Chronic condition

A chronic condition is a human health condition or disease that is persistent or otherwise long-lasting in its effects or a disease that comes with time. The term chronic is often applied when the course of the disease lasts for more than three months. Common chronic diseases include arthritis, asthma, cancer, chronic obstructive pulmonary disease, diabetes and some viral diseases such as hepatitis C and acquired immunodeficiency syndrome. An illness which is lifelong because it ends in death is a terminal illness. It is possible and not unexpected for an illness to change in definition from terminal to chronic. Diabetes and HIV for example were once terminal yet are now considered chronic due to the availability of insulin and daily drug treatment for individuals with HIV which allow these individuals to live while managing symptoms.[1]

In medicine, a chronic condition can be distinguished from one that is acute. An acute condition typically affects one portion of the body and responds to treatment. A chronic condition on the other hand usually affects multiple areas of the body, is not fully responsive to treatment, and persists for an extended period of time.[2]

Chronic conditions may have periods of remission or relapse where the disease temporarily goes away, or subsequently reappears. Periods of remission and relapse are commonly discussed when referring to substance abuse disorders which some consider to fall under the category of chronic condition.[3]

Chronic conditions are often associated with non-communicable diseases which are distinguished by their non-infectious causes. Some chronic conditions though, are caused by transmissible infections such as HIV/AIDS.

In the United States 25% of adults have at least two chronic conditions.[4] Chronic diseases constitute a major cause of mortality, and the World Health Organization (WHO) attributes 38 million deaths a year to non-communicable diseases.[5]

Types[edit]

Chronic conditions have often been used to describe the various health related states of the human body such as syndromes, physical impairments, disabilities as well as diseases. Epidemiologists have found interest in chronic conditions due to the fact they contribute to disease, disability, and diminished physical and/or mental capacity.[6]

For example, high blood pressure or hypertension is considered to be not only a chronic condition itself but also correlated to diseases such as heart attack or stroke. Additionally, some socioeconomic factors may be considered as a chronic condition as they lead to disability in daily life. An important one that public health officials in the social science setting have begun highlighting is chronic poverty.[7][8]

The list below includes these chronic conditions and diseases:

In 2015 the World Health Organization produced a report on non-communicable diseases, citing the four major types as:[9]

Other examples of chronic diseases and health conditions include:

Risk factors[edit]

While risk factors vary with age and gender, most of the common chronic diseases in the US are caused by dietary, lifestyle and metabolic risk factors that are also responsible for the resulting mortality.[10] Therefore, these conditions might be prevented by behavioral changes, such as quitting smoking, adopting a healthy diet, and increasing physical activity. Social determinants are important risk factors for chronic diseases.[11] Social factors, e.g., socioeconomic status, education level, and race/ethnicity, are a major cause for the disparities observed in the care of chronic disease.[11] Lack of access and delay in receiving care result in worse outcomes for patients from minorities and underserved populations.[12] Those barriers to medical care complicate patients monitoring and continuity in treatment.

In the US, Minorities and low-income populations are less likely to access and receive preventive services necessary to detect conditions at an early stage.[13]

The majority of US health care and economic costs associated with medical conditions are for the costs of chronic diseases and conditions and associated health risk behaviors. Eighty-four percent of all health care spending in 2006 was for the 50% of the population who have one or more chronic medical conditions (CDC, 2014).

There are several psychosocial risk and resistance factors among children with chronic illness and their family members. Adults with chronic illness were significantly more likely to report life dissatisfaction than those without chronic illness.[14] Compared to their healthy peers, children with chronic illness have about a twofold increase in psychiatric disorders.[15] Higher parental depression and other family stressors predicted more problems among patients.[16] In addition, sibling problems along with the burden of illness on the family as a whole led to more psychological strain on the patients and their families.[16]

Prevention[edit]

A growing body of evidence supports that prevention is effective in reducing the effect of chronic conditions; in particular, early detection results in less severe outcomes. Clinical preventive services include screening for the existence of the disease or predisposition to its development, counseling and immunizations against infectious agents. Despite their effectiveness, the utilization of preventive services is typically lower than for regular medical services. In contrast to their apparent cost in time and money, the benefits of preventive services are not directly perceived by patient because their effects are on the long term or might be greater for society as a whole than at the individual level.[17]

Therefore, public health programs are important in educating the public, and promoting healthy lifestyles and awareness about chronic diseases. While those programs can benefit from funding at different levels (state, federal, private) their implementation is mostly in charge of local agencies and community-based organizations.[18]

Studies have shown that public health programs are effective in reducing mortality rates associated to cardiovascular disease, diabetes and cancer, but the results are somewhat heterogeneous depending on the type of condition and the type of programs involved.[19] For example, results from different approaches in cancer prevention and screening depended highly on the type of cancer.[20]
The rising number of patient with chronic diseases has renewed the interest in prevention and its potential role in helping control costs. In 2008, the Trust for America’s Health produced a report that estimated investing $10 per person annually in community-based programs of proven effectiveness and promoting healthy lifestyle (increase in physical activity, healthier diet and preventing tobacco use) could save more than $16 billion annually within a period of just five years.[21]

Epidemiology[edit]

The role of epidemiology in chronic disease has not been widely valued. There is currently not a thorough understanding of chronic disease epidemiology, though some think that a further investigation into this field would be valuable to the study and treatment of chronic disease. Currently, there are a few programs which aim to gain more knowledge on the epidemiology of chronic disease using data collection. The hope of these programs is to gather epidemiological data on various chronic diseases across the United States and demonstrate how this knowledge can be valuable in addressing chronic disease.[22]

The epidemiology of chronic disease is diverse and the epidemiology of some chronic diseases can change in response to new treatments. In the treatment of HIV, the success of antiretroviral therapies means that many patients will experience this infection as a chronic disease that for many will span several decades of their life.[23] Some epidemiology of chronic disease can apply to multiple diagnosis. Obesity and body fat distribution for example contribute and are risk factors for many chronic diseases such as diabetes, heart, and kidney disease.[24] Other epidemiological factors, such as social, socioeconomic, and environment do not have a straightforward cause and effect relationship with chronic disease diagnosis. While typically higher socioeconomic status is correlated with lower occurrence of chronic disease, it is not known is there is a direct cause and effect relationship between these two variables.[25] The epidemiology of communicable chronic diseases such as AIDS is also different than that of noncommunicable chronic disease. While social factors do play a role in AIDS prevalence, only exposure is truly needed to contract this chronic disease. Communicable chronic diseases are also typically only treatable with medication intervention, rather than lifestyle change as some non-communicable chronic diseases can be treated.[26]

United States[edit]

In the United States, nearly one in two Americans (133 million) has at least one chronic medical condition, with most subjects (58%) between the ages of 18 and 64.[27] The number is projected to increase by more than one percent per year by 2030, resulting in an estimated chronically ill population of 171 million.[27] The most common chronic conditions are high blood pressure, arthritis, respiratory diseases like emphysema, and high cholesterol.

According to research by the Centers for Disease Control and Prevention, chronic disease is also especially a concern in the elderly population in America. Chronic diseases like stroke, heart disease, and cancer were among the leading causes of death among Americans aged 65 or older in 2002, accounting for 61% of all deaths among this subset of the population.[28] While the majority of chronic conditions are found in individuals between the ages of 18 and 64, it is estimated that at least 80% of older Americans are currently living with some form of a chronic condition, with 50% of this population having two or more chronic conditions.[28] The two most common chronic conditions in the elderly are high blood pressure and arthritis, with diabetes, coronary heart disease, and cancer also being reported among the elder population.[29]

In examining the statistics of chronic disease among the living elderly, it is also important to make note of the statistics pertaining to fatalities as a result of chronic disease. Heart disease is the leading cause of death from chronic disease for adults older than 65, followed by cancer, stroke, diabetes, chronic lower respiratory diseases, influenza and pneumonia, and, finally, Alzheimer’s disease.[28] Though the rates of chronic disease differ by race for those living with chronic illness, the statistics for leading causes of death among elderly are nearly identical across racial/ethnic groups.[28]

Chronic illnesses cause about 70% of deaths in the US and in 2002 chronic conditions (heart disease, cancers, stroke, chronic respiratory diseases, diabetes, Alzheimer’s disease, mental illness and kidney diseases) were 6 of the top ten causes of mortality in the general US population.[30] In the United States, 90% of seniors have at least one chronic disease, and 77% have two or more chronic conditions.[31]

Economic impact[edit]

United States[edit]

Chronic diseases are a major factor in the continuous growth of medical care spending.[32] Healthy People 2010 reported that more than 75% of the $2 trillion spent annually in US medical care are due to chronic conditions; spending are even higher in proportion for Medicare beneficiaries (aged 65 years and older).[13]
Spending growth is driven in part by the greater prevalence of chronic illnesses, and the longer life expectancy of the population. Also improvement in treatments has significantly extended the life spans of patients with chronic diseases but results in additional costs over long period of time. A striking success is the development of combined antiviral therapies that led to remarkable improvement in survival rates and quality of life of HIV-infected patients.

In addition to direct costs in health care, chronic diseases are a significant burden to the economy, through limitations in daily activities, loss in productivity and loss of days of work. A particular concern is the rising rates of overweight and obesity in all segments of the US population.[13] Obesity itself is a medical condition and not a disease, but it constitutes a major risk factor for developing chronic illnesses, such as diabetes, stroke, cardiovascular disease and cancers. Obesity results in significant health care spending and indirect costs, as illustrated by a recent study from the Texas comptroller reporting that obesity alone cost Texas businesses an extra $9.5 billion in 2009, including more than $4 billion for health care, $5 billion for lost productivity and absenteeism, and $321 million for disability.[33]

Social Impact[edit]

There have been recent links between social factors and prevalence as well as outcome of chronic conditions. Specifically, the connection between loneliness and health and chronic condition has recently been highlighted. Some studies have shown that loneliness has detrimental health effects similar to that of smoking and obesity.[34] One study found that feelings of isolation are associated with higher self reporting of health as poor, and feelings of loneliness increased the likelihood of mental health disorders in individuals.[35] The connection between chronic illness and loneliness is established, yet often times ignored in treatment. One study for example found that a greater number of chronic illnesses per individual were associated with feelings of loneliness.[36] Some of the possible reasons for this listed are an inability to maintain independence as well as the chronic illness being a source of stress for the individual. A study of loneliness in adults over age 65 found that low levels of loneliness as well as high levels of familial support were associated with better outcomes of multiple chronic conditions such as hypertension and diabetes.[36] There are some recent movements in the medical sphere to address these connections when treating patients with chronic illness. The biopsychosocial approach for example, developed in 2006 focuses on patients “patient’s personality, family, culture, and health dynamics.”[37] Physicians are leaning more towards a psychosocial approach to chronic illness to aid the increasing number of individuals diagnosed with diagnosed with these conditions. Despite this movement, there is still criticism that chronic conditions are not being treated appropriately, and there is not enough emphasis on the behavioral aspects of chronic conditions[38] or psychological types of support for patients.[39]

The mental toll of chronic illness is often underestimated in society. Adults with chronic illness that restrict their daily life present with more depression and lower self-esteem than healthy adults and adults with non-restricting chronic illness.[40] The emotional influence of chronic illness also has an effect on the intellectual and educational development of the individual.[41] For example, people living with type 1 diabetes endure a lifetime of monotonous and rigorous health care management usually involving daily blood glucose monitoring, insulin injections, and constant self-care. This type of constant attention that is required by type 1 diabetes and other chronic illness can result in psychological maladjustment. There have been several theories, namely one called diabetes resilience theory, that posit that protective processes buffer the impact of risk factors on the individual’s development and functioning.[42]

Race and gender also influence how chronic disease is viewed and treated in society. Women’s chronic health issues are often considered to be most worthy of treatment, or most severe when the chronic condition interferes with a woman’s fertility. Historically, there is less of a focus on a woman’s chronic conditions when it interferes with other aspects of her life or well being. Many women report feeling less than or even “half of a woman” due to the pressures that society puts on the importance of fertility and health when it comes to typically feminine ideals. These kinds of social barriers interfere with women’s ability to perform various other activities in life and fully work toward their aspirations.[43]

Race is also implicated in chronic illness. Racial minorities are 1.5-2 times more likely to have most chronic diseases than white individuals. Non Hispanic blacks are 40% more likely to have high blood pressure that non Hispanic whites, diagnosed diabetes is 77% higher among non Hispanic blacks, and American Indians and Alaska Natives are 60% more likely to be obese than non-Hispanic whites.[44] Some of this prevalence has been suggested to be in part from environmental racism. Flint Michigan for example had high levels of lead poisoning in their drinkable water after waste was dumped into low value housing areas.[45] There are also higher rates of asthma in children who live in lower income areas due to an abundance of pollutants being released on a much larger scale in these areas.[46][47]

Chronic Illness Narratives[edit]

  • Final Negotiations: A Story of Love, Loss, and Chronic Illness by Carolyn Ellis[48]
  • Beyond Words: Illness and the Limits of Expression by Kathlyn Conway[49]
  • Ordinary Life: A Memoir of Illness by Kathlyn Conway[50]
  • The Wounded Storyteller: Body, Illness, and Ethics by Arthur W. Frank[51]
  • Tender Points by Amy Berkowitz[52]
  • Illness as Metaphor by Susan Sontag[53]
  • Regarding the Pain of Others by Susan Sontag[54]
  • Bodies in Protest: Environmental Illness and the Struggle Over Medical Knowledge by Steve Kroll-Smith and H. Hugh Floyd[55]
  • Inside Chronic Pain: An Intimate and Critical Account by Louis Heshusius and Scott M. Fishman[56]
  • The Nearness of Others: Searching for Tact and Contact in the Age of HIV by David Caron[57]
  • Narrative Medicine: Honoring the Stories of Illness by Rita Charon[58]
  • Good Days, Bad Days: The Self in Chronic Illness and Time by Kathy Charmaz[59]

Chronic Condition Scholarship Summary[edit]

Chronic illness scholarly writing can be found in the fields of gender studies, disability studies, and/or feminist disability studies, among others. Within the field of disability studies, there are several scholars who specialize in chronic illness, either based on their own epistemic standpoint or their academic interests.

One of the early disability studies scholars who wrote about chronic illness is Susan Wendell. Wendell wrote “Toward a Feminist Theory of Disability” after experiencing chronic illness and disability herself in 1985[60]. Cited in 359 scholarly sources, Wendell’s paper is considered a seminal contribution to the scholarly field of Disability Studies[61]. In “Toward a Feminist Theory of Disability”, Wendell deconstructs philosophy’s understanding of disability and interrogates the notion of independence in American society[60]. Wendell’s paper influenced other disability studies perspectives on chronic illness, such as Claiming Disability: Knowledge and Identity, “Inquiry into Environment and Body: Women, Work, and Chronic Illness”, and Leaky Bodies and Boundaries: Feminism, Postmodernism, and (Bio)ethics, among others[62][63][64].

One of the premiere journals that focuses on disability studies is the Journal of Literary and Cultural Disability Studies (JLCDS)[65]. Authors who have been published in JLCDS who have written about chronic conditions include: Ann M. Fox, Cath Nichols, Merri Lisa Johnson, Robert McRuer, Mel Y. Chen, Alyson Patsavas, Lorraine Krall McCarry, Lavonna L. Lovern, Declan Gould, Ally Day, Roberto Brigati, Daniela Crocetta, and Laura Hershey[66].

See also[edit]

References[edit]

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External links[edit]