No One Is Immune To Chronic Conditions. Men And Chronic Conditions
Number 1
CHRONIC AND DISABLING CONDITIONS
CHALLENGES FOR THE 21
November 1999
Chronic
Conditions
NATIONAL
ACADEMY ON AN
AGING SOCIETY
A challenge for the 21st century
Chronic conditions are the major cause of illness, disability, and death in the United
States. Almost 100 million Americans have chronic conditions and millions more will
develop them as America ages. The continued growth in the number of elderly—as
baby boomers age and as people live longer—will cause an increase in the number of
people who are most vulnerable to and most affected by chronic conditions.
Projections indicate that by 2040, almost 160 million people will have chronic con-
ST
ditions. The cost of medical care for Americans with chronic conditions was $470 bil-
lion in 1995. By 2040 that cost could be as high as $864 billion.1
CENTURY
MOST
No one is immune to chronic conditions. Men and
women, people of all racial and ethnic groups, and
people of all ages and financial means have chronic
COMMON
conditions. The extent to which chronic conditions affect
people’s lives differs, however. Moreover, those who have the
CHRONIC
conditions are not the only ones affected. Family members
:
CONDITIONS
and friends who arrange for or provide care may also have to
modify their lives to accommodate chronic conditions.
ALL AGES
s Sinusitis
s Arthritis
The elderly have more disabling
s Orthopedic impairments
conditions
s Hypertension
The type of chronic conditions that are common varies con-
s Hay Fever
siderably with age. For example, asthma is the most common
condition among children, but is less common among adults,
AGE 75+
and arthritis is more common among adults, especially older
s Arthritis
adults. On the whole, the conditions that are most common
s Hypertension
among older age groups require more care, are more disabling,
s Hearing impairments
and are more difficult and costly to treat than the conditions
s Heart Disease
that are more common for younger age groups.
s Cataracts
The prevalence of conditions also varies with age. For exam-
ple, asthma affects 7 percent of children. Arthritis, the most
common condition for 45 to 74 year olds affects 28 percent of
that population and half of all people age 75 and older.
N A T I O N A L A C A D E M Y O N A N A G I N G S O C I E T Y
dic impairments, hypertension, and hay
WHAT ARE CHRONIC
fever. Some diseases are associated more
with blacks than whites, however. For exam-
CONDITIONS?
ple, anemia is among the five most prevalent
conditions for black children, but not for
Chronic conditions have persistent or recurring
white children. Diabetes is among the five
health consequences lasting for years. They are
most common conditions in the 45-to-74-
illnesses or impairments that cannot be cured.
year age group for blacks but not for whites.
Some of the most prevalent chronic conditions,
The same conditions comprise the list of
such as sinusitis or hay fever, are generally not
most common chronic conditions for black
disabling; however, others, such as heart disease
and white women, but there is some varia-
and arthritis, can cause significant limitations in
tion among men. Arthritis is among the most
people’s ability to perform certain basic activities
common conditions for the black male pop-
of daily living, or ADLs. Thus, in addition to med-
ulation, while hearing impairments are more
ical services, people who have chronic conditions
common among white males (see Table 2).
often need personal, social, or rehabilitative care
over a prolonged period of time.
TABLE 1
Most Common Chronic
Common conditions are
Conditions, by Age and Gender
different for middle-aged
MALE
FEMALE
men and women
ALL AGES
• Orthopedic
• Sinusitis
impairments
• Arthritis
Four of the five most prevalent conditions
• Sinusitis
• Orthopedic
for men and women are the same. They
• Hearing
impairments
include orthopedic impairments, sinusitis,
impairments
• Hypertension
• Hypertension
• Hay Fever
hypertension, and hay fever. But hearing
• Hay Fever
impairments are more common for men.
Arthritis is more common for women. Some
0–17
• Asthma
• Sinusitis
• Hay Fever
• Asthma
15 percent of women and 9 percent of men
• Sinusitis
• Hay Fever
have arthritis. The five most common condi-
• Bronchitis
• Bronchitis
tions are the same for boys and girls.
• Dermatitis
• Dermatitis
Similarly, for people age 75 and older, regard-
18–44
• Orthopedic
• Sinusitis
less of gender, the five most common condi-
impairments
• Orthopedic
tions are the same. But differences arise
• Sinusitis
impairments
among young and middle-aged adults. For
• Hay Fever
• Hay Fever
• Hearing
• Migraine
example, three of the most common condi-
impairments
• Asthma
tions—orthopedic impairments, sinusitis,
• Hypertension
and hay fever—are the same for men and
45–74
• Hypertension
• Arthritis
women in the 18-to-44-year age group.
• Arthritis
• Hypertension
However, hearing impairments and hyper-
• Hearing
• Sinusitis
tension are the other common conditions for
impairments
• Orthopedic
men, while migraines and asthma are more
• Orthopedic
impairments
impairments
• Hay Fever
common for women (see Table 1).
• Heart Disease
75+
• Hearing
• Arthritis
Some conditions are
impairments
• Hypertension
associated more with
• Arthritis
• Hearing
• Heart Disease
impairments
blacks than whites
• Hypertension
• Heart Disease
• Cataracts
• Cataracts
Overall, the five most common chronic
SOURCE: National Academy on an Aging Society
conditions are the same for blacks and
analysis of 1994 National Health Interview Survey data.
whites. They are sinusitis, arthritis, orthope-
N A T I O N A L A C A D E M Y O N A N A G I N G S O C I E T Y
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TABLE 2
Most Common Chronic Conditions, by Age, Gender and Race
MALE
FEMALE
BLACK
WHITE
BLACK
WHITE
ALL AGES
Hypertension
Orthopedic impairments
Sinusitis
Sinusitis
Orthopedic impairments
Sinusitis
Hypertension
Arthritis
Sinusitis
Hearing impairments
Arthritis
Orthopedic impairments
Arthritis
Hay Fever
Orthopedic impairments
Hypertension
Hay Fever
Hypertension
Hay Fever
Hay Fever
0–17
Asthma
Asthma
Sinusitis
Sinusitis
Sinusitis
Hay Fever
Asthma
Hay Fever
Hay Fever
Bronchitis
Hay Fever
Asthma
Anemia
Sinusitis
Dermatitis
Bronchitis
Orthopedic impairments
Dermatitis
Anemia
Dermatitis
18–44
Orthopedic impairments
Orthopedic impairments
Sinusitis
Sinusitis
Sinusitis
Sinusitis
Hay Fever
Orthopedic impairments
Hypertension
Hay Fever
Orthopedic impairments
Hay Fever
Hay Fever
Hearing impairments
Migraine
Migraine
Arthritis
Hypertension
Hypertension
Asthma
45–74
Hypertension
Hypertension
Hypertension
Arthritis
Arthritis
Hearing impairments
Arthritis
Hypertension
Orthopedic impairments
Arthritis
Sinusitis
Sinusitis
Diabetes
Orthopedic impairments
Orthopedic impairments
Orthopedic impairments
Sinusitis
Heart Disease
Diabetes
Hay Fever
75+
Arthritis
Hearing impairments
Arthritis
Arthritis
Hypertension
Arthritis
Hypertension
Hypertension
Cataracts
Heart Disease
Heart Disease
Hearing impairments
Diabetes
Hypertension
Orthopedic impairments
Heart Disease
Visual impairments
Cataracts
Cataracts
Cataracts
NOTE: Estimate for black males age 75+ is based on a small sample and should be interpreted with caution.
SOURCE: National Academy on an Aging Society analysis of 1994 National Health Interview Survey data.
People with lower
FIGURE 1
incomes have more
Prevalence of Most Common
serious conditions
Chronic Conditions for Women,
by Income Group
> $50,000
In general, people with lower incomes are
< $20,000
more likely to have conditions that are
more difficult or costly to treat. For exam-
HAY FEVER
14
9
ple, the most common conditions, includ-
HYPERTENSION
7
ing orthopedic impairments, hypertension,
17
sinusitis, and arthritis, are more prevalent
ORTHOPEDIC
11
for men and women with annual family
IMPAIRMENTS
16
incomes of less than $20,000 than for those
9
with incomes greater than $50,000. But hay
ARTHRITIS
21
fever is more prevalent among men and
15
SINUSITIS
women with incomes greater than $50,000
16
(see Figure 1).
0
5
10
15
20
25
P E R C E N T
SOURCE: National Academy on an Aging Society
analysis of 1994 National Health Interview Survey data.
N A T I O N A L A C A D E M Y O N A N A G I N G S O C I E T Y
3
Millions are disabled
age 75 and older with arthritis, the condi-
tion is most likely to cause activity limita-
by chronic conditions
tions for black women and black men.
Many people who have chronic condi-
tions lead active, productive lives, but
some experience significant difficulties
Chronic conditions
because of their conditions. Some 41 mil-
and poor health
lion of the almost 100 million people who
have chronic conditions are limited in
When people are asked to rate their health,
their daily activities by their condition.2
those with chronic conditions are general-
Generally, the elderly population is most
ly more likely than the population as a
affected (see Figure 2). In part, this is
whole to report that they are in fair or poor
because the conditions common among
health. Among the general population,
gender differences for self-reported health
status are not great, but the proportion of
FIGURE 2
people reporting fair or poor health
Percent of Individuals in Each Age
increases with age. In each age group, black
Group Limited in Activities Because
men and women are more likely to report
fair or poor health than white men and
of Chronic Conditions
women (see Table 3).
50
Patterns are similar for those with specif-
40
45
ic conditions. In most cases, black males
are most likely to report fair or poor health.
30
34
In each age group, high proportions of
20
23
black females with specific conditions also
PERCENT
10
report fair or poor health.
10
0
6
<18
18–44
45–64
65–74
75+
TABLE 3
A G E
Percent of the Population Reporting Fair or Poor
SOURCE: Trupin, Laura and Dorothy Rice, Health Status,
Medical Care Use, and Number of Disabling Conditions
Health, by Age, Gender and Race
in the United States, Disability Statistics Abstract Number
9 (June 1995), National Institute on Disability and
MALE
FEMALE
Rehabilitation Research.
AGE
ALL BLACK WHITE
ALL BLACK WHITE
0–17
Everyone age 0–17
4
6
3
3
4
3
the elderly tend to be more disabling. In
Everyone age 0–17
addition, some conditions begin in middle
with asthma
13
23
11
12
19
12
age but progress in severity as people age.
18–44
For example, hypertension is among the
Everyone age 18–44
6
10
5
8
13
6
most common chronic conditions for men
Everyone age 18–44 with
and women age 45 and older. But in the
orthopedic impairments
15
34
12
15
40
12
45-to-74-year-old group 38 percent of men
45–74
with hypertension report that they limit
Everyone age 45–74
18
29
16
20
35
19
activities. By contrast, 44 percent of men
Everyone age 45–74
with hypertension
30
53
27
37
47
35
age 75 and older who have hypertension
limit activities.
75+
Blacks are more likely than whites to
Everyone age 75+
33
47
32
30
43
28
Everyone age 75+
have limitations in daily activities when
with arthritis
39
47
37
38
36
38
chronically ill. For example, among black
children with asthma, 21 percent of boys
NOTE: Estimate for black males age 75+ is based on a small sample and should be
interpreted with caution.
and 24 percent of girls missed some school
SOURCE: National Academy on an Aging Society analysis of 1994 National Health
or had to attend special classes. The pro-
Interview Survey data.
portions are much lower for whites, 12
percent for boys and girls. Among people
N A T I O N A L A C A D E M Y O N A N A G I N G S O C I E T Y
4
FIGURE 3
Number of People with Chronic Conditions
160
158
140
148
134
120
120
100
112
105
99
80
60
MILLIONS
40
20
0
1995
2000
2005
2010
2020
2030
2040
Y E A R
SOURCE: The Robert Wood Johnson Foundation (1996), Chronic Care in America: A 21st Century Challenge.
The number of Americans
common chronic conditions for that age
group—than for the general population
with chronic conditions is
that age (see Figure 4). Expenditures for
expected to increase
hospital care and related services con-
tribute to the high costs associated with
Projections indicate that by 2040 the
chronic conditions.
number of people in the U.S. with chron-
ic conditions will increase by 50 percent
(see Figure 3).
FIGURE 4
The U.S. already faces the challenge of
Percent of People Hospitalized in
providing appropriate and accessible care
the Past Year
for people with chronic conditions and of
ALL
WITH ARTHRITIS
making accommodations so that those
WITH HYPERTENSION
with disabling conditions can lead lives
30
that are more active and productive. In
planning for the future it will be impor-
25
tant to consider not only how to achieve
26
these goals for growing numbers of peo-
20
21
ple, but also to recognize that different
20
groups of chronically ill people will have
15
15 16
different needs.
10
10
Hospitalization rates
5
PERCENT
are higher for people
0
with chronic conditions
45–74
75+
A G E
Among people 45 years and older, hospi-
SOURCE: National Academy on an Aging Society
talization rates are higher for those with
analysis of 1994 National Health Interview Survey data.
arthritis and hypertension—the two most
N A T I O N A L A C A D E M Y O N A N A G I N G S O C I E T Y
5
Chronic conditions also
FIGURE 5
have an emotional impact
Percent of the Population
Chronic conditions affect emotional as well
Age 51 to 61 Reporting
as physical well-being. For example, 51 to
Fair or Poor Emotional Health
61 year olds with chronic conditions are
WOMEN
more likely than the general population
MEN
that age to rate their emotional health as
WITH
fair or poor. Among those with three of the
51
HEARING
most common chronic conditions for that
31
IMPAIRMENTS
age group, women are more likely than
27
men to say that their emotional health is
WITH
HYPERTENSION
23
fair or poor (see Figure 5). Black women
with chronic conditions give the least posi-
WITH
28
tive assessment of their emotional well-
ARTHRITIS
25
being. For example, among those with
arthritis, the proportions of people report-
21
ALL
16
ing that their emotional health is fair or
poor are 22 percent for white men, 23 per-
0 10 20 30 40 50 60
cent for white women, 33 percent for black
P E R C E N T
men, and 39 percent for black women.
SOURCE: National Academy on an Aging Society
Relative to other conditions, the propor-
analysis of 1992 Health and Retirement Study data.
tion of people reporting fair or poor emo-
tional health is particularly high for those
with hearing impairments.
ABOUT THE DATA
1. The Robert Wood Johnson Foundation (1996). Chronic Care
Unless otherwise noted, the data presented
in America: A 21st Century Challenge, Princeton, New Jersey.
in this Profile come from three national sur-
Note: Costs are expressed in 1990 dollars.
veys of the community-dwelling population
living within the United States. The 1994
2. Ibid.
National Health Interview Survey (NHIS) was
conducted by the National Center for Health
ABOUT THE PROFILES
Statistics. The NHIS provides data for the
entire population, including children. Wave 1
This series, Challenges for the 21st Century: Chronic and
of the Health and Retirement Study (HRS)
Disabling Conditions is supported by a grant from the Robert
provides information for a population age 51
Wood Johnson Foundation. This Profile was written by Laura
to 61 in 1992. Wave 1 of the study of Asset
Summer with assistance from Greg O’Neill and Lee Shirey.
and Health Dynamics Among the Oldest Old
It is the first in the series.
(AHEAD) provides information about respon-
dents age 70 and older in 1993 and 1994.
The National Academy on an Aging Society is a Washington-
The HRS and AHEAD data sets were spon-
based nonpartisan policy institute of The Gerontological
sored by the National Institute on Aging and
Society of America. The Academy studies the impact of demo-
conducted by the Institute for Social Research
graphic changes on public and private institutions and on the
at the University of Michigan.
economic and health security of families and people of all ages.
NATIONAL ACADEMY ON AN AGING SOCIETY
1030 15th Street NW, Suite 250, Washington, DC 20005
PHONE 202-408-3375 FAX 202-842-1150
E-MAIL info@agingsociety.org WEBSITE www.agingsociety.org
N A T I O N A L A C A D E M Y O N A N A G I N G S O C I E T Y
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