Basics Blog
SHADAC has created a series of “Basics Blogs” to familiarize readers with common terms, concepts, and topics that are frequently covered. See all Basics Blogs here.
Following advancements in public health and medicine that reduced mortality from infectious illnesses such as tuberculosis and influenza in the early 20th century, many of the leading causes of death in the U.S. have shifted from infectious disease to chronic disease.
According to data from the Centers for Disease Control and Prevention (CDC), the leading cause of death in the United States is heart disease, a chronic disease causing an estimated 2,500 deaths daily. Eight of the top ten leading causes of death in the U.S. are chronic diseases, including:
- Diabetes
- Chronic Lower Respiratory Diseases
- Stroke
- Chronic Liver Disease
One recent CDC study found that 75% of U.S. adults have at least one chronic condition, and over half have two or more chronic conditions. Even this may be an undercount, as people who lack health insurance or a primary care physician might be missing from official calculations of those diagnosed with chronic diseases, even if they are currently living with a chronic illness.
Impacts of chronic disease go beyond deaths and tolls on physical health. Researchers from Johns Hopkins University found that 40% of adults with chronic pain experienced “clinically significant depression and anxiety”. Chronic illness can feel isolating: symptoms can flare up unexpectedly, leading to canceled plans or missed experiences, and can affect mental health or an individual’s sense of well-being through persistent feelings of general pessimism about one’s condition and future. Attending doctor’s appointments can be time-consuming, and symptoms may prevent patients from engaging in hobbies or activities that may normally bring them joy.
With chronic diseases impacting millions, causing thousands of deaths, and costing Americans trillions of dollars annually, it’s important for everyone to understand this widespread public health issue.
So: What is chronic disease? Is a chronic disease different from a chronic condition or chronic illness? Does chronic disease prevalence differ by state or population? What are the risk factors for developing chronic disease, and how can we work to manage, and potentially prevent, these conditions?
In this blog, SHADAC reviews the answers to these questions and more, also diving into statistics on chronic disease prevalence by state and by subpopulation using our data tool, State Health Compare. Keep reading to learn more!
Chronic Disease Definition
The word “chronic” generally means persistent or recurring, while a “disease” is defined by the National Cancer Institute as “an abnormal condition that affects the structure or function of part or all of the body and is usually associated with specific signs and symptoms.” Diseases are diagnosed by a health care provider.
“Chronic disease” broadly refers to diseases that are long-lasting. While the specific timeframe indicated by “long-lasting” varies by source, both the Centers for Medicare & Medicaid Services (CMS) and the CDC specify that in order to qualify as a chronic disease, conditions must generally “last 1 year or more and require ongoing medical attention or limit activities of daily living or both.”
In addition to those listed in the introduction, examples of common chronic diseases in the U.S. include obesity, Alzheimer’s, asthma, and many more.
While chronic diseases are long-lasting and oftentimes not curable, many can be managed with medication, medical treatment, lifestyle change, or a combination of the three. For example, diabetes management can include monitoring blood sugar; following a specific diet and exercise plan; and using medications like insulin.
Chronic Disease vs. Chronic Illness vs. Chronic Condition
Now that we have a broad definition of chronic disease, let’s define chronic illness and chronic condition. While all three terms are often used interchangeably, there are slight differences between them.
Chronic Illness
The Cleveland Clinic defines illness as “an imbalance in physical, mental, or psychosocial well-being.” Experiencing illness for an extended period of time can therefore be understood as chronic illness. While certain diseases can also be considered illnesses, not all illnesses are diseases. For example, a headache can be considered an illness, but is not a disease.
Another way to think about chronic disease vs. chronic illness is through the lens of clinical diagnosis. Diseases are diagnosed by health care providers, while illness can be described as “something you feel or experience” and may not have a specific, clinical diagnosis.
Chronic Condition
The term “chronic condition” is the most general definition of the three concepts explored in this blog post. A “condition” refers to the state of an individual’s health. This state may include disease, disorder, injury, or illness affecting physical or mental well-being.
A chronic condition, as defined by the Agency for Healthcare Research and Quality (AHRQ), is “a condition that lasts 12 months or longer and meets one or both of the following tests: (a) it places limitations on self-care, independent living, and social interactions; (b) it results in the need for ongoing intervention with medical products, services, and special equipment." Most chronic conditions are not curable and may persist throughout the entirety of a person’s life.
Put simply, a chronic condition is one that sticks around long-term and changes how a person manages daily life. Similar to what we mentioned with “disease” vs. “illness”, diseases and illnesses are medical conditions, but not all medical conditions are diseases or illnesses. For example, chronic pain, irritable bowel syndrome (IBS), lactose intolerance, and autism spectrum disorder (ASD) are all chronic conditions, but are not considered chronic diseases or chronic illnesses.
Now that we have a better understanding of how chronic disease, illness, and conditions are defined, let’s take a look at who is affected.
Chronic Disease Risk Factors
While chronic disease impacts people of all ages and backgrounds, there are risk factors that can make people or populations more prone to developing chronic disease.
Common risk factors include:
- Tobacco use
- Poor diet or nutrition
- Excessive alcohol consumption
- Physical inactivity
- Genetic predisposition
Beyond these risk factors, an individual’s environment, income, housing, access to health care, and other factors, sometimes referred to as social determinants of health, can also affect a person’s chance of developing a chronic condition. For example, studies have shown that people who live or work around major roadways have an increased incidence of health problems related to air pollution from traffic; this can increase risk for chronic conditions like asthma.
Another example: Studies show that obesity (considered a chronic condition) is more common in “food deserts”, or areas without access to fresh and nutritious foods. Most food deserts are in low-income and rural areas, meaning residents of those areas are more likely to develop obesity.
Chronic disease risk can also be impacted by stress and mental health. Stress can exacerbate symptoms of chronic conditions, affecting “all systems of the body” according to the American Psychological Association. Additionally, stress is often reinforced by challenges patients face while navigating their illness (e.g., higher health care costs, difficult symptoms, coverage of care) and can become a compounding factor in the progression of a chronic disease, as patients must find ways to manage stress along with other symptoms of their condition.
Examining Chronic Disease Prevalence Using State Health Compare
Now that we have a better understanding of what chronic disease is, let’s turn to SHADAC’s data tool, State Health Compare, to understand the prevalence of chronic disease across the states and among different populations.
SHADAC’s “Chronic Disease Prevalence” measure provides annual, state-level estimates of the “percent of adults who report having one or more of the following chronic conditions: diabetes, cardiovascular disease, heart attack, stroke and asthma” using data from the Behavioral Risk Factor Surveillance System (BRFSS). These data can be viewed nationally and for all 50 states and DC, and can be broken down by insurance coverage type, education level, race/ethnicity, and sexual orientation.
By examining chronic disease prevalence in the United States, we can better understand the national impact of this subset of chronic diseases. Examining these data at more granular levels can reveal differences between states and populations, helping us to identify who might experience greater impacts of chronic disease.
Chronic Disease Prevalence in the U.S. from 2020–2024
Let’s start by looking at chronic disease prevalence nationally over the past 5 years.
Figure 1. Chronic Disease Prevalence in the U.S., 2020–2024
As we can see in the trendline graph generated on State Health Compare above, the prevalence of these chronic diseases in the U.S. significantly increased by over 2 percentage points (PP) in the past five years, jumping from 23.7% in 2020 to a record high of 25.9% in 2024. However, as with many measures of public health, the national-level rate does not necessarily represent state-level experiences. Disaggregating these data by state reveals the wide variation of chronic disease rates at the state level.
Chronic Disease Prevalence by State
In 2024, chronic disease prevalence ranged from 21.7% in the District of Columbia to 35.3% in West Virginia, a difference of over 13 percentage points.
West Virginia had the highest rate (35.3%), followed by Kentucky (32.2%), Alabama (30.3%), Michigan (30.0%), and Arkansas (29.8%).
In contrast, the five states with the lowest rates of chronic disease in 2024 were the District of Columbia (DC) at 21.7%, followed by Idaho (22.1%), Utah (22.8%), California (23.0%), and Colorado (23.2%).
To understand whether these state percentages were consistent throughout the years or variable each year, SHADAC researchers also looked at the five states with the highest and lowest percentage of chronic disease prevalence over the past five years (Table 1).
Table 1. States with Highest and Lowest Chronic Disease Prevalence by Year, 2020–2024
2024 Highest Rates | 2023 Highest Rates | 2022 Highest Rates | 2021 Highest Rates | 2020 Highest Rates |
|---|---|---|---|---|
West Virginia - 35.3% | West Virginia - 35.4% | West Virginia - 34.3% | West Virginia - 32.3% | West Virginia - 32.3% |
Kentucky - 32.2% | Louisiana - 30.1% | Arkansas - 31.3% | Mississippi - 29.8% | Kentucky - 28.9% |
Alabama - 30.3% | Tennessee - 29.3% | Alabama - 30.6% | Kentucky - 29.6% | Tennessee - 28.5% |
Michigan - 30.0% | Alabama - 29.2% | Tennessee - 29.8% | Alabama - 28.7% | Mississippi - 28.2% |
Arkansas - 29.8% | Arkansas - 28.8% | Oklahoma - 29.8% | Tennessee - 27.9% | Oklahoma - 27.6% |
2024 Lowest Rates | 2023 Lowest Rates | 2022 Lowest Rates | 2021 Lowest Rates | 2020 Lowest Rates |
|---|---|---|---|---|
District of Columbia - 21.7% | District of Columbia - 20.1% | District of Columbia - 21.4% | Colorado - 19.9% | Alaska - 19.5% |
Idaho - 22.1% | Utah - 21.3% | Colorado - 21.8% | Alaska - 20.2% | Colorado - 19.8% |
Utah - 22.8% | New Jersey - 22.0% | South Dakota - 22.0% | Utah - 20.3% | District of Columbia - 20.3% |
California - 23.0% | Nebraska - 22.5% | Utah - 22.1% | District of Columbia - 20.6% | South Dakota - 20.3% |
Colorado - 23.2% | Colorado - 22.7% | California - 22.6% | Nebraska - 20.9% | Nebraska - 21.0% |
West Virginia consistently ranked as the state with the highest chronic disease prevalence every year from 2020 to 2024. This trend is not new, either: this has been the case since SHADAC began tracking this measure in 2011.
The District of Columbia and Colorado consistently appeared in the states with the lowest rates of chronic disease from 2020 to 2024; Utah also appeared consistently among the states with the lowest chronic disease prevalence, except for 2020. Tennessee was excluded from 2024 estimates due to insufficient data collection that year but ranked among the five highest states from 2020 to 2023.
Chronic Disease Prevalence by Subpopulation
Disaggregating the data by education, race and ethnicity, and insurance coverage reveals differences in the prevalence of chronic illness among population subgroups. We can use SHADAC’s State Health Compare tool to understand how different communities in the U.S. were impacted by CVD, stroke, heart attack, asthma, and/or diabetes in 2024.
Although the District of Columbia consistently appeared in the states with the lowest rates of chronic disease from 2020 to 2024, breaking down the data by race and ethnicity can highlight disparities in outcomes among groups. For example, Black individuals in D.C. reported chronic disease prevalence at 10PP higher than the overall state rate (31.7% compared to 21.7%) in 2024.
Figure 2. Chronic Disease Prevalence in Washington, D.C., by Race/Ethnicity, 2024
Breaking these data down by type of insurance coverage also reveals certain disparities: Rates of chronic disease prevalence among individuals with public insurance coverage in D.C. were nearly 12PP higher than the overall state rate (33.0% compared to 21.7%) and more than double the rate among those with private insurance coverage (33.0% compared to 15.9%).
Figure 3. Chronic Disease Prevalence in Washington, D.C., by Insurance Coverage Type, 2024
Managing and Preventing Chronic Disease Using Data
Using State Health Compare, we can see that chronic disease prevalence is widespread across states. So how can policymakers, public health professionals, and community members manage and even prevent chronic disease?
As we referenced earlier, managing chronic disease can be costly, amounting to $4.77 trillion dollars spent in the U.S. in 2024 alone. A 2022 study of adults with private health insurance found that patients with chronic diseases face significantly worse financial outcomes than those without a chronic disease. Beyond the cost of care, patients may be unable to work or earn a steady income due to their condition, deepening the financial burden of chronic disease.
Implementing new programs and policies to help manage chronic disease could be key to improving outcomes and reducing impacts of chronic disease. Offered by the Centers for Medicare & Medicaid Services, Chronic Care Management (CCM) is a Medicare Part B program that reimburses healthcare providers for coordinating care for individuals living with two or more chronic conditions. These programs are designed to help manage symptoms, fill prescriptions, and prevent future health problems for those living with chronic conditions.
Additionally, mitigating chronic risk factors or supporting protective factors can be another option for managing chronic disease. Examples include programs to improve nutrition, educate on disease management, encourage active living, and provide support for caregivers.
However, the best method for addressing chronic disease is prevention.
At an individual level, a balanced diet and engaging in regular physical activity have been shown to lower the risk of chronic disease. Additionally, health care providers can more effectively perform necessary screenings and assess risk factors for various chronic conditions when individuals engage regularly with the medical system, such as through annual checkups and physicals with a consistent doctor. This can also help people receive a diagnosis earlier and begin managing the condition before it progresses.
At a community level, lack of access to affordable healthy food and lack of walkable neighborhoods can also contribute to the growing issue of chronic disease by imposing limits that make it more difficult to maintain a healthy diet and lifestyle. By considering chronic disease indicators in land use plans, comprehensive planners and policymakers can work to promote healthier behaviors through the built environment, making it easier for community members to manage, or even prevent, chronic disease.
At the national level, the CDC’s National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) uses epidemiological data to support and promote healthy behaviors and the uptake of preventive medical care. These initiatives aim to both support individuals currently managing chronic diseases and implement preventive measures to address and reduce national trends in chronic diseases overall.
In addition, the BRFSS’s companion survey, the Youth Risk Behavior Surveillance System (YRBSS), collects data on the prevalence of chronic conditions among adolescents. This information can help researchers identify patterns of chronic disease over time and across age groups to plan appropriate interventions, starting at earlier ages, such that some acute conditions might be prevented from turning into chronic ones.
What Is Chronic Disease Like in Your State? Explore Your State’s Chronic Disease Data on State Health Compare
The national and subpopulation trends in chronic disease prevalence outlined here are only part of the picture. State- and population-specific chronic disease data can be explored and filtered by population subgroups and tracked over time directly using SHADAC’s State Health Compare.