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IntroductionKey FindingsNational InsightsOverviewAccess to Health CareImmunizationsChronic Disease PreventionInequity InsightsAccess to Health Care: Dedicated Health Care ProviderImmunizations: Pneumococcal VaccinationChronic Disease Prevention: Colorectal Cancer ScreeningState Insights: OverallState Insights: Access to Health CareState Insights: ImmunizationsState Insights: Chronic Disease PreventionAppendix 1Appendix 2Footnotes
Background
Elevated total serum cholesterol and high blood pressure are major and modifiable risk factors for heart disease, and both can be addressed through behavior changes and medications. According to the Centers for Medicare and Medicaid Services, high blood pressure and high cholesterol were the most common chronic conditions among Medicaid beneficiaries in 2010.
Almost half the US population—117 million people—had at least one chronic health condition in 2012, and nearly one-quarter had two or more chronic conditions.[xxi] Chronic diseases, which disproportionately affect minority and low-income populations,[xxii] are among the costliest health conditions; 86% of total health care spending in 2010 was for individuals with one or more chronic conditions.[xxiii] Delays in diagnosis and care of chronic diseases can increase medical costs and risk of disability or death.
Heart disease and cancer are the top two causes of deaths in the United States, accounting for 46% of all deaths in 2013.[xxiv] Routine screening can lead to early detection and treatment of chronic disease risk factors, including high cholesterol and high blood pressure, reducing heart disease and cancer mortality.
Figure 6: Chronic Disease Prevention National Goals
HP2020 has set chronic disease prevention objectives including the following:
Findings
The Chronic Disease Prevention category was examined through three measures: adult awareness of High Blood Pressure, Colorectal Cancer Screening, and Cholesterol Check. (Table 4)
Looking at each of these measures individually reveals the following insights:
- 31.4% of adults have been told by a health care provider that they have high blood pressure. The percentage varies from 41.0% in West Virginia to 24.2% in Utah. High blood pressure awareness is weakly correlated [8] with the Access to Health Care measures, which may suggest that Americans are being diagnosed through alternative care delivery channels and programs. Notably only about half of people with high blood pressure have their condition under control. [xxv]
- 76.4% of adults have had their cholesterol checked in the past five years. This varies from 84.0% of adults in Massachusetts to 68.3% of adults in Utah. This measure is highly correlated [9] with having a dedicated health care provider, and it supports research indicating individuals who have a regular health care provider are receiving recommended cholesterol checks.
- 66.4% of adults aged 50 to 74 report being up to date with colorectal cancer screening. The percentage varies from 76.3% in Massachusetts to 57.0% in Wyoming. This measure is highly correlated with having a dedicated health care provider and annual dental visit and moderately correlated with health care coverage. [10] It supports research indicating that individuals who report having health insurance and a dedicated health care provider are likely to be screened. [xxvi]
8. r=0.28 9. r=0.69 10. Dedicated health care provider (r=0.70), annual dental visit (r=0.70), and health care coverage (r=0.61).
For both men and women, colorectal cancer is the third most common type of cancer. Routine screening can lead to early detection and treatment, thus improving survival and decreasing mortality. The National Colorectal Cancer Roundtable offers tools and resources for primary care clinicians to increase colorectal cancer screening rates among eligible individuals.
Figure 7: Chronic Disease Prevention: National Average and Range of State Values
Figure 7 shows the national average as a diamond and how each state (blue dots) performs on chronic disease prevention activities examined in this report. States at the top perform better than the national average, while those at the lower ends have greater room for improvement. This visual illustrates more adults are receiving cholesterol checks than colorectal screening.
Table 4: Measures: Chronic Disease Prevention
Footnotes
xi Chronic Disease Overview. Centers for Disease Control and Prevention. http://www.cdc.gov/chronicdisease/overview/. Updated January 20, 2016. Accessed February, 8, 2016.
xxii Low-income Americans and Racial and Ethnic Minorities Experience Disproportionately Higher Rates of Disease. US Medicine. http://www.usmedicine.com/2009-issues/july-2009-issue/low-income-americans-and-racial-and-ethnic-minorities-experience-disproportionately-higher-rates-of-disease/. Accessed February 8, 2016.
xxiii Gerteis J, Izrael D, Deitz D, LeRoy L, Ricciardi R, Miller T, Basu J. Multiple Chronic Conditions Chartbook. AHRQ Publications No, Q14-0038. Rockville, MD: Agency for Healthcare Research and Quality. April 2014.
xxiv Centers for Disease Control and Prevention. National Center for Health Statistics. Deaths: Final Data for 2013. Table 10. http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_02.pdf. Accessed January 20, 2016.
xxv High Blood Pressure Facts. Centers for Disease Control and Prevention. http://www.cdc.gov/bloodpressure/facts.htm. Accessed February 5, 2016.
xxvi Brown ML, Klabunde CN, Cronin KA, White MC, Richardson LC, McNeel TS. Challenges in Meeting Healthy People 2020 Objectives for Cancer-Related Preventive Services, National Health Interview Survey, 2008 and 2010. Prev Chronic Dis 2014;11:130174. DOI: http://dx.doi.org/10.5888/pcd11.130174