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Decrease in life expectancy linked to number of chronic health conditions

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In a new study of more than a million Americans receiving Medicare, the more chronic conditions they have such as heart disease or cancer, the lower their life expectancy. If the trend continues, Social Security and Medicare planners may have to change how they plan and predict costs in the future.

“Living with multiple chronic diseases such as diabetes, kidney disease and heart failure is now the norm and not the exception in the United States,” says Eva H. DuGoff, a researcher at the Johns Hopkins Bloomberg School of Public Health in Baltimore and lead author of the report.

“The medical advances that have allowed sick people to live longer may not be able to keep up with the growing burden of chronic disease. It is becoming very clear that preventing the development of additional chronic conditions in the elderly could be the only way to continue to improve life expectancy,” she adds in a statement on the study provided by Bloomberg School of Public Health.

DuGoff and her colleagues evaluated a 5 percent representative sample of 1.4 million Medicare enrollees ages 67 and older who were enrolled in the national program as of January 1, 2008. It included 21 specific chronic conditions based on medical records. The chronic conditions included:

  • heart disease;
  • cancer;
  • chronic obstructive pulmonary disease;
  • stroke;
  • and Alzheimer disease.

On average, the researchers found that life expectancy decreases with each additional chronic condition. For example, a 67-year-old person with no chronic conditions will live on average 22.6 additional years. But a 67-year-old individual with five chronic conditions will live 7.7 fewer years, and someone with 10 or more chronic conditions will live 17.6 fewer years.

Additionally, they found in general that women continue to live longer than men; and white people live longer than black people.

The type of disease a person has matters. A 67-year-old with heart disease is estimated to live an additional 21.2 years on average, but a person of the same age with Alzheimer disease is estimated to live an additional 12 years on average.
Each additional chronic condition reduces life expectancy by 1.8 years, decreasing life expectancy more as the person has more diseases.

“We tend to think about diseases in isolation. You have diabetes or you have heart failure. But many people have both, and then some,” says senior author Gerard F. Anderson, PhD, a professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health.

“The balancing act needed to care for all of those conditions is complicated, more organ systems become involved as do more physicians prescribing more medications. Our system is not set up to care for people with so many different illnesses. Each one adds up and makes the burden of disease greater than the sum of its parts,” he adds.

The researchers say the study results may be useful to Social Security and Medicare planners, as they make population and cost predictions for the future. The fact that 60 percent of Americans 67 years old and older have at least three chronic diseases may mean life expectancy will continue to decline.

Already life expectancy in the United States is rising more slowly than in other parts of the developed world. The authors attribute this partly to the obesity epidemic and its related health conditions for the worsening health of the American population.

“We already knew that living with multiple chronic conditions affects an individual’s quality of life, now we know the impact on quantity of life,” DuGoff says. “The growing burden of chronic disease could erase decades of progress. We don’t want to turn around and see that life expectancy gains have stopped or reversed.”

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