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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. Chronic Diseases.

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The burden of chronic diseases in missouri opportunities and challenges for public health l.jpg

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


Chronic diseases l.jpg
Chronic Diseases and Challenges for Public Health

  • 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 and Challenges for Public Health

  • 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 and Challenges for Public Health

  • Cardiovascular Disease

  • Cancer

    • Lung Cancer

    • Colorectal Cancer

    • Breast Cancer

    • Cervical Cancer

    • Prostate Cancer


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Major Chronic Diseases and Challenges for Public Health

  • 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


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Chronic Diseases in the U.S. and Challenges for Public Health

  • 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.


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Leading Causes of Death in Missouri, 2004 and Challenges for Public Health

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 Nation

*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 Sources, 1994-2004

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 Sources, 1994-2004

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 Sources, 1994-2004

  • 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 Sources, 1994-2004

*Age Adjustment Uses 2000 Standard US Population

Data Source: Missouri Cancer Registry


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All Cancer Hospitalization Rates* in Missouri, 1994-2004 Sources, 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 by Pay Sources

* 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 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 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 1990-2004

* Age Adjustment Uses 2000 Standard US Population

Data Source: DHSS-MICA


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Diabetes is on the rise in Missouri 1990-2004

  • 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 1990-2004

  • 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 Pay Sources, 1994-2004

*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 Pay Sources, 1994-2004

  • 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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Arthritis Hospitalization Rates* in Missouri, 1993-2003 Pay Sources, 1994-2004

*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 <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%


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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 Pay Sources

Age Adjustment Uses 2000 Standard US Population

Source: DHSS-MICA. * Asthma as the principal diagnosis


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Opportunities Pay Sources

  • 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 Pay Sources

TopicsAlcoholCancerDiabetesMental HealthMotor VehicleNutritionOral HealthPhysical Activity

PregnancySexual BehaviorSocial EnvironmentSubstance AbuseTobaccoVaccinesViolence

http://www.thecommunityguide.org/alcohol/default.htm


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Challenges Pay Sources

  • 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 Pay Sources

  • 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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Aging population Missouri Adults, 1990-2002


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Thank You Missouri Adults, 1990-2002


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