If you’ve sought care from a doctor recently, the odds are you did so because of a skin problem, a joint disorder or back pain.
For according to a Mayo Clinic study published Wednesday, those are the three leading reasons people visit their health-care providers.
As the study’s authors point out, one-fourth of Americans with chronic conditions account for almost two-thirds of health-care costs in the United States. Research into how to lower these costs has tended to focus, however, only on the chronic conditions that have the highest rates of disability and death — heart disease and diabetes, for example.
The Mayo researchers decided to find out what other kinds of non-acute conditions might be affecting large numbers of Americans and using up a substantial amount of health-care resources.
“To improve the health of a population — any population — it’s really important to understand which diseases or conditions are actually occurring in the population to appropriately target resources toward those areas,” said lead author Jennifer St. Sauver, an associate professor of epidemiology at Mayo, in a video that accompanied the study’s release.
A representative population
For the study, St. Sauver and her colleagues turned to the Rochester Epidemiology Project, a medical database of more than 142,000 residents of Olmsted County, where the Mayo Clinic is located. The age and gender distribution within this group is essentially identical to that of the rest of the United States. By race, however, the group was slightly less white than the overall U.S. population.
The researchers analyzed and categorized all the medical diagnoses of the residents who had visited the Mayo Clinic and its two affiliated hospitals, the Olmsted Medical Center and the Rochester Family Medicine Clinic, during the five-year period 2005-2009. Based on that analysis, the researchers identified these top 10 reasons for the visits:
- Skin disorders
- Osteoarthritis/joint disorders
- Back problems
- Cholesterol problems
- Upper respiratory conditions (not including asthma)
- Anxiety, depression and bipolar disorder
- Chronic neurologic disorders (such as Parkinson’s and Alzheimer’s diseases)
- High blood pressure
- Headaches/migraine
- Diabetes
A surprising finding
Discovering that skin conditions topped the list surprised the researchers. Almost half of the Olmsted County residents — in all age categories — received a diagnosis of a skin disorder within the five-year period of the study. The specific types of skin disorders varied by age, however. Younger people tended to receive care for an unspecified skin rash or acne, while older people more were likely to have a pre-cancerous skin lesion that needed to be treated and followed.
“Skin disorders are not typically major drivers of disability or death but may be important determinants of health care utilization and cost,” wrote St. Sauver and her colleagues.
Age was also a factor in the ordering of the “top 10” conditions. For example, among children and teens, the most prevalent conditions were skin disorders, upper respiratory conditions, and osteoarthritis and joint disorders. Among people aged 65 and older, however, high blood pressure, cholesterol problems and skin disorders led the list.
Seven of the 10 conditions also became more common with age. The “upper respiratory conditions” category was one of the exceptions: The prevalence of those illnesses was relatively consistent across all age groups. Another exception was the category of “anxiety, depression and bipolar disease.” Its prevalence started out low in the 0- to 18-year-olds, increased dramatically in the 19- to 29-year-olds, and then remained constant throughout the other age groups. Headaches was the third exception: Its prevalence also increased in the 19- to 29-year-old group, but declined once people reached the age of 50.
Gender and ethnicity
The study also found that most of the “top 10” conditions were more commonly diagnosed in women than in men with the exceptions of high cholesterol, high blood pressure and diabetes. Ethnicity also revealed some differences. Blacks, for example, had a higher prevalence of back problems and headaches, including migraine, than whites. And Asians had a higher prevalence of diabetes.
“Our population looks very much like the rest of the United States when we consider the number of people who are affected by these different conditions,” stressed St. Sauver in the video. The study’s findings therefore highlight, she said, “the need to consider conditions beyond things like diabetes and heart disease when trying to understand what is driving health utilization.”
The study was published in the January issue of the Mayo Clinical Proceedings.
