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US Patients See Rising Burdens of Mental Health, Chronic Disease

Mental health concerns and chronic diseases are on the rise across the nation, according to the 29th annual ranking from the United Health Foundation.

Chronic disease, population health, and mental health

Source: Thinkstock

By Jennifer Bresnick

- Mental health issues, behavioral health concerns, and chronic diseases are on the rise for individuals in the United States, creating significant challenges for healthcare providers in many regions of the country, according to the United Health Foundation’s latest population health report.

Despite some laudable public health successes and a slight uptick in the number of practicing healthcare providers, the annual America’s Health Rankings overview shows that much more work is still required to eliminate disparities and improve outcomes.

“This year, the report finds increases in mortality and chronic disease such as obesity that continue to impact the nation’s health,” says the report, now in its 29th year of tracking socioeconomic and clinical trends across the nation.

The obesity rate ticked upwards by 5 percent over the past year, now affecting one in three Americans.

“This means more people will likely develop obesity-related chronic diseases like cardiovascular disease (CVD), diabetes and cancer,” said Dr. Rhonda Randall, chief medical officer of UnitedHealthcare National Markets, and an adviser to America’s Health Rankings.

READ MORE: Combating Chronic Disease through the Social Determinants of Health

There has been a concurrent rise of deaths from CVD, with 112,403 more deaths reported in 2018 than in 2015.  CVD is most likely to claim the lives of black adults, and is significantly more common among men of any race or ethnicity than women.

And while the overall mortality rate from cancer is decreasing, more than 30 states have seen a rise in cancer deaths or have seen little positive changes since 1990.

In Oklahoma, for example, cancer deaths have increased by 12 percent during that time period.  In Mississippi and Kentucky, deaths from the condition have increased by 11 percent since 1990.

Cardiovascular disease mortality rates over time

Source: United Health Foundation

“Deaths from these chronic diseases and others contribute to the nation’s premature death rate — the number of years lost before an individual reaches age 75,” the report stated. “This rate increased for the fourth straight year, driven by suicide and drug deaths with 7,432 years lost per 100,000 people this year.”

Drug deaths have jumped by 25 percent in the past three years, while suicide has increased 16 percent since 2012.

READ MORE: Using Risk Scores, Stratification for Population Health Management

Mental and behavioral health issues which contribute to these outcomes are also on the rise. 

“More Americans are also reporting poor mental health for 14 or more days out of the last month, with frequent mental distress now impacting nearly one in eight adults,” says the study. “In fact, self-reported mental distress measured by the Behavioral Risk Factor Surveillance System increased 7 percent over the past two years.”

However, the report does offer some hope.  Despite numerous forecasts of provider shortages, the number of practicing clinicians has increased over the past year.  The national rate of mental healthcare providers has increased by 8 percent, from 218 providers per 100,000 people to 234.7 clinicians.

Primary care physicians are also entering the field at a net-positive rate.  The nation has seen a 5 percent increase in PCP availability, with 156.7 provider per 100,000 people now available.

But these providers are not evenly distributed, leaving some states with significant shortfalls – and lower scores on measures of wellbeing.

READ MORE: Identifying Big Data Sources for Population Health Management

“The national rate of health care providers is increasing. mental health providers per 100,000 people is more than six times greater in Massachusetts, the healthiest state for this measure, compared to Alabama, the state with the lowest concentration of mental health providers,” the report explains.

Changes in cancer mortality rates by state from 2017 to 2018

Source: United Health Foundation

124 million Americans currently live in mental healthcare shortage areas, according to the Kaiser Family Foundation.  Rates of mental distress are significantly higher in rural regions, where access to care is also traditionally more difficult. 

“Similar disparities are found in primary care, as the number of primary care physicians per 100,000 people is three times greater in Rhode Island, the healthiest state for this measure, compared to Idaho, the state with the lowest concentration,” the brief continued. 

The Health Services & Resource Administration (HRSA) estimates that an additional 6900 primary care providers will be required to close the gaps in access to basic health services.

Many of the disparities included in the assessment can be attributed to the social determinants of health, the report notes. 

Educational attainment appears to be a particularly strong predictor of wellness, the study observed.

“Disparities emerge among many measures across the states when analyzing health behaviors, clinical care and outcomes by education level (less than a high school education, high school graduate, some college and college graduate),” said the report.

Distribution of mental healthcare providers across the US in 2018

Source: United Health Foundation

High school graduation rates vary significantly between ethnic and racial groups both between and within states.

“The highest high school graduation rate for black students is lower than the graduation rate among white students in 28 states, while the state with the fifth highest graduation rate for black students is lower than the graduation rate among white students in 42 states,” said the brief.

While obesity, physical inactivity, smoking, diabetes, and low birth weight are most common among those with less formal education, excessive drinking is actually more common among the college-educated.

Excessive drinking is most common in the Great Plains and Midwestern states, but is also prevalent in Alaska, Hawaii, and Massachusetts.

Meanwhile, obesity and its associated chronic conditions remain entrenched in Appalachia and the southern section of the country.  More than 38 percent of residents in West Virginia are obese, and 31 percent report habitual physical inactivity.  Fifteen percent of residents have been officially diagnosed with diabetes.

“Contributing factors [to obesity rates] include poor diet, physical inactivity, social and physical environment, genetics and medical history,” the report explains. “Populations that experience a higher prevalence of obesity include non-Hispanic black and Hispanic adults compared with white and Asian adults, and adults living in nonmetropolitan counties compared with adults living in metropolitan counties.”

These regions also experience high levels of tobacco use, higher numbers of children living in poverty, higher cholesterol and blood pressure rates, lower rates of immunizations for common preventable diseases, and decreased access to dental care

The uninsured rate is also very high, with between 10 and 17 percent of individuals lacking health insurance in Florida, Mississippi, Georgia, North Carolina, and South Carolina.

Louisiana, which ranked last in overall health, has an uninsured rate of 9.4 percent, measurably higher than the nation’s overall 8 percent uninsured rate.

“While these findings paint a concerning picture of America’s health this year, United Health Foundation recognizes that federal, local and state leaders are working to move the needle on these markers and is encouraged by the improvements being made in communities across the country,” said the study.

On the other end of the scale, Hawaii was named the healthiest state in 2018, followed by Massachusetts and Connecticut.

These states ranked highly on the core measures of behaviors and lifestyle choices, community and environmental factors, clinical care, and longer-term outcomes.

Overall, the report reveals a number of opportunities for healthcare stakeholders to engage in impactful population health management programs to address chronic diseases, outcomes disparities, and the underlying social determinants of health.

“We encourage health professionals, public health officials and elected leaders to use these findings to explore opportunities to better support people in their communities in all aspects of their health,” Randall concluded.

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