As we begin 2023 my thoughts turn to all those suffering with chronic conditions in the United States. As of the end of 2021, the National Health Care Expenditure (NHE) was $4.3 trillion, representing 18.3% of the Gross Domestic Product (GDP). This is projected to grow to $6.8 trillion and nearly 20% of the GDP by 2028. Chronic diseases affect nearly 60% of Americans, and amazingly consume more than 85% of the overall health care spend.  Furthermore, this epidemic is projected to only grow in the coming years.  While 2022 will likely become infamous for many reasons, one certainly will be inflation with Global averages at about 9% and in the United States rates of about 7% were endured (the highest in 40 years).  Healthcare inflation rose through November of 2022 by about 4.2% which is lower than the month over month average of about 5% in health care inflation since 1948.  While some are projecting the lagging nature of healthcare inflation will end in 2023 due to the huge wage increases in healthcare and supply chain issues the industry is facing, there are still massive, devastating, and growing current problems for many of those suffering from chronic disease, which are bound to have long-term health and economic impacts.  

     While the overall statistics of NHE, chronic diseases, and the economy are sobering, unfortunately, a darker set of statistics underscores that not all are affected equally by these problems.  When looking at income disparities and the most prevalent chronic diseases (focus on cardiovascular diseases (CVD)) researchers found that when comparing the upper 20% of household incomes and the remaining lower 80%, (mean $234 000 and $54,053 per household respectively), those in lower 80% were 2-3 times more likely to develop CVD during the first 20 years of the 21st century.  As an example of this, an amazing 76.9% of dual eligible elderly people (eligible for both Medicaid and Medicare) have two or more chronic conditions (polychronic), and of those younger than 65, those on public insurance vs private insurance are almost two times more likely to be polychronic.  Chronic disease is a major health equality issue which must be tackled.  As of July 2022, 33% of Americans reported they had forgone a recommended medical procedure, and 43% reported they had delayed getting any healthcare, because of cost.

     The effect of forgoing or delaying healthcare disproportionately affects those with chronic disease, and so in a year unlike any since the late 70s and early 80s, and as inflation disproportionately harms the poor, it stands to reason that 2022 caused significant and long reaching negative impacts on the United States chronic care population.  The missed appointments, the delayed care, the reduced dietary choice, the decreased medicine compliance, and effects of increased underlying financial insecurities and anxieties will show up in future years as increased mortality, increased hospitalizations, increased overall health costs and a decreased overall quality of life for those suffering from one or more chronic diseases.

     And so, at this time of year, a time of reflection and gratitude, time with family, let’s encourage us all to take an extra moment to remember those in our lives who are struggling with chronic conditions and check on them to see if they need a bit of extra help after an extra tough year for many.

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