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Chronic Disease
A Public Health Perspective
Ronald Fischbach, Ph.D.
Chronic Disease Overview
• The most prevalent, costly, and preventable
chronic diseases
– cardiovascular disease (primarily heart disease
and stroke),
– cancer, and
– diabetes
Leading Causes of Death in the
U.S., 2003
Costs of Chronic Disease, U.S.
• In 2005, 133 million people, almost half of all Americans
lived with at least one chronic condition
• The medical care costs of people with chronic diseases
account for more than 75% of the nation’s $2 trillion
medical care costs.
• $17,239 expenditure per household
• Chronic diseases account for one-third of the years of
potential life lost before age 65.
• Hospitalizations for pregnancy-related complications
occurring before delivery account for more than $1 billion
annually.
• The direct and indirect costs of diabetes is $174 billion a
year.
Costs of Chronic Disease, U.S.
(Continued)
• Each year, arthritis results in estimated medical care
costs of nearly $81 billion, and estimated total costs
(medical care and lost productivity) of $128 billion.
• The estimated direct and indirect costs associated with
smoking exceed $193 billion annually.
• In 2008, the cost of heart disease and stroke in the U.S.
is projected to be $448 billion.
• The estimated total costs of obesity was nearly $117
billion in 2000.
• Cancer costs the nation an estimated $89 billion
annually in direct medical costs.
• Nearly $98.6 billion is spent on dental services each
year.
Cost-Effectiveness of Prevention
• Water fluoridation
• Smoking cessation
• Safer Choice Program (a school-based
HIV, other STD, and pregnancy prevention
program),
• Preconception care
• Arthritis Self-Help Course
• Breast cancer
CDC's Chronic Disease Programs
• CDC supports a variety of programs to improve the nation's
health by preventing chronic diseases and their risk factors.
• These programs provide national leadership
• Sample CDS Program
• Arthritis
• Cancer Control
• Diabetes
• Healthy Aging
• Healthy Youth
• Heart Disease and Stroke
• Nutrition, Physical Activity and Obesity
• Safe Motherhood
• Tobacco
Targeting Arthritis
• Improving Quality of Life for More Than
46 Million Americans
• The Nation’s Most Common Cause of
Disability
• Arthritis comprises over 100 different
diseases and conditions
• Common symptoms
Why Is Arthritis a Public Health
Problem?
• An estimated 46 million U.S. adults (about 1 in
5) reported doctor-diagnosed arthritis
• Nearly 19 million U.S. adults reported activity
limitations because of arthritis
• Work limitations attributable to arthritis affect
about 1 in 20 adults
• Arthritis results in 750,000 hospitalizations and
36 million outpatient visits
• 128 billion dollars in annual costs
• Arthritis is responsible for 9,500 deaths in the
U.S. annually
What Can Be Done to Target
Arthritis?
• Self-management education programs
• Chronic Disease Self-Management
Program
• Physical activity
• Weight control and injury prevention
• Early diagnosis and appropriate
management
What Are CDC and Its Partners
Doing About Arthritis?
• CDC is committed to leading strategic
public health efforts to promote well-being,
prevent chronic disease, and achieve
health equity.
• For example, the National Arthritis Action
Plan
What Activities Does CDC’s
Arthritis Program Support?
• The primary goal is to improve the quality
of life for people affected by arthritis.
• The program achieves this goal by
supporting the following five key activities:
– Building state programs
– Reaching the Public
– Improving the science base
– Measuring the burden of arthritis
– Making policy and systems changes
Future Directions for the CDC
• Improve the quality of life for people affected by
arthritis
• Move state programs from building capacity to
implementing programs on a wider scale
• Identify model dissemination efforts
• Develop innovative interventions that meet the
needs of diverse populations
• Work collaboratively with other chronic disease
programs at federal and state levels
CDC Funding for State Arthritis
Programs, 2008
Chronic Disease Indicators
• Ninety indicators that allows states and
territories to uniformly define, collect, and report
chronic disease data
• Seven categories:
–
–
–
–
–
–
–
Physical activity and nutrition
Tobacco and alcohol use
Cancer
Cardiovascular disease
Diabetes
Overarching conditions
Other diseases and risk factors
Tobacco Use
• The definition for each indicator includes a hyperlink to additional
information and data resources. These include—
• Behavioral Risk Factor Surveillance System (BRFSS)
• Alcohol and Public Health
• Youth Risk Behavioral Surveillance System (YRBSS)
• State Tobacco Activities Tracking and Evaluation (STATE) System
• National Program of Cancer Registries
• State Cancer Profiles
• CDC WONDER
• Health-Related Quality of Life
• United States Renal Data System (USRDS)*
• Current Population Survey, American Community Survey
• National Diabetes Surveillance System
• National Oral Health Surveillance System
Tobacco Use: Behavioral Risk Factor
Surveillance System (YRBSS)
Tobacco Use: Behavioral Risk Factor
Surveillance System (YRBSS)- California
Tobacco Use: Behavioral Risk Factor
Surveillance System (YRBSS)- California
Tobacco Use: Behavioral Risk Factor
Surveillance System (YRBSS)- California
Tobacco Use: Behavioral Risk Factor
Surveillance System (YRBSS)- California by
Income
Tobacco Use: Behavioral Risk Factor
Surveillance System (YRBSS)- California by
Race
Tobacco Use: Behavioral Risk Factor
Surveillance System (YRBSS)- California by
Education
Tobacco Use: Behavioral Risk Factor
Surveillance System (YRBSS)- California by
Gender
Current California Adults
Current California Adults Grouped
by Income
What You Can Do
• http://apps.nccd.cdc.gov/brfss/page.asp?cat=TU&yr=200
7&state=CA#TU
What You Can Do (Continued)
• Choose one of the other chronic diseases
• Click on the choice
• Explore the links and identify a possible
public health intervention issue and target
population
Review Questions (Developed by
the Supercourse team)
• What is the role of CDC in the prevention
of non-communicable diseases?
• Arthritis is a serious chronic disease, do
you feel that it is receiving sufficient
attention?
• What more can be done to reduce
smoking in the US?