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Source: Loeppke R, Taitel M, Richling D, Parry T, Kessler RC, Hymel P,
Konicki D. Health and productivity as a business strategy. J Occup Environ
Med 2007; 49(7):712-21.
These data were obtained from medical and pharmacy claims data over 12
months from four companies, and included about 58,000 employees. Survey
data about health and work performance were obtained from about 15,000 of
these. The 27 most common conditions were selected and recorded if they
were the primary diagnosis on the claims form.
This chart identifies the top ten health conditions occurring on medical claims
and pharmacy claims. Conditions costing the most in terms of medical and
pharmacy costs are in the left column; all but two are conventional biomedical
diagnoses. The middle column shows that the most costly conditions in terms
of lost productivity are primarily symptoms or signs; only three are
conventional diagnoses. Lost productivity costs were more than four times
medical and pharmacy costs. As a result, total costs reflected the occurrence
of symptoms and signs rather than conventional medical conditions. That is,
the mostly costly problems to employers are people’s problems, not their
diagnoses.
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Sources:
Chin J. The AIDS Pandemic: the Collision of Epidemiology with Political
Correctness. Oxon, UK: Radcliffe Publishing, 2007.
De Maeseneer J, Willems S, De Sutter A, Van de Geuchte I, Billings M.
Primary Health Care as a Strategy for Achieving Equitable Care: a
Literature Review Commissioned by the Health Systems Knowledge
Network. WHO Health Systems Knowledge Network (
http://www.who.int/social_determinants/resources/csdh_media/
primary_health_care_2007_en.pdf, accessed December 7, 2009), 2007.
Mangin D, Sweeney K, Heath I. Preventive health care in elderly people needs
rethinking. BMJ 2007; 335(7614):285-287.
Murray CJ, Lopez AD, Wibulpolprasert S. Monitoring global health: time for
new solutions. BMJ 2004; 329(7474):1096-1100.
Tinetti ME, Fried T. The end of the disease era. Am J Med 2004; 116(3):
179-185.
Walker N, Bryce J, Black RE. Interpreting health statistics for policymaking: the
story behind the headlines. Lancet 2007; 369(9565):956-963.
Rosenberg CE. The tyranny of diagnosis: specific entities and individual
experience. Milbank Q 2002;80:237-60.
Moynihan R, Henry D. The fight against disease mongering: generating
knowledge for action. PLoS Med 2006;3:e191.
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Source: Davidoff F. Heterogeneity is not always noise: lessons from
improvement. JAMA 2009; 302(23):2580-2586.
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Source: Mensah GA, Brown DW. An overview of cardiovascular disease
burden in the United States. Health Aff 2007; 26(1):38-48.
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Source: Topol EJ, Murray SS, Frazer KA. The genomics gold rush. JAMA
2007; 298(2):218-221.
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Source: Dixon JB, O’Brien PE, Playfair J, Chapman L, Schachter LM, Skinner
S, Proietto J, Bailey M, Anderson M. Adjustable gastric banding and
conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA
2008; 299(3):316-23.
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Source: Jones OAH, Maguire ML, Griffin JL. Environmental pollution and
diabetes: a neglected association. Lancet 2008; 371(9609):287-288.
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Source: Kolata G. Diabetes study partially halted after deaths. Seattle, WA:
University of Washington press release, February 2, 2008.
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Source: Begg CB, Haile RW, Borg A et al. Variation of breast cancer risk
among BRCA1/2 carriers. JAMA 2008; 299(2):194-201.
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Source: Franco EL, Duarte-Franco E. Ovarian cancer and oral contraceptives.
Lancet 2008; 371(9609):277-278.
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Sources:
Fabbri LM, Rabe KF. From COPD to chronic systemic inflammatory
syndrome? Lancet 2007; 370(9589):797-799.
Calverley PMA, Rennard SI. What have we learned from large drug treatment
trials in COPD? Lancet 2007; 370(9589):774-785.
Beasley R, Weatherall M, Travers J, Shirtcliffe P. Time to define the disorders
of the syndrome of COPD. Lancet 2009;374:670-2.
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Source: Michel JP, Newton JL, Kirkwood TB. Medical challenges of improving
the quality of a longer life. JAMA 2008; 299(6):688-90.
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Source: Raterman HG, van Halm VP, Voskuyl AE, Simsek S, Dijkmans BA,
Nurmohamed MT. Rheumatoid arthritis is associated with a high prevalence of
hypothyroidism that amplifies its cardiovascular risk. Ann Rheum Dis 2008; 67
(2):229-32.
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Source: Australian Institute of Health and Welfare. Indicators for Chronic
Diseases and Their Determinants, 2008. Canberra, Australia: AIHW, 2008.
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Source: Beaglehole R, Ebrahim S, Reddy S, Voute J, Leeder S, Chronic
Disease Action Group. Prevention of chronic diseases: a call to action. Lancet
2007; 370(9605):2152-2157.
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The challenges in primary care practice are person-focused rather than
disease-focused. Most people have more than one health problem,
increasingly as they age. Therefore, attention to health needs in primary care
requires an awareness of the simultaneous presence of more than one health
problem, which must be taken into account in providing person-focused care,
at the very least in order to avoid conflicting management strategies.
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In a general non-elderly population of patients, at least 50% have more
than one type of diagnosis in a year. At least 10% have 5 or more types
of different diagnoses in a year.
Source: HMO health plan with 500K members.
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Source: Thorpe KE, Florence CS, Howard DH, Joski P. The rising prevalence
of treated disease: effects on private health insurance spending. Health Aff
2005; W5: 317-25 (http://content.healthaffairs.org/cgi/reprint/hlthaff.w5.317v1).
With progressively decreasing thresholds for diagnosis of disease, and
possibly with real increases in some diseases, the prevalence of diseases
under treatment is increasing rapidly throughout the world. This chart shows
the very large increases in prevalence of particular diseases in the US in the
fifteen years between 1987 and 2002. As this information comes from
populations with private insurance, the estimates of prevalence undoubtedly
understate the true prevalence of disease in the entire population, as people
without insurance have more illness. In five of the 10 conditions, the
prevalence has more than doubled in the fifteen years; in the case of
hyperlipidemia, the prevalence has increased over four-fold. Thus, at the same
time that mortality rates have been increasing, the treated prevalence of major
illnesses has been increasing.
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Socially disadvantaged people are more likely to have a large number of
different diagnoses as compared with those who are more socially
advantaged. This diagram shows that those enrolled in community health
clinics for low-income people in the US are at least 3 times more likely to have
more than 5 different types of diagnoses in a year. As socially disadvantaged
people are less likely to receive adequate health care, the greater health
disadvantage shown in this diagram is likely to be an underestimation of the
increased morbidity among socially disadvantaged people.
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The data in this chart, based on experiences in the United States, show
that the best predictor of subsequent costs of care is the ACG morbidity
burden measure (number of different types of diagnosed morbidity –
ADGS – or number of different types of serious (major) morbidity types).
Neither hospitalization nor costs in the prior year predicted subsequent
resource use as well as the morbidity measure. (Not shown is the ACG
measure of combinations of types of morbidity – which does as well or
better for uses of the ACG system that concern utilization of different
types of morbidity and prediction of subsequent morbidity.)
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This graph, concerning people of age 65 and over in the US, shows that
rates of hospitalization for causes that should be preventable by good
primary care, rates of complications during hospitalization, and costs of
care increase rapidly with increases in comorbidity (as measured by the
number of types of chronic condition per person). That is, comorbidity is
associated with higher costs, higher hospitalization for preventable
conditions, and more adverse effects.
Source: Wolff JL, Starfield B, Anderson G. Prevalence, expenditures,
and complications of multiple chronic conditions in the elderly. Arch
Intern Med 2002; 162(20):2269-2276.
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This diagram shows that as comorbidity increases, so does the
likelihood of a repeat diagnosis of urinary tract infection (UTI) (which is
generally not considered a chronic disease) in the year after a previous
diagnosis. Those with a diagnosis of UTI in one year are not very likely
to have it diagnosed in the subsequent year if they have little or no
comorbidity, but are more likely to have a repeat diagnosis with
increasing comorbidity. The same is the case for other conditions. That
is, persistence of a health condition is more likely in the presence of
other health conditions.
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These data, from one province in Canada, show that there is little difference in
resource use for people with only acute conditions, people with any chronic
conditions, or people with only serious chronic conditions when the morbidity
burden is the same. However, increasingly higher morbidity burden (i.e., more
multimorbidity) is associated with progressively higher resource use, and the
increase is the same regardless of the type of diagnosis (acute, chronic, major
chronic). Chronic conditions alone do not, by themselves, imply high need for
resources.
Source: Broemeling A-M, Watson D, Black C. Chronic Conditions and Comorbidity among Residents of British Columbia. Vancouver, BC: University of
British Columbia, 2005.
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Calculated from Table 2 in Sibley LM, Moineddin R, Agha MM, Glazier RH.
Risk adjustment using administrative data-based and survey-derived methods
for explaining physician utilization. Med Care 2010;48:175-82.
In a study of adults of ages 20-79 seen over a two-year period, the number of
different types of morbidity was the leading influence on both the number of
primary care and specialist visits. The second most important influence was
the extent of morbidity, that is, the pattern of different combinations of different
kinds of diagnoses as reflected in resource use. Other influences were
weaker.
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Sources:
IBRD/World Bank, April 8, 2008.
King CH, Bertino AM. Asymmetries of poverty: why global burden of disease
valuations underestimate the burden of neglected tropical diseases. PLoS
Negl Trop Dis 2008;2:e209.
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