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, 2 nd 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, 2 nd 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

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 Source: http://www.cdc.gov/nccdphp/bb_heartdisease/index.htm Age-adjusted Death Rates per 100,000 Population

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 Topics Alcohol Cancer Diabetes Mental Health Motor Vehicle Nutrition Oral Health Physical Activity AlcoholCancerDiabetesMental HealthMotor VehicleNutritionOral HealthPhysical Activity Pregnancy Sexual Behavior Social Environment Substance Abuse Tobacco Vaccines Violence 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

47. Thank You