Projecting the Chronic Disease Burden Among the Adult Population in the United States Using a Multi-State Population Model

Research

Projecting the Chronic Disease Burden Among the Adult Population in the United States Using a Multi-State Population Model

Over the next three decades, the US population will age significantly. The number of people 50 years and older will increase by nearly 90 million people by 2050. As our population ages, the number of Americans with multiple, chronic conditions will nearly double by 2050.

Abstract

Introduction: As the United States population ages, the adult population with chronic diseases is expected to increase. Exploring credible, evidence-based projections of the future burden of chronic diseases is fundamental to understanding the likely impact of established and emerging interventions on the incidence and prevalence of chronic disease. Projections of chronic disease often involve cross-sectional data that fails to account for the transition of individuals across different health states. Thus, this research aims to address this gap by projecting the number of adult Americans with chronic disease based on empirically estimated age, gender, and race-specific transition rates across predetermined health states.

Methods: We developed a multi-state population model that disaggregates the adult population in the United States into three health states, i.e., (a) healthy, (b) one chronic condition, and (c) multimorbidity. Data from the 1998 to 2018 Health and Retirement Study was used to estimate age, gender, and race-specific transition rates across the three health states, as input to the multi-state population model to project future chronic disease burden.

Results: The number of people in the United States aged 50 years and older will increase by 61.11% from 137.25 million in 2020 to 221.13 million in 2050. Of the population 50 years and older, the number with at least one chronic disease is estimated to increase by 99.5% from 71.522 million in 2020 to 142.66 million by 2050. At the same time, those with multimorbidity are projected to increase 91.16% from 7.8304 million in 2020 to 14.968 million in 2050. By race by 2050, 64.6% of non-Hispanic whites will likely have one or more chronic conditions, while for non-Hispanic black, 61.47%, and Hispanic and other races 64.5%.

Conclusion: The evidence-based projections provide the foundation for policymakers to explore the impact of interventions on targeted population groups and plan for the health workforce required to provide adequate care for current and future individuals with chronic diseases.

Keywords: United States of America; adult population; chronic disease; multi-state population projection; projections.

Ansah JP, Chiu CT. Projecting the chronic disease burden among the adult population in the United States using a multi-state population model. Front Public Health. 2023 Jan 13;10:1082183. doi: 10.3389/fpubh.2022.1082183. PMID: 36711415; PMCID: PMC9881650.

Summary

Introduction:

The aging US population is expected to increase the prevalence of chronic diseases among adults.
Cross-sectional data often fails to consider transitions across health states, prompting the development of a multi-state population model.

Methods:

Developed a model with three health states: healthy, one chronic condition, and multimorbidity.
Used 1998-2018 Health and Retirement Study data for age, gender, and race-specific transition rates.

Results:

US population aged 50+ to increase by 61.11% from 137.25 million (2020) to 221.13 million (2050).
Those with at least one chronic disease to increase by 99.5%, from 71.52 million (2020) to 142.66 million (2050).
Multimorbidity projected to increase by 91.16%, from 7.83 million (2020) to 14.97 million (2050).
By 2050, 64.6% non-Hispanic whites, 61.47% non-Hispanic blacks, and 64.5% Hispanics and other races may have at least one chronic condition.

Conclusion:

Evidence-based projections provide insight for policymakers to plan interventions and healthcare workforce.
Emphasizes the need for high-quality primary care to address the increasing burden of chronic diseases.

Implications for Public Health:

Stresses the importance of prioritizing access to quality primary care to manage chronic diseases.
Highlights the need for health education, especially focusing on lifestyle and social determinants.
Recommends continuous care models and interventions to reduce the economic burden of chronic diseases on healthcare systems and employers.

Discussion:

Majority of adults aged 50+ expected to have at least one chronic condition by 2050.
Advocates for health education and care models focusing on self-care and self-management.
Emphasizes the economic impact of chronic diseases on productivity and the need for cost-effective interventions.

Strengths and Limitations:

Strengths include using 20 years of data and a multi-state model.
Limitations involve a non-comprehensive list of chronic diseases, self-reported data, and assumptions about chronic disease transition patterns.

Funding and Conflicts:

Research supported by the Center for Community Health Integration at Case Western Reserve University.
No declared conflicts of interest.

Data Availability:

The Health and Retirement Study data used is publicly available.