Skin, Joint, and Back Problems Prompt Most Physician Visits
Most patients without acute conditions see their
physicians not because of diabetes, heart disease, or cancer but because
of skin problems, joint disorders, and back pain, according to an article published in the January issue of Mayo Clinic Proceedings.
Jennifer L. St. Sauver, PhD, MPH, from the Division of Epidemiology, Mayo Clinic Center for the Science of Health Care Delivery, Rochester, Minnesota, and colleagues analyzed the medical records of residents of Olmstead County, Minnesota, as of April 1, 2009, through the Rochester Epidemiology Project medical records linkage system.
Spurred on by healthcare reform, the researchers sought to determine how healthcare resources were being used for nonacute conditions. They examined records between January 1, 2005, and December 31, 2009, and categorized patients according to disease group and according to International Classification of Diseases, Ninth Revision (ICD-9), codes.
Of the 146,687 Olmstead residents (53% female) included in the Rochester Epidemiology Project in April 2009, 142,377 (97.1%) consented for their records to be used for research.
"Skin disorders were the most prevalent disease group in this population," the researchers write. "Almost half of the population (42.7%) had at least one ICD-9 code for a skin condition within approximately 5 years." Conditions included actinic keratosis, acne, and sebaceous cysts.
After skin disorders, the most common conditions were osteoarthritis and joint disorders (33.6%), back problems (23.9%), disorders of lipid metabolism (22.4%), and upper respiratory tract disease (22.1%).
The top 10 disease groups varied in prevalence by age and ethnicity. For instance, 0- to 18-year-olds experienced the highest prevalence of skin disorders, whereas patients aged 65 years and older experienced the highest prevalence of hypertension. Blacks had a higher prevalence of back problems and headaches than whites, whites had higher prevalence of skin disorders than blacks and Asians, and Asians had a higher prevalence of diabetes than whites.
"Much research already has focused on chronic conditions, which account for the majority of health care utilization and costs in middle-aged and older adults," Dr. St. Sauver said in a Mayo Clinic news release. "We were interested in finding out about other types of conditions that may affect large segments of the population across all age groups."
Limitations of the study include the inability to validate ICD-9 codes that may have been assigned in error or the possibility that some patients were missed who should have had a code. However, the researchers point out that their prevalence estimates for 10 chronic conditions are similar to published US population estimates.
The researchers write that although skin disorders are not
major drivers of disability or death, they may be "important
determinants of health care utilization and cost." They recommend that
newer models of dermatological care, including teledermatology, should
be considered as possible ways to increase care efficiency.
"Finding that skin and back problems are major drivers of health care utilization affirms the importance of moving beyond the commonly recognized health care priorities such as diabetes, heart disease, or cancer," the researchers conclude. "Our findings highlight opportunities to improve health care and decrease costs related to common nonacute conditions as we move forward through the changing health care landscape."
This research was supported by a grant from the Rochester Epidemiology Project and by the Mayo Clinic Center for Translational Science Activities. The authors have disclosed no relevant financial relationships.
Mayo Clin Proc. 2013;88:56-67. Full text
Jennifer L. St. Sauver, PhD, MPH, from the Division of Epidemiology, Mayo Clinic Center for the Science of Health Care Delivery, Rochester, Minnesota, and colleagues analyzed the medical records of residents of Olmstead County, Minnesota, as of April 1, 2009, through the Rochester Epidemiology Project medical records linkage system.
Spurred on by healthcare reform, the researchers sought to determine how healthcare resources were being used for nonacute conditions. They examined records between January 1, 2005, and December 31, 2009, and categorized patients according to disease group and according to International Classification of Diseases, Ninth Revision (ICD-9), codes.
Of the 146,687 Olmstead residents (53% female) included in the Rochester Epidemiology Project in April 2009, 142,377 (97.1%) consented for their records to be used for research.
"Skin disorders were the most prevalent disease group in this population," the researchers write. "Almost half of the population (42.7%) had at least one ICD-9 code for a skin condition within approximately 5 years." Conditions included actinic keratosis, acne, and sebaceous cysts.
After skin disorders, the most common conditions were osteoarthritis and joint disorders (33.6%), back problems (23.9%), disorders of lipid metabolism (22.4%), and upper respiratory tract disease (22.1%).
The top 10 disease groups varied in prevalence by age and ethnicity. For instance, 0- to 18-year-olds experienced the highest prevalence of skin disorders, whereas patients aged 65 years and older experienced the highest prevalence of hypertension. Blacks had a higher prevalence of back problems and headaches than whites, whites had higher prevalence of skin disorders than blacks and Asians, and Asians had a higher prevalence of diabetes than whites.
"Much research already has focused on chronic conditions, which account for the majority of health care utilization and costs in middle-aged and older adults," Dr. St. Sauver said in a Mayo Clinic news release. "We were interested in finding out about other types of conditions that may affect large segments of the population across all age groups."
Limitations of the study include the inability to validate ICD-9 codes that may have been assigned in error or the possibility that some patients were missed who should have had a code. However, the researchers point out that their prevalence estimates for 10 chronic conditions are similar to published US population estimates.
"Finding that skin and back problems are major drivers of health care utilization affirms the importance of moving beyond the commonly recognized health care priorities such as diabetes, heart disease, or cancer," the researchers conclude. "Our findings highlight opportunities to improve health care and decrease costs related to common nonacute conditions as we move forward through the changing health care landscape."
This research was supported by a grant from the Rochester Epidemiology Project and by the Mayo Clinic Center for Translational Science Activities. The authors have disclosed no relevant financial relationships.
Mayo Clin Proc. 2013;88:56-67. Full text
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