ANSWER
A shared language, or at least a shared understanding of the meaning of the keywords used in a conversation, is an important component of effective communication. “Chronic disease” is a term frequently used in discussions between patients and medical providers, academic literature, and policy discussions. There is not only a wide range of diseases included under the umbrella term “chronic disease,” but also a range of times a disease must be present for something to be considered chronic. Furthermore, there is a push to include chronic conditions that are not disease indicators but rather long-term functional disabilities, such as developmental disorders and visual impairment (1–4).
Chronic disease is used differently in different professional communities (e.g., medical, public health, academic, and policy). According to the Centers for Disease Control (CDC), chronic diseases include heart disease, stroke, cancer, type 2 diabetes, obesity, and arthritis (5). Alzheimer’s disease, depression, and HIV are just a few of the 19 chronic conditions listed by the Centers for Medicare and Medicaid Services. While not surprising to those in the field, this difference can create confusion and misunderstanding when speaking in broad strokes about the impact of chronic disease, the cost of chronic disease, and overall measures to reduce chronic disease.
The same type of terminology variation can be found in academic literature. Differences in how the term “chronic disease” is used are largely determined by the research data and the discipline of the lead authors (i.e., public health and sociology). For example, one study by Harvard Medical School researchers investigated chronic disease prevalence using NHANES data (1999–2004). The study classified the following as chronic diseases: cardiovascular disease, hypertension, type 2 diabetes, hypercholesterolemia, asthma, COPD, and prior cancer (6). Another geriatrician-authored academic study on chronic disease defines chronic illness as “conditions that last a year or more and require ongoing medical attention and limit activities of daily living” (7). A non-uniform use of the term implies that a thorough reading of each study is required to avoid drawing incorrect conclusions about interventions needed to reduce the burden of chronic disease on individuals and society.
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Popular Internet sources for medical information use the terms “chronic disease” and “chronic condition” to mean slightly different things. MedicineNet, for example, defines chronic disease as
According to the National Center for Health Statistics, one lasts three months or more. Chronic diseases, in general, cannot be prevented or cured by vaccines, nor do they disappear (8).
A chronic condition, according to Wikipedia, is,
a human health condition or disease that is persistent or otherwise long-lasting in its effects or a disease that comes with time. When a disease’s course lasts more than three months, it is referred to as chronic. Arthritis, asthma, cancer, COPD, diabetes, and viral diseases such as hepatitis C and HIV/AIDS are common chronic diseases (9).
Finally, according to the World Health Organization, chronic diseases,
are not passed from one person to the next. They have a long duration and a slow progression. Cardiovascular diseases (such as heart attacks and strokes), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma), and diabetes are the four main types (10).
The CDC’s Chronic Disease Overview excludes chronic respiratory conditions like COPD and asthma and does not mention disease duration or symptoms. The definition on MedicineNet does not include specific diseases, but it does include the phrase “cannot be cured by medication.” Wikipedia, like MedicineNet, uses 3 months as a marker, but it does list specific diseases, including HIV. According to the WHO, HIV is not chronic because it is “transmitted from person to person.”
When viewed in an international context, the variation in meaning is amplified. The Australian Institute of Health and Welfare, for example, lists the following as common features of chronic disease (11):
Complex causation, with multiple factors contributing to their onset; a long development period during which there may be no symptoms; and a prolonged course of illness, possibly leading to other health complications associated with functional impairment or disability.
The burden of mental illness and oral disease is prominently highlighted in the Australian government’s chronic disease information. Both of these conditions are frequently left out of the chronic disease discussion in the United States (12, 13).
Given the global dissemination of medical information, the disparity in public information is confusing on paper and has real-world implications for those dealing with chronic diseases or conditions. Individuals unaware that the information applies to them may miss recommendations for chronic disease management; conversely, individuals may use the recommendation when it is not recommended. For example, the CDC classifies “cancer” as a chronic disease when only certain types of cancer (such as multiple myeloma) qualify as such. Other cancers have few treatment options and are fatal in the short term.
Visit: Diseases Can Change From Fatal to Chronic
Transitions in disease states – from terminal diagnosis to chronic disease or from acute to chronic – are not unexpected in the public health and medical communities. For example, approximately 1.2 million people in the United States are infected with HIV, with 50,000 new cases confirmed each year (14). People with HIV are now typically treated with once-daily, fixed-dose pills that must be taken for the rest of their lives. It is a vast improvement over early HIV treatment, which included a complicated pill regimen with difficult-to-manage side effects. Advances in HIV treatment have altered the course of a newly diagnosed HIV-positive person’s life. As of 2015, a person living with HIV had roughly the same lifespan as someone who had not been diagnosed with HIV (15–19).
However, from 1/1/2015 to 5/1/2016, a search of news articles from two national news sources (the New York Times and the Washington Post) yielded zero articles containing the words “HIV, Chronic, and Disease/Condition.” If the general public relies on these news sources to understand the changing nature of the chronic disease, it is understandable that HIV is not typically thought of in the same category as diabetes or COPD, and the stigma of HIV as a “death sentence” persists. It is reasonable to assume that the general public is unaware that HIV-positive people have a longer life expectancy than people with diabetes.
HIV is now a risk factor for other chronic diseases, such as cardiovascular disease and diabetes, thanks to advances in HIV treatment. Patients, clinicians, public health professionals, and others interested in reducing chronic disease’s public health and economic burdens may benefit from viewing HIV as a precursor to other chronic diseases rather than a single chronic disease (20–22).
Go to: Imagining the Future
According to the National Health Council, the seven most common chronic conditions – cancer, diabetes, hypertension, stroke, heart disease, pulmonary conditions, and mental illness – cost the United States $1.3 trillion in annual economic burden (23). This figure excludes many other chronic conditions and diseases, such as HIV. If we want to reduce chronic disease’s health effects and fiscal burden, we need to change the conversation. To reduce chronic disease, we must promote lifestyle changes and medical breakthroughs. Still, we also need patients, providers, policymakers, and those promoting public discourse to be precise in the words we use to describe health, disease, and illness.
Rather than adhering to a specific list of diseases and a time frame, we advocate for a more straightforward approach. Merriam-Webster defines “chronic” as something that “continues or occurs repeatedly for a long time.” Using this simplified definition, a broken leg would be excluded as a chronic condition, but recurring lower back pain or hormone-related migraine headaches would be included. Diseases, conditions, and syndromes that do not make the top seven list but affect many people can be expensive to manage and are understandably emotionally and physically taxing for patients and caregivers. We are not advocating for diverting attention away from the most commonly discussed chronic diseases, such as heart disease, diabetes, arthritis, and COPD, but rather for bringing more diseases (and conditions) under the umbrella in the hopes of increasing awareness, sharing knowledge, and creating a larger community of individuals working to improve the health of those who suffer from chronic health problems.
Visit Author Contributions
SB: conceived of the paper topic, wrote the manuscript as the lead author and finalized information for submission. SH: contributed to the writing of the paper, edited it meticulously, and reviewed it for overall impact.
Go to: Conflict of Interest Declaration
The authors declare that no commercial or financial relationships that could be construed as a potential conflict of interest existed during the research.
QUESTION
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A 61-year-old Black male with a history of hypertension presents to your clinic for complaints of headaches and blurred vision x 4 days. He denies any weakness, numbness, chest pain, shortness of breath, palpitations, or recent, illicit drug use. He states he has been compliant with his medications (hydrochlorothiazide and metoprolol), and he took his meds this morning.
His V/S include: B/P 190/100, P- 90, T- 98.9, R- 22. Recent labs show that TC- 260, LDL-190, HDL- 35, Trig- 320. He did not return for these results and did not start any new meds.
What are your diagnoses and plan of care for this patient? Remember to include your rationales.
Word at least 250.
Recent five year scholarly reference.