Studies Raise Concern About Health Status of U.S. Residents

Two reports issued last week have raised eyebrows because they seem to indicate a disturbing prevalence of illness. In California, according to one study, about 1 in 3 hospitalized people older than 34 has diabetes. And a survey by the Centers for Disease Control and Prevention (CDC) showed that about half of all Americans have taken a prescription drug in the last 30 days.

The California study, by the UCLA Center for Health Policy Research and the California Center for Public Health Advocacy, is alarming, explains (KHN), not only because diabetes is a chronic, life-threatening disease, but because treating it is complex and more expensive because the disease impairs the body’s ability to heal.

The study analyzed a year’s worth of hospital discharge data and financial reports from California’s Office of Statewide Health Planning and Development.

Care for hospitalized patients with diabetes cost about $2,200 more, on average, than for patients who didn’t have the disease, no matter what problem brought them into the hospital in the first place.

The data showed that diabetes was the primary cause in only 1.7 in 100 hospitalizations, but those patients are at increased risk for kidney and heart disease, blindness and limb amputations. The study year was 2011, but the researchers noted that in 2006, 2 in 3 patients with diabetes were estimated to have had at least one of those complications, at a cost of almost $23 billion nationally.

“The time is now to turn around this epidemic because we know the health-care system is going to be overwhelmed,” the study’s lead author told KHN.

The study didn’t distinguish between hospitalizations for patients with type 1 diabetes, which is partly genetic, and type 2, which is associated with obesity, inactivity and affects minority groups disproportionately.

Because almost all adults diagnosed with diabetes have type 2, the researchers said creating programs and communities that promote healthful eating and regular exercise, combined with improved access to primary care, would help address the incidence of the disease, and help lower its costs.

That’s hardly news. But some such programs, such as supplying calorie information on restaurant menus, promoting the use of food stamps at farmers markets and limiting the number of fast food outlets in communities with limited access to fresh foods, seem to have only moderate influence in improving eating habits and helping people to lose weight.

Too Much Medication?

“Americans pop pills more than most other nations,” is the lead on the story about our conspicuous consumption of drugs.

Prescription drug use in the U.S. is up sharply over the last couple of decades, and it’s not just about an age wave – all age groups take a lot of drugs, although if you’re older than 65 and you’re not on any meds, you’re in the minority 1 in 10 who don’t.

The WBUR story referred to the nation’s health report released last week by the CDC’s National Center for Health Statistics. It shows that:

  • About half of all Americans from 2007 to 2010 reported taking one or more prescription drugs in the past 30 days, and use increased with age – 1 in 4 children took one or more prescription drugs compared with 9 in 10 adults 65 and older.
  • Cardiovascular (for high blood pressure, heart disease or kidney disease) and cholesterol-lowering drugs were two of the most commonly used among adults (18 and older). Nearly 18 in 100 of adults 18 to 64 took at least one cardiovascular agent in the past 30 days.
  • The use of cholesterol-lowering drugs (such as statins) among people 18 to 64 has increased more than six-fold since1994. (See our newsletter, “Spotlight on Statins.”)
  • Among adults 65 and older, more than 7 in 10 took at least one cardiovascular agent and nearly half took a cholesterol-lowering drug in the past 30 days.
  • The use of antidepressants among adults18 and older increased more than four-fold from 1994 to 2010.

But there was some good news about antibiotics, whose efficacy is being eroded, thanks to our overuse of these drugs, which develop resistance to the bugs they were designed to fight (See our blog, “Why Doctors Overprescribe Antibiotics and What to Do About It.”): The prescribing of antibiotics during medical visits for cold symptoms declined by almost 40% from 1995-1996 to 2009-2010.

And what we spend every year on retail prescription drugs slowed by almost 12% from 2001 to 2011.

That we are a druggy nation is beyond dispute, and no doubt our use of medicine contributes not only to the high cost of health care, but, often, its overuse and unnecessary side effects and complications. Still, drugs undeniably can be lifesavers and life enhancers, and, as a couple of readers commented on the WBUR site, raw numbers don’t tell the whole story.

“I don’t think these data tell you much without knowing which drugs people are actually taking,” wrote one reader. “Birth control would be the big one that I think needs to be spelled out. Many women of childbearing age take birth control on a daily basis, not to treat a disease, but to prevent pregnancy… By contrast, in other parts of the world, IUD’s are used much more regularly than birth control pills, so this would skew Americans toward taking more drugs than in other countries… The point is, we would really need more details in order to draw any conclusions from this report.”

“Interesting data point,” said another, “but not useful without analysis. The real question is whether or not there is an improvement in overall health that can be demonstrated to be caused by ingestion of drugs, not just coincidental with taking more meds.”

As a society, we’ve got a lot to learn about the consumption of medical care, but, clearly, a lot of people are studying hard.

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