The Burden of Chronic Diseases in Missouri: Opportunities and Challenges for Public Health

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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
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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
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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
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Major Chronic Diseases

• Cardiovascular Disease
• Cancer
• Lung Cancer
• Colorectal Cancer
• Breast Cancer
• Cervical Cancer
• Prostate Cancer

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Major Chronic Diseases

• Chronic Lung Diseases
• Asthma
• Chronic Obstructive Pulmonary Disease
• Diabetes
• Arthritis and Other Musculoskeletal Diseases
• Osteoarthritis
• Rheumatoid Arthritis
• Osteoporosis
• Chronic Neurologic Disorders
• Alzheimers Disease
• Parkinsons Disease

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Chronic Diseases in the U.S.

• According to CDC, more than 90 million people in
  the U.S. live with a chronic illness. 
• Chronic diseasessuch 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.

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Leading Causes of Death in Missouri, 2004
Septicemia
Source DHSS-MICA
Source DHSS-MICA
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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.

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CVD Hospitalization Rates in Missouri, 1994-2004
Age Adjustment Uses 2000 Standard US
Population Source DHSS-MICA. CVD as the
principal diagnosis
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CVD Inpatient Hospitalization Charges in
Missouri, by Pay Sources, 1994-2004
Source DHSS-MICA. CVD as the principal
diagnosis
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CVD Inpatient Hospitalization Charges in
Missouri, by Pay Sources, 1994-2004
Source DHSS-MICA. CVD the principal
diagnosis Taking into account population change
and CPI medical component
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CVD Mortality Rates in Missouri, 1990-2004
Age Adjustment Uses 2000 Standard US
Population Source DHSS-MICA. CVD as the
underlying cause
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CVD Death Rates in the US , 1999
Age-adjusted Death Rates per 100,000 Population
Source http//www.cdc.gov/nccdphp/bb_heartdisease
/index.htm
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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.

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All Cancer Incidence Rates in Missouri, 1996-2002
Age Adjustment Uses 2000 Standard US Population
Data Source Missouri Cancer Registry
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All Cancer Hospitalization Rates in Missouri,
1994-2004
Age Adjustment Uses 2000 Standard US
Population Data Source DHSS-MICA
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All Cancer Inpatient Hospitalization Charges in
Missouri, by Pay Sources
Source DHSS-MICA. Cancer as the principal
diagnosis Taking into account population change
and CPI medical component
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All Cancer Mortality Rates in Missouri, 1990-2004
Age Adjustment Uses 2000 Standard US
Population Data Source DHSS-MICA
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Breast Cancer Mortality Rates Among Women in
Missouri, 1990-2004
Age Adjustment Uses 2000 Standard US
Population Data Source DHSS-MICA
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Breast Cancer Mortality Rates in Missouri,
1990-2004
Age Adjustment Uses 2000 Standard US
Population Data Source DHSS-MICA
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Lung Cancer Mortality Rates in Missouri,
1990-2004
Age Adjustment Uses 2000 Standard US
Population Data Source DHSS-MICA
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Lung Cancer Mortality Rates in Missouri, by Sex,
1990-2004
Age Adjustment Uses 2000 Standard US
Population Data Source DHSS-MICA
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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.

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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.

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Prevalence of Self-reported Physician Diagnosed
Diabetes in Missouri, 1990-2005
Data Source Missouri BRFSS
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Diabetes Inpatient Hospitalization Rates in
Missouri, 1993-2001
Age Adjustment Uses 2000 Standard US
Population Source DHSS-MICA. Diabetes as
the principal diagnosis
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Diabetes Emergency Room Visit Rates in Missouri,
1994 - 2004
Age Adjustment Uses 2000 Standard US
Population Source DHSS-MICA. Diabetes as the
principal diagnosis
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Diabetes Inpatient Hospitalization Charges in
Missouri, by Pay Sources, 1994-2004
Diabetes as the principal diagnosis Taking into
account population change and CPI medical
component
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Diabetes Mortality Rates in Missouri, 1990-2004
Age Adjustment Uses 2000 Standard US
Population Source DHSS-MICA. Diabetes as the
underlying cause
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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.

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Prevalence of Physician-diagnosed Arthritis, 2005
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Arthritis Hospitalization Rates in Missouri,
1993-2003
Age Adjustment Uses 2000 Standard US
Population Source DHSS-Community Data Profile
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Osteoarthritis Inpatient Hospital Charges in
Missouri, by Pay Sources, 1994-2004
Source DHSS-MICA. Osteoarthritis as the
principal diagnosis Taking into account
population change and CPI medical component
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Asthma Leading Cause of Hospitalization among
Children lt15 Yrs

• More than 30,000 ER visits each year in Missouri
• More than 1/3 by children lt 15 yrs
• More than 7,000 hospitalizations each year
• More than 1/3 by children lt 15 yrs
• Adults with current asthma in 2005 9

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Asthma Inpatient Hospitalization Rates in
Missouri, 1994-2004
Age Adjustment Uses 2000 Standard US
Population Source DHSS-Community Data Profile
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Asthma Inpatient Hospitalization Charges in
Missouri, by Pay Sources
Source DHSS-MICA. Asthma as the principal
diagnosis Taking into account population change
and CPI medical component
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Asthma ER Rates in Missouri, 1994-2004
Age Adjustment Uses 2000 Standard US
Population Source DHSS-MICA. Asthma as the
principal diagnosis
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Opportunities

• Chronic diseases are preventable.
• Prevention is cost-effective.
• Public health interventions work.
• Infrastructure for chronic disease prevention and
  control exists.

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Evidence-Based Interventions
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.h
tm
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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

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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

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Prevalence of Smoking among Adults in Missouri
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Obesity Prevalence among Adults in Missouri, 1990
- 2002
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Prevalence of No Leisure-time Physical Activity
among Missouri Adults, 1990-2002
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Aging population
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