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Whether Chronic Diseases Are Diagnosed May Depend on Where You Live
Date:3/15/2011

ion Americans aged 65 and up who received fee-for-service Medicare benefits in 2007. In particular, they examined data on diagnoses of nine serious chronic conditions: cancer, chronic obstructive pulmonary disease, coronary artery disease, congestive heart failure, peripheral artery disease, severe liver disease, diabetes with end-organ disease, chronic renal failure and dementia.

The mean number of chronic health conditions diagnosed was 8.7 for every 10 people. But that varied significantly depending on which of the 306 U.S. regions patients sought care.

On the low end, patients in the Grand Junction, Colo., and Idaho Falls, Idaho, were diagnosed with 5.8 chronic illnesses for every 10 people, compared to more than 12 illnesses for every 10 people in Miami and McAllen, Texas.

Not surprisingly, the more chronic conditions a person had, the more likely they were to die. The fatality rate among people with no chronic health conditions was 16 per 1,000 annually; 45 per 1,000 for those with one condition; 93 per 1,000 for those with two conditions.

Yet paradoxically, among subgroups of Medicare patients in regions where patients tended to receive more diagnoses, the risk of death from a chronic condition falls.

Patients were divided in quintiles (or fifths) based on the frequency of diagnoses in that region.

Among patients with one chronic condition, 51 per 1,000 of those in the lowest quintile for diagnoses died, compared to only 38 per 1,000 in the highest quintile. For patients diagnosed with three conditions, 168 died in the lowest quintile compared to 137 per 1,000 in regions where chronic conditions were more readily diagnosed.

That could be because they receive far better care, Wennberg said. But more likely, the real reason is because in "high intensity" health-care regions, patients are more likely to be diagnosed with a chronic illness even if it's not particular serious or they're not actually ill.

The data sho
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