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In 1995, the number increased to almost 100 million Americans.
Chronic illnesses that Americans suffer from include a broad range of disorders, including diabetes, arthritis, heart disease, ulcers, bronchitis, HIV infection, renal failure and chronic obstructive pulmonary disease.
The study by the UCSF Institute of Health and Aging, supported by the Robert Wood Johnson Foundation, is being published in the Nov. 13, 1996 issue of JAMA.
The study results are reported in a chartbook, entitled "Chronic Care in America: A 21st Century Challenge." The 76-page report will be released by the Robert Wood Johnson Foundation at a press conference on Tuesday, Nov. 12.
While the objective of the research was to examine the prevalence and cost of chronic conditions, one of the most significant findings of the year-long study was the necessity for "(transforming) our health care delivery system so that it better meets the needs of those living with chronic conditions."
A major issue, the researchers found, is that current health care delivery in the United States is geared to acute care and, therefore, is not meeting the needs of the chronically ill who are increasing in numbers every year. By the year 2030, the study projected, the number of people with chronic conditions will increase to almost 150 million.
Since the 1920s, chronic illness has replaced infectious diseases as the biggest health care challenge in the United States. The study examined data from the federal National Medical Expenditure Survey and found that, in 1987, 90 million Americans were living with chronic conditions, 39 million of whom had more than one chronic condition.
Using age and sex-adjusted rates, the researchers projected a 1990 cost of $659 billion, including $425 billion for direct health care costs and $234 billion in indirect costs.
The study found that chronic conditions affect persons of every age, not only the elderly, and that the majority of these individuals are not disabled and relatively few are institutionalized.
Working-aged adults accounted for 60 percent of those with chronic conditions who were not institutionalized. More than one-third of young adults aged 18 to 44 and two-thirds of adults 45 to 64 reported at least one chronic condition.
The costs of care for the chronically ill are disproportionally high, the researchers found, because these people have greater health needs no matter what their age.
"The importance of this study," said Dorothy Rice, ScD (Hon), UCSF professor emeritus, social and behavioral sciences, UCSF School of Nursing, "is that it focuses attention on the high prevalence of chronic illness and its enormous costs. The future growth of the baby boomer generation will substantially increase the number of people with chronic conditions. We must begin to make adjustments to our current fragmentary medical care programs that address acute care problems rather than chronic care. This will require different approaches to the delivery and financing of health and long term care, among them continuity of community-based services."
The study provides the most recent estimates of the number of Americans with chronic conditions since a study that was undertaken in 1966. In the thirty years since the first study, life expectancy has increased from 69.7 years in 1960 to 75.5 years in 1993, and the elderly population, which has the most chronic diseases, has increased from 16.6 million to 32.8 million.
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The study found:
-- Almost half of the population has chronic conditions and they account for three-fourths of the U.S. health care expenditures.
-- Because the number of persons with disabilities due to chronic conditions is most often reported rather than all persons with conditions, the total prevalence of chronic conditions has probably been underreported.
-- Persons with chronic conditions are at risk for not having sufficient health insurance, particularly individuals with more than one chronic ailment.
-- With 100 million Americans who have one or more chronic conditions, nearly every family in the United States is affected. The chances a person will become a caregiver for a chronically ill family member is greater in 1996 than it ever has been and it will be even greater in the coming years with the growing number of persons over age 85 and the limited network of potential caregivers due to small family sizes.
-- The continuing decrease in mortality rates due to better care and medical advances will result in more people with chronic conditions living longer. In 1990, one of eight persons are elderly and at risk for chronic illness; in 2030 one out of five persons will be in this high risk group.
-- The U.S. health care delivery system is largely based on handling acute illness and does not meet the full needs of those with chronic conditions.
Of the many sobering projections included in the Robert Wood Johnson Foundation chartbook, two of particular importance are:
-- Based on current trends, by the year 2020 up to 14 million elderly will need long-term care -- double the seven million who need long-term care today.
-- By 2030, unless new systems of care are created, chronic care alone is projected to cost the United States $798 billion (in 1990 dollars) in direct medical and nursing home costs.
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The Robert Wood Johnson Foundation has provided a website: http://www.chronicnet.org for persons interested in more information on the chartbook.
The UCSF researchers for the JAMA study included Rice, Catherine Hoffman, ScD, and Hai-Yen Sung, PhD. Hoffman, who was the first author, is now with the Henry J. Kaiser Family Foundation, Menlo Park, Calif. Sung is with the Department of Quality and Utilization with Kaiser Permanente Medical Group, Oakland, Calif.
(End of advance for release 9:00 a.m. EST, Nov. 12.)
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