Death due to chronic disease represents a significant burden among Ohioans. In 2016, six of the 10 leading causes of death in Ohio were attributed to chronic disease (heart disease, cancer, chronic lower respiratory disease, stroke, diabetes and kidney disease), accounting for 57 percent (71,746) of Ohio deaths. Heart disease was the leading cause of death in Ohio in 2016 and claimed the lives of 27,407 Ohioans, accounting for 22 percent of all deaths. Men in Ohio were more likely to die from chronic disease (585.0 per 100,000) than women (411.5 per 100,000). Chronic disease mortality rates by race/ethnicity indicate that blacks have higher death rates of heart disease, stroke, diabetes, cancer and chronic kidney disease compared with other racial groups. Black men had the highest chronic disease death rate in 2016 (700.1 per 100,000), with approximately 39 percent of these deaths occurring before age 65. Chronic disease mortality rates also vary by geographic region in Ohio. For example, in 2016, the diabetes death rate was 17.2 percent higher and the heart disease death rate was 14.3 percent higher in the 32-county Appalachian region of Ohio compared to non-Appalachia Ohio.
Ohioans have a higher prevalence of chronic disease compared with the United States. According to 2016 data, Ohioans age 18 and older had a higher prevalence of heart disease (7.4 percent), stroke (3.6 percent), diabetes (11.1 percent), cancer (7.1 percent), chronic obstructive pulmonary disease (COPD, 8.7 percent), kidney disease (2.9 percent), asthma (9.7 percent) and arthritis (30.5 percent) compared with U.S. adults.
In Ohio in 2016, 20.5 percent of adults reported having two or more chronic diseases. People with multiple chronic diseases are often in poorer health, have higher rates of disability, and have more complex and costly treatment than those with only one or no chronic diseases.
The chronic disease burden in Ohio is greatly influenced by social determinants of health, which are the social, economic and physical conditions in the environment in which people are born, live, learn, play, work and age. Social determinants influence the health of people and communities and affect a wide range of health, functional and quality-of-life outcomes and risks related to chronic disease. For example, the prevalence of heart disease, stroke, diabetes, cancer, COPD, asthma, arthritis, chronic kidney disease and depression is higher among populations with the lowest income and lowest education. To address social determinants and achieve health equity, chronic disease programs and initiatives use data and tools to segment target populations based on burden and need, and implement interventions that can effectively reach these populations.
Chronic Diseases and Conditions
Arthritis is a group of more than 100 diseases (including arthritis, rheumatoid arthritis, gout, lupus, fibromyalgia, rheumatism, polymyalgia rheumatic, osteoarthritis, tendonitis, bursitis, bunion, tennis elbow, carpal tunnel syndrome, tarsal tunnel syndrome and joint infection) that affect the joints and cause inflammation and pain. In nearly all forms of arthritis, the major symptoms are pain, swelling and stiffness of joints often localized to just the affected joint.
- Asthma is a chronic inflammatory disease of the airways. The main symptoms of asthma, which are inconsistent and come and go periodically, include difficulty breathing, wheezing, coughing and tightness in the chest. The symptoms are caused by spasms of the passageways in the lungs and obstructed airways that can be reversed with medications.
- Cancer is a group of more than 100 different diseases characterized by uncontrolled growth and spread of abnormal cells. Cancer was the 2nd leading cause of death in Ohio in 2016, accounting for nearly one of every four deaths. The lifetime risk of developing cancer is 40 percent for men and 38 percent for women in the United States.
Chronic Kidney Disease
Chronic kidney disease (CKD) is any condition where the kidneys are damaged and cannot filter blood as effectively as they should. CKD causes excess fluid and waste from the blood to accumulate in the body, which may lead to a variety of health problems such as heart disease and stroke. CKD was the 8th leading cause of death in Ohio in 2016.
Chronic Obstructive Pulmonary Disease (COPD)/Chronic Lower Respiratory Disease (CLRD)
Chronic obstructive pulmonary disease (COPD) is a group of diseases that involve inflammation and thickening of the airways and destruction of the tissue of the lung where oxygen is exchanged. COPD typically includes chronic bronchitis and emphysema. Similar to COPD, chronic lower respiratory disease (CLRD) is a group of diseases that are characterized by shortness of breath caused by airway obstruction. In addition to chronic bronchitis and emphysema, CLRD typically includes asthma. CLRD was the 3rd leading cause of death in Ohio in 2016.
Diabetes occurs when the pancreas can no longer make enough insulin to control blood sugar. Type 1 diabetes (also called juvenile diabetes or insulin-dependent diabetes) occurs when the body’s immune system attacks and destroys certain cells in the pancreas which produce insulin. Type 1 diabetes accounts for about 5 percent of cases in the United States. Type 2 diabetes is the most common form of diabetes, accounting for about 90-95 percent of diagnosed diabetes cases in U.S. adults. In type 2 diabetes, the pancreas makes some insulin but not enough, or the body is unable to use insulin correctly, or both. In 2016, diabetes was the 7th leading cause of death in Ohio.
Heart disease, which includes coronary heart disease (CHD), myocardial infarction (MI or heart attack) and heart failure, was the leading cause of death in Ohio in 2016. CHD is the most common type of heart disease and is caused by a buildup of plaque along the walls of arteries, reducing blood flow to the heart. This reduction in blood flow can cause recurrent chest pain (angina) or, if severe, can deprive heart muscle of oxygen and cause an MI. Heart failure occurs when the heart muscle is too weak to pump blood well enough to supply the body with enough oxygenated blood.
High Blood Cholesterol
High blood cholesterol, also called hyperlipidemia, is the persistent presence of high levels of cholesterol in the blood. There are two types of cholesterol—LDL, or low-density lipoproteins, and HDL, or high-density lipoproteins. High levels of LDL can increase the risk of heart disease, while high levels of HDL are protective.
Hypertension, also called high blood pressure, is defined as a blood pressure of 140/90 mmHg or higher. Consistently elevated blood pressure can put strain on the heart muscle and vascular system. High blood pressure that is not under control can increase an individual’s risk for heart disease, stroke and kidney disease, among other conditions.
Obesity in the adult population is defined as having a body mass index (BMI) of 30 kg/m2 or higher. For children and adolescents, obesity is defined as a BMI that is greater than or equal to the 95th percentile for age and sex. Obesity can increase a person’s risk for cardiovascular disease, cancer, type 2 diabetes, asthma and arthritis, among other diseases.
Prediabetes is a condition where blood sugar levels are higher than normal, but not high enough to be considered type 2 diabetes. If not diagnosed and managed, individuals with prediabetes are at a 15-20 percent higher risk of developing type 2 diabetes within five years.
Stroke occurs when blood flow to part of the brain is reduced or completely blocked, typically causing the affected brain tissue to die. The symptoms of stroke depend on the part of the brain affected and can include confusion, headache, sudden numbness or weakness especially on one side of the body, dizziness and trouble talking, walking or seeing. In 2016, stroke was the 4th leading cause of death in Ohio.
Chronic diseases result primarily from four modifiable health behaviors—smoking and other tobacco use, poor diet, insufficient physical activity and heavy alcohol consumption—behaviors that often begin early in life. According to 2015 and 2016 data, nearly one in four Ohio adults (22.5 percent) were current smokers, 43.4 percent ate less than one fruit and 27.1 percent ate less than one vegetable daily, four in five (81.1 percent) did not meet physical activity guidelines and 6.4 percent were heavy drinkers. In addition, the prevalence of many of these risk factors among adults was higher in Ohio compared to the United States.
Many risk factors are associated with not just one, but multiple chronic conditions. In fact, tobacco use, insufficient physical activity and poor nutrition are each associated with heart disease, stroke, type 2 diabetes and cancer. Thus, improvements in these risk factors will have a significant impact on the chronic disease burden in Ohio.
Chronic disease outcomes can also be improved by controlling clinical risk factors such as obesity, high blood pressure and high cholesterol. Obesity is defined as a body mass index (BMI) of 30 kg/m2 or higher for adults. Nearly one in three (31.5 percent) Ohio adults were obese in 2016, and the prevalence of obesity was higher in Ohio compared to the United States. In addition, more than one in three Ohio adults had high blood pressure (34.3 percent) and high cholesterol (38.9 percent) in 2015. Coordinated efforts targeting health behaviors and clinical risk factors are therefore necessary to reduce the burden of chronic disease in Ohio.
The majority of healthcare costs in Ohio and the United States are associated with chronic disease and related health behaviors. In 2010, 86 percent of all healthcare spending in the United States was for people with one or more chronic conditions. Thus, chronic disease presents a real economic threat to Ohio, both now and in the future.
In 2016, chronic diseases cost the state of Ohio an estimated $31.9 billion in direct medical costs. Direct medical costs were highest for cancer ($7.1 billion), arthritis ($6.7 billion) and coronary heart disease ($6.5 billion). Costs for six of the leading chronic diseases in Ohio—heart disease, stroke, diabetes, cancer, arthritis and asthma—are expected to rise to nearly $44 billion by 2020.
However, if Ohioans achieve even modest improvements in chronic disease prevention and early detection, the state could save billions of dollars in healthcare spending and prevent multiple cases of chronic disease. It is estimated that a 5 percent reduction in body mass index (BMI) would save Ohio $1.2 billion and prevent 650,000 cases of diabetes, heart disease and cancer by 2030.