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

1. 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

2. 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

3. 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

4. Major Chronic Diseases • Cardiovascular Disease • Cancer • Lung Cancer • Colorectal Cancer • Breast Cancer • Cervical Cancer • Prostate Cancer

5. 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

6. 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.

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

8. 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.

9. CVD Hospitalization Rates* in Missouri, 1994-2004 *Age Adjustment Uses 2000 Standard US Population Source: DHSS-MICA. * CVD as the principal diagnosis

10. CVD Inpatient Hospitalization Charges* in Missouri, by Pay Sources, 1994-2004 Source: DHSS-MICA. * CVD as the principal diagnosis

11. 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

12. CVD Mortality Rates* in Missouri, 1990-2004 Age Adjustment Uses 2000 Standard US Population Source: DHSS-MICA. * CVD as the underlying cause

13. 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

14. 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.

15. All Cancer Incidence Rates* in Missouri, 1996-2002 *Age Adjustment Uses 2000 Standard US Population Data Source: Missouri Cancer Registry

16. All Cancer Hospitalization Rates* in Missouri, 1994-2004 *Age Adjustment Uses 2000 Standard US Population Data Source: DHSS-MICA

17. 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

18. All Cancer Mortality Rates* in Missouri, 1990-2004 * Age Adjustment Uses 2000 Standard US Population Data Source: DHSS-MICA

19. Breast Cancer Mortality Rates* Among Women in Missouri, 1990-2004 * Age Adjustment Uses 2000 Standard US Population Data Source: DHSS-MICA

20. Breast Cancer Mortality Rates* in Missouri, 1990-2004 * Age Adjustment Uses 2000 Standard US Population Data Source: DHSS-MICA

21. Lung Cancer Mortality Rates* in Missouri, 1990-2004 * Age Adjustment Uses 2000 Standard US Population Data Source: DHSS-MICA

22. Lung Cancer Mortality Rates* in Missouri, by Sex, 1990-2004 * Age Adjustment Uses 2000 Standard US Population Data Source: DHSS-MICA

23. 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.

24. 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.

25. Prevalence of Self-reported Physician Diagnosed Diabetes in Missouri, 1990-2005 Data Source: Missouri BRFSS

26. Diabetes Inpatient Hospitalization Rates* in Missouri, 1993-2001 Age Adjustment Uses 2000 Standard US Population Source: DHSS-MICA. * Diabetes as the principal diagnosis

27. Diabetes* Emergency Room Visit Rates in Missouri, 1994 - 2004 Age Adjustment Uses 2000 Standard US Population Source: DHSS-MICA. * Diabetes as the principal diagnosis

28. 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

29. Diabetes Mortality Rates* in Missouri, 1990-2004 *Age Adjustment Uses 2000 Standard US Population Source: DHSS-MICA. * Diabetes as the underlying cause

30. 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.

31. Prevalence of Physician-diagnosed Arthritis, 2005

32. Arthritis Hospitalization Rates* in Missouri, 1993-2003 *Age Adjustment Uses 2000 Standard US Population Source: DHSS-Community Data Profile

33. 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

34. 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%

35. Asthma Inpatient Hospitalization Rates* in Missouri, 1994-2004 *Age Adjustment Uses 2000 Standard US Population Source: DHSS-Community Data Profile

36. 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

37. Asthma ER Rates in Missouri, 1994-2004 Age Adjustment Uses 2000 Standard US Population Source: DHSS-MICA. * Asthma as the principal diagnosis

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

39. Evidence-Based Interventions TopicsAlcoholCancerDiabetesMental HealthMotor VehicleNutritionOral HealthPhysical Activity PregnancySexual BehaviorSocial EnvironmentSubstance AbuseTobaccoVaccinesViolence http://www.thecommunityguide.org/alcohol/default.htm

40. 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

41. 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%

42. Prevalence of Smoking among Adults in Missouri

43. Obesity Prevalence among Adults in Missouri, 1990 - 2002

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

45. Aging population

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