, Liu Y, Brewer RD, Garvin WS, Balluz L. Vital signs: Binge drinking prevalence, frequency, and intensity among adults—United States, 2010. MMWR. 2012;61:14-19. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6101a4.htm?s_cid=mm6101a4_e%0d%0a. Accessed April 9, 2014.
15. Gerteis J, Izrael D, Deitz D, LeRoy L, Ricciardi R, Miller T, Basu J. Multiple Chronic Conditions Chartbook. [PDF - 10.62 MB] AHRQ Publications No, Q14-0038. Rockville, MD: Agency for Healthcare Research and Quality; 2014. Accessed November 18, 2014.
16. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics--2014 update: a report from the American Heart Association.Circulation. 2014;129(3):e28-292. http://circ.ahajournals.org/content/early/2013/12/18/01.cir.0000441139.02102.80.full.pdf. [PDF - 15.97 MB] Accessed January 6, 2014.
17. National Cancer Institute. Cancer Prevalence and Cost of Care Projections. http://costprojections.cancer.gov/. Accessed December 23, 2013.
18. American Diabetes Association. The Cost of Diabetes. http://www.diabetes.org/advocacy/news-events/cost-of-diabetes.html. Accessed December 23, 2013.
19. Centers for Disease Control and Prevention. Arthritis Cost Statistics. http://www.cdc.gov/arthritis/data_statistics/cost.htm. Accessed December 23, 2013.
20. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer- and service-specific estimates. Health Aff. 2009;28(5):w822-31. http://content.healthaffairs.org/content/28/5/w822.full.html. Accessed December 23, 2013.
21. Bouchery EE, Harwood HJ, Sacks JJ, Simon CJ, Brewer RD. Economic costs of excessive alcohol consumption in the US, 2006. Am J Prev Med. 2011;41(5):516-24. http://www.sciencedirect.com/science/article/pii/S0749379711005381. Accessed December 23, 2013.