What is the most common chronic disease in the US?

High prevalence of chronic conditions has been a key driver of healthcare costs in the United States, and Medicaid beneficiaries tend to have higher rates of chronic diseases than people not on Medicaid.

High prevalence of chronic conditions has been a key driver of healthcare costs in the United States, and Medicaid beneficiaries tend to have higher rates of chronic diseases than people not on Medicaid.

A new review published in American Journal of Preventive Medicine examined studies published between 2000 and 2016 to estimate the prevalence and cost of noncommunicable chronic diseases in Medicaid.

“As the Medicaid population continues to change, it is increasingly important to understand the major health burdens this population faces and the associated medical costs, which is important for informing future program design and developing health promotion programs to contain or reduce the public health burden and healthcare costs,” the authors explained.

The review looked at adults between the ages of 18 and 64 years and, based on the 29 studies selected, reported the following prevalence estimates:

• 8.8% to 11.8% for heart disease
• 17.2% to 27.4% for hypertension
• 16.8% to 23.2% for hyperlipidemia
• 7.5% to 12.7% for diabetes
• 9.5% for cancer
• 7.8% to 19.3% for asthma
• 5% to 22.3% for depression
• 55.7% to 62.1% for 1 or more chronic conditions

The review presented the total cost per patient with disease and the disease-related cost per patient with disease separately. For total cost per patient, heart failure/congestive heart failure ($29,271 to $51,937) and cancer ($29,384 to $46,194) were the most expensive. However, in the disease-related cost category, congenital heart disease ($5835), heart failure/congestive heart failure ($7031), and chronic obstructive pulmonary disease (COPD) ($3968 to $6491) were the most expensive based on the studies reviewed.

In general, Medicaid beneficiaries have a high prevalence of heart diseases. Hypertension, hyperlipidemia, heart disease, and diabetes were common comorbidities. The review also found that patients with COPD had high rates of hypertension and diabetes.

The authors did acknowledge some limitations, such as many studies using state-level data, which is important since states’ Medicaid populations can vary. In addition, the use of claims data in many of the studies in the review might undercount the number of patients with certain chronic conditions. Despite the limitations, the review confirms the high prevalence of noncommunicable chronic diseases among Medicaid beneficiaries.

“The specific prevalence and cost estimates highlighted here could be used to inform the evaluation of interventions for effectively managing chronic diseases and controlling costs in this vulnerable population and for informing future designs of the Medicaid program,” the authors concluded.

Written by Brianne Cipich, DDS

Pediatric Dental Trainee in the Indiana LEND program

Dental cavities (also known as caries or decay) is the most common chronic disease in children: it is about 5 times more common than asthma and 7 times more common than hay fever1. It is also preventable. Yet, about 1 of 5 children aged 5-11 has as least one untreated tooth with decay. The argument most people make is, “Well, they’re just baby teeth. They’re going to lose them anyway.” While they will lose these teeth eventually, losing them early can lead to future problems. When children lose these teeth early due to large cavities, it is very possible that their adult teeth will not come into the correct spot. This is because the adult tooth needs the baby tooth to be present to save space and to guide the tooth to where it needs to go. This can then lead to very severe crowding and a need for braces, which not all families can afford. This becomes a fairly expensive treatment for something that was preventable (the cavities) from the start. 

Did you know that children with poor oral health miss more school and have lower grades than children who don’t have cavities? On average, children miss more than 51 million school hours per year due to illnesses related to dental problems2. They also have many difficulties focusing when they are experiencing tooth pain, which can lead to lower success in the classroom. Dental cavities also increase the risk for other health problems.

This has become a national crisis. 

Oral health care is part of overall health care. Oral health education is very much lacking, especially early on in a child’s life. A great opportunity is to begin the oral health discussion with parents even before the child is born. There is evidence that maternal oral health status and oral hygiene practice has a significant influence on a child’s general and oral health3. The risk for an infant to get cavities strongly goes hand in hand with the mother having high amounts of cavity-causing bacteria, which can then be transmitted to the infant. We know these things, yet little early education takes place. Once the child has been born, the parents should be informed to wipe the child’s gums at least once a day with a clean washcloth. This will help remove the bacteria that is already starting to live in the infant’s mouth, helping set the infant up for success in the future.

Coordination between the dental team and pediatricians, family physicians, nurses who are at the front-line would also be ideal. This could lead to more education for the parents at the very beginning. This is especially important due to the lack of dentists/pediatric dentists in some areas. Parents can be better informed about how cavities start. I commonly have parents tell me, “But I brush my child’s teeth two times a day, why does he/she have cavities?” There are many factors involved: the presence of the bacteria that causes cavities, sipping sugary drinks multiple times a day (this includes juice!), not cleaning the teeth effectively, and frequent snacking on fermentable carbohydrates. This is fancy term for snacks that break down into simple sugars and acid that then hurts the teeth. This can include goldfish, sticky fruits, raisins, not just the common “cookies, cake and candy.”  The more frequently the teeth are attacked by these acids during the day, the less time they have to recover in between attacks. These snacks are best for big mealtimes and healthier options are best for in-between mealtimes (like cheese, nuts, carrots, celery, apples). A discussion about what foods can cause cavities and the importance of oral hygiene should take place at well-child visits or at the least a pamphlet could be handed out. It’s sometimes a challenge for dentists to discuss changes in diet and snacking habits with parents because they claim they have not been told they need to make these changes by another healthcare provider. The child should ideally see a dentist by the time they get their first tooth or their first birthday to help set the family up for success and to get the child accustomed to dental checkups early on.

Lastly, more resources for parents would be great. It’s easy for me to say, “get in your car and go to the dentist two times a year.” But what about for the parents who maybe don’t have a car? Or those who the nearest dentist is 2 hours away? Or the child who doesn’t have dental insurance? Or the child’s insurance doesn’t cover all treatment needs? There are many other factors that go with this discussion, and I hope that we can advocate for change to see progress in treating this common chronic disease. 

1) Benjamin RM. Oral health: the silent epidemic. Public Health Rep. 2010;125(2):158-159. doi:10.1177/003335491012500202

2) Jackson SL, Vann WF Jr, Kotch JB, Pahel BT, Lee JY. Impact of poor oral health on children's school attendance and performance. Am J Public Health. 2011;101(10):1900-1906. doi:10.2105/AJPH.2010.200915

3) Abou El Fadl R, Blair M, Hassounah S. Integrating Maternal and Children's Oral Health Promotion into Nursing and Midwifery Practice- A Systematic Review. PLoS One. 2016;11(11):e0166760. Published 2016 Nov 23. doi:10.1371/journal.pone.0166760

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