- A study has found that adults in the U.S. are increasingly dealing with multiple chronic conditions.
- These cardiac, renal, and metabolic conditions include type 2 diabetes, heart disease, and kidney disease.
- These conditions are the leading cause of morbidity and mortality in the United States, and are estimated to account for every 1 in 3 deaths.
A new study found that the number of Americans with multiple cardiac, renal, and metabolic conditions is rising.
Approximately 1 in 4 adults have a chronic cardiac, renal, or metabolic condition, and nearly 1 in 10 have multiple cardiac, renal, or metabolic conditions, according to the report published in
The risk of also increased with age—one in three adults 65 and older had a cardiac, renal, or metabolic condition, while almost 1 in 4 had overlapping conditions.
According to the study authors, these conditions are the leading cause of morbidity and mortality in the United States and are estimated to account for every 1 in 3 deaths.
We have medications to treat the underlying mechanisms that contribute to co-existing cardiac, renal, and metabolic (CRM) conditions, however, they aren’t being prescribed or taken nearly as frequently as they should be.
The new report sheds light on how significantly the incidence of these conditions has grown over the past two decades along with the urgent need to address the situation.
“The findings are doubly concerning as they demonstrate both an increase in the prevalence of cardiac, renal, and metabolic disease and concurrent high levels of under-treatment,” Dr. Dmitriy Nevelev, associate director of Cardiology at Staten Island University Hospital, told Healthline. Nevelev wasn’t involved in the study.
To determine the prevalence of CRM conditions in the U.S., the researchers evaluated health data from January 2015 through March 2020 sourced from the
They compared those trends against NHANES health data collected between 1999 and 2002.
The analysis included 11,607 non-pregnant adults aged 20 and over.
Of the data pooled from 2015 to 2020, 26.3% had at least 1 CRM condition, 8% had at least two, and 1.5% had three CRM conditions.
The most common comorbid conditions were type 2 diabetes plus chronic kidney disease (3.2%), followed by cardiovascular disease plus type 2 diabetes (1.7%) and cardiovascular disease plus chronic kidney disease (1.6%).
The burden was greatest among non-hispanic Black individuals along with people who reported they were unemployed, of low socioeconomic status, or had no high school degree.
“Disparities in access to healthcare services can result in delayed diagnosis and treatment of cardiac, renal, and metabolic conditions, leading to worse outcomes,” said Dr. David Cutler, board certified family medicine physician at Providence Saint John’s Health Center in Santa Monica, CA. Cutler was not involved in the study.
Of those with three CRM conditions, roughly one-third (30.5%) did not report statin use, only 4.8% used medication common for weight loss and diabetes called glucagon-like peptide-1 receptor agonists (GLP1 agonists.)
Additionally, only 3% took medication commonly used to treat high blood sugar, sodium-glucose
“Newer medications like GLP1 agonists — for example, semaglutide — and SGLT2 inhibitors which have been found to improve these conditions are very expensive and were found to be prescribed at a very low rate in this study,” said Cutler.
The proportion of U.S. adults with multiple CRM conditions has grown significantly over the past few decades — from 5.3% in 1999 to 8% in 2020.
The proportion of Americans with three CRM conditions also grew, from 0.7% in 1999 to 1.5% in 2020.
Research shows that heart, kidney, and metabolic functions are intertwined and share the same risk factors, such as:
- obesity
- hypertension
- blood sugar that is too high or low
- cholesterol imbalance
Diet and lack of physical activity can contribute to metabolic disorders and obesity, said Cutler.
Other factors may include:
- genetics
- age
- access to healthcare
In addition, stress can affect health behaviors and contribute to the development of these conditions, he added.
The report states that issues with one body system may lead to dysfunction of others and the development of multiple morbidities.
“Fortunately, we can use the common link between these conditions to personalize treatment and prevent their onset,” said Nevelev.
There are drugs that target the underlying pathways involved in the development of comorbidities, such a SGLT2 inhibitors, and may help lower the prevalence of multiple conditions, however, they are being prescribed at a low rate.
“Several factors are at play, including insurance coverage and the associated insurance authorizations burden, overall cost to the patient, prescriber comfort in using newer medications, fear of medication side effects, and in the case of GLP-1 antagonists — availability,” said Nevelev.
The rising prevalence of multiple conditions are expected to accelerate due to the COVID-19 pandemic.
“We now have good data demonstrating pandemic-related decreases in physical activity and increases in sedentary activity and weight gain,” he said.
The findings highlight the need to improve the situation and promote public health efforts, such as:
- promoting healthy lifestyles
- improving access to healthcare
- raising awareness about risk factors and early detection
“We have the tools to lower rates of these diseases. We have to make better use of them,” said Cutler.
A new study found that the number of adults in the U.S. with multiple cardiac, renal, and metabolic (CRM) conditions is rising.
There are medications to treat the underlying mechanisms that contribute to these co-existing conditions.
However, they aren’t being prescribed or taken as frequently as they should be. The research sheds light on the urgent need to address the situation, ideally through awareness, screening, and improved access to healthcare.