Six in Ten in US Have Chronic Disease - is CDC correct?

[TheVat]

This CDC stat I saw recently in a news article was a bit of a shock.

https://www.cdc.gov/chronicdisease/index.htm

"Six in ten Americans live with at least one chronic disease, like heart disease and stroke, cancer, or diabetes."

 This number really doesn't line up with my own experiences, with a variety of social and work circles in five different states, so clearly I have had sampling errors and perceptual filters that led me to think that number would be lower.  Either that, or the statistic presented has been tinkered with in some misleading way.  (if that figure was describing, say, all adults over fifty, I would find it easier to swallow)

[StringJunky]

Quote

The latest data from American has revealed that over 73% of US adults are overweight or obese.

Of those, 42% American adults had obesity and 10% were severely obese, while another 30.7% were overweight with a body mass index (BMI) of 25 to 29.9.

BMI is a person’s weight in kilograms divided by the square of height in metres, with the overweight range between 25 and 29.9 and obese range from 30 to 39.9.

A new report has also revealed that 19.3% of children and young people, aged between two and 19, had obesity, with 6.1% of kids identified as being severely obesity.

https://www.diabetes.co.uk/news/2020/dec/more-than-73-of-american-adults-overweight-or-obese.html#:~:text=The latest data from American,BMI) of 25 to 29.9.

Anecdotally, friends who have been over there say there is a lot of very overweight people your side. The UK isn't great either these days, but Americans top the overweight podium, it seems.

[Phi for All]

Their definition of "chronic disease" is pretty broad, and includes anything you take a regular medication for, and anything that hampers any aspect of "daily living". 

Quote

Chronic diseases are defined broadly as conditions that last 1 year or more and require ongoing medical attention or limit activities of daily living or both.

That said, for the money we pay out, we have a terrible healthcare system, where who gets paid is more important than who gets well.

[exchemist]

55 minutes ago, TheVat said:

This CDC stat I saw recently in a news article was a bit of a shock.

https://www.cdc.gov/chronicdisease/index.htm

"Six in ten Americans live with at least one chronic disease, like heart disease and stroke, cancer, or diabetes."

 This number really doesn't line up with my own experiences, with a variety of social and work circles in five different states, so clearly I have had sampling errors and perceptual filters that led me to think that number would be lower.  Either that, or the statistic presented has been tinkered with in some misleading way.  (if that figure was describing, say, all adults over fifty, I would find it easier to swallow)

If you are a member of the professional class, active and in work, you won’t see that much of the unhealthy portion of the population. Commuting to work in London, one notices how young and healthy many people are, compared with say a coastal English town that one might visit on holiday. In the US I suspect there is also a strong ethnic divide, with poor health prevalent among groups one meets fewer of. 
 

But I see they include as chronic disease anything that lasts over a year and requires treatment. That strikes me as very broad.

[swansont]

1 hour ago, StringJunky said:

Anecdotally, friends who have been over there say there is a lot of very overweight people your side. The UK isn't great either these days, but Americans top the overweight podium, it seems.

Almost two-thirds of US adults are overweight or obese, and that triggers a lot of chronic issues.

https://www.aha.org/system/files/content/00-10/071204_H4L_FocusonWellness.pdf

There’s also the overall aging, as the baby boom generation are all senior citizens now.

 

I wonder if the CDC meant to say adults, vs all. 

 

There’s also this

https://www.latimes.com/business/story/2023-04-05/americas-decline-in-life-expectancy-speaks-volumes-about-our-problems

 

[TheVat]

I thought several of your observations - the broadness of their category, the profit-focused trend in healthcare, the differentials between regions and socioeconomic groups, and the aging population - all helpful in understanding this lamentable stat.  Also the aggressive marketing of cheap junk food.  (go to France, hang with the locals, and try snacking on a bag of cheezits - they will emit horrified noises and toss you in the nearest river)(and if you eat lots of junk food you you will float easily)

I've seen stark contrasts myself between states.  When I'm in the Colorado front range, for example, it's really noticeable how thin and fit people look, compared to rural western Kansas and Nebraska, a couple hundred miles away.  In Colorado, lots of bikes and bike trails, lots of hikers, lots of healthy food stores, great variety of outdoor activities, etc.  IOW, a fitness oriented culture, and people who move there to be part of it.  I saw this statistical study by state, of rates of multiple chronic conditions and found huge differences, with Arkansas at 60.5% and Colorado at 42%. 

 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7199953/

Interesting that DC was the lowest, at 38%.  (which may relate to factors like more walkable neighborhoods, quality healthcare, young healthy people who move there to work government jobs and then move away when older, etc)

[StringJunky]

There's also the problem of avoiding the appearance of victimizing said cohort when trying to address this publicly.. I see a few comments in Quora of people disgusted that such 'personal' topics were being openly discussed. I was looking into the proportions of overweight police officers and why things were this way, the culture, lack of routine health oversight, work conditions etc. US police unions are an obstacle as well, apparently, to any major reforms.

Edited July 19, 2023 by StringJunky

[CharonY]

I am not sure why having a broad definition is an issue. In fact, it is rather necessary to assess health burden. I may be misunderstanding OP, but it sounds to me that it is potentially assumed that "chronic" is somewhat aligned with severity and should therefore be visible.

However in this context the issue with chronic diseases is that they require ongoing management, regardless of severity. A lot of folks have hypertension, for example. Often it is well managed. Similarly, you would not easily notice folks with osteoathritis or osteoporosis other in their most extreme forms. Likewise, depression is a chronic disease, which has spiked a fair bit during the pandemic.

And if you go down the list of common chronic diseases, it is rather easy to see how you would get to 40-60% of the population having at least one of the issues especially taking an aging (and/or overweight) population into account. It should also be noted that chronic disease information in various jurisdictions can vary or missing, so comparison between countries could be difficult. Some require multi-year treatment rather than 1yr to qualify, or could be based on self-reporting (as in some European databases).

That being said, diabetes is a very strong indicator with enormous health burden and we can see here that the UK has a surprisingly low prevalence (about 4%), whereas Canada, Germany USA and Mexico are way higher (7.6, 10.4, 10.8 and 13.5).

 

[iNow]

4 hours ago, CharonY said:

diabetes is a very strong indicator with enormous health burden

Did you intend your comment to include both types of diabetes here, or just Type 2?

[StringJunky]

24 minutes ago, iNow said:

Did you intend your comment to include both types of diabetes here, or just Type 2?

Type 1 is not the result of a life style issue, is it?

Edited July 20, 2023 by StringJunky

[CharonY]

2 hours ago, iNow said:

Did you intend your comment to include both types of diabetes here, or just Type 2?

The data is for total (including unclassified). But the vast majority is typeII.

[iNow]

13 hours ago, StringJunky said:

Type 1 is not the result of a life style issue, is it?

Generally no, but that’s not to say it’s impossible. 

11 hours ago, CharonY said:

The data is for total (including unclassified). But the vast majority is typeII.

Helpful. Thx. 

[OldChemE]

On 7/19/2023 at 4:10 PM, CharonY said:

I am not sure why having a broad definition is an issue. In fact, it is rather necessary to assess health burden. I may be misunderstanding OP, but it sounds to me that it is potentially assumed that "chronic" is somewhat aligned with severity and should therefore be visible.

However in this context the issue with chronic diseases is that they require ongoing management, regardless of severity. A lot of folks have hypertension, for example. Often it is well managed. Similarly, you would not easily notice folks with osteoathritis or osteoporosis other in their most extreme forms. Likewise, depression is a chronic disease, which has spiked a fair bit during the pandemic.

And if you go down the list of common chronic diseases, it is rather easy to see how you would get to 40-60% of the population having at least one of the issues especially taking an aging (and/or overweight) population into account. It should also be noted that chronic disease information in various jurisdictions can vary or missing, so comparison between countries could be difficult. Some require multi-year treatment rather than 1yr to qualify, or could be based on self-reporting (as in some European databases).

That being said, diabetes is a very strong indicator with enormous health burden and we can see here that the UK has a surprisingly low prevalence (about 4%), whereas Canada, Germany USA and Mexico are way higher (7.6, 10.4, 10.8 and 13.5).

 

I believe the main issue with the broad definition is that it makes the problem more easily discounted or ignored ("What, 6 in 10?? politics!")

[TheVat]

On 7/19/2023 at 5:10 PM, CharonY said:

I am not sure why having a broad definition is an issue. In fact, it is rather necessary to assess health burden. I may be misunderstanding OP, but it sounds to me that it is potentially assumed that "chronic" is somewhat aligned with severity and should therefore be visible.

However in this context the issue with chronic diseases is that they require ongoing management, regardless of severity. A lot of folks have hypertension, for example. Often it is well managed. Similarly, you would not easily notice folks with osteoathritis or osteoporosis other in their most extreme forms. Likewise, depression is a chronic disease, which has spiked a fair bit during the pandemic.

Thanks, I think the way this was quoted was what initially led to my surprise, because it made it sound like the stat was about severe conditions.  Yes, once you include all with managed hypertension, asthma, common conditions of aging like osteoarthritis (something like 25-30 percent of population), and those who have had an extended period of depression, then that figure makes sense and could even be on the low side.  

[mistermack]

Doesn't this average income map look a bit like the earlier "age at death" map? I wonder why? 

[CharonY]

15 hours ago, OldChemE said:

I believe the main issue with the broad definition is that it makes the problem more easily discounted or ignored ("What, 6 in 10?? politics!")

I get what you are saying, and it is a general issue in public health that folks tend to think in extremes (e.g. deaths) but forget about health burden, loss of quality of life, and associated cost and drain on the health care system. After all managing a a disease for decades is often  more expensive than just dropping dead. 

[OldChemE]

6 hours ago, CharonY said:

I get what you are saying, and it is a general issue in public health that folks tend to think in extremes (e.g. deaths) but forget about health burden, loss of quality of life, and associated cost and drain on the health care system. After all managing a a disease for decades is often  more expensive than just dropping dead. 

exactly!

[CharonY]

On 7/20/2023 at 11:50 AM, iNow said:

Generally no, but that’s not to say it’s impossible. 

Helpful. Thx. 

I should also add that the pandemic might have increased levels in at least some jurisdictions as infections have been associated with increased risk of developing either Type I or II diabetes. But considering the baseline, it is also very possible that the levels have not moved much.

[Steve81]

Well, as anecdotal evidence goes, of the three people in my office, two of us have chronic diseases, and lucky me, I have multiple 😄

Of course since dementia runs on both sides of my family, I welcome that early (but hopefully not too early) demise.

[Ayass Researc]

Yes it is true

[Wigberto Marciaga]

There may be several explanations, but one that occurs to me is that perhaps there are people around you who do not tell everyone about the illnesses they suffer from.

I'm not American, I'm from Panama. But, my particular case is that although I have stage 4 morbid obesity (35 years old), I do not have a conventional chronic disease because of it. But, I do have chronic illnesses like probably gastritis, Wolf Parkinson White (a birth condition), and allergies. I could also mention scoliosis and leg valgus (legs in x).

Those are also chronic diseases, but I rarely mention them because I consider them practically harmless. I don't take medication for them and, in fact, I don't take medication at all.

On the other hand, there are people who have health problems, called mental health problems. These so-called mental illnesses are also usually chronic and many people prefer not to talk about it.

Of course, in the case of mental illness there are a lot of false positives, it seems. As I have recently been reading what has happened in long covid cases. Many with this condition appear to have been diagnosed with anxiety. That would only be evidence of the lack of rigor in the diagnosis of mental illnesses and in the issue of mental health in general.

So people can have various chronic pathologies, whether they take medication or not. Some more serious, others less. And, of course, there are also the wrong diagnoses and wrong prescriptions that could be adding to the list.

In my case, as I said, I am obese stage 4. But I have been with calorie replacement for almost a year, that may explain, in part, why I do not develop hypertension, diabetes, or risky cholesterol. Although I have had high triglycerides, but for that I have taken some measures such as giving up juices, doing more frequent physical activity and, especially, I think it would be useful to reduce stress.

Actually the studies I have read do not point towards conventional obesity as one of the 4 main health problems, nor a trigger primary. The worst situation is known as visceral fat, or central obesity, and this condition occurs in thin people as well (normal weight). 

In fact, studies point to what is known as the obesity paradox, where people who are considered obese by BMI may have better health than those considered normal weight, or have a greater probability of surviving cardiovascular events.

In my case, my current diet is mainly based on whole grains. Lately I'm eating more meat, but it's not the norm. I also consume dairy products in somewhat outstanding quantities (more than the recommended servings).

The cereals that I consume the most are brown rice and wheat (whole wheat bread).

I also consumed a lot of fruit, and in terms of juices I consumed, I estimate, the sugar equivalent of almost 5 Coca-Colas daily. But now I prefer to give up juices because of the issue of triglycerides, although it seems to me that the main cause of their increase has been stress.

On the subject, well, it seems to me that there can be many chronic diseases. However, obese people who spend their time eating refined foods will obviously end up very sick and with metabolic syndrome (but this is not something exclusive to obese people).

Perhaps in the United States chronic diseases present in metabolic syndrome, like metabolic syndrome itself, are the main cause of chronic disease in people. But, we can consider that it is probably not the only one.

P.S I want to mention, obesity is not recommended, the point is that losing weight is possible, but maintaining the lost weight is almost impossible for most. A healthier approach, in that context, would be calorie replacement, stress reduction, and physical activity. When people lose weight using calorie restriction, ghrelin increases, this will make them very hungry and possibly enlarge the stomach and the next time it will be more difficult to lose weight again.

Blessing in the name of Yeshu.

On 7/19/2023 at 11:11 PM, StringJunky said:

Type 1 is not the result of a life style issue, is it?

I think not, that would be purely genetic.

I am Hispanic and also have black and Indian ancestors, so from what I have read I would be at higher risk for cardiometabolic diseases such as type 2 diabetes than other populations. But this can be avoided with healthy habits.

Blessing

Edited April 7 by Wigberto Marciaga