Chronic, non-communicable diseases are the leading cause of death worldwide. In the United States, these diseases make up 8 of the 10 top causes of death. Chronic conditions can be impacted by both medical and nonmedical factors such as access to healthcare, physical inactivity, poor nutrition, tobacco consumption and alcohol abuse. Public health interventions, preventive care, and early treatment can shape the prevalence of chronic illnesses and reduce mortality related to these diseases.
Across several chronic diseases, the U.S. has a higher rate of illness in comparison to its peer nations. Identifying trends of chronic diseases such as obesity, hypertension, diabetes, asthma, kidney disease, depression, chronic obstructive pulmonary disease (COPD), and cancer can help determine how the burden of chronic illness has evolved overtime and assess how chronic disease rates in the U.S. compare to its peers. Broadly, a larger share of residents in the U.S. have chronic diseases compared to other countries, including over twice as many people with obesity (2.4 times the comparable country average), diabetes (2 times), and asthma (1.7 times) and an overall higher burden of depression (1.3 times). These rates are age-standardized to adjust for older populations in some countries. These differences in chronic disease prevalence also drive higher death rates and shorter life expectancy in the U.S.
This chart collection compares rates of various chronic diseases in the United States compared to other countries of similar size and wealth, including Australia, Austria, Belgium, Canada, France, Germany, Japan, the Netherlands, Sweden, Switzerland, and the U.K. Disease prevalence is one part of understanding how chronic disease impacts the U.S. population and future pieces will also consider the number of deaths caused by these diseases and the average health care cost of having a chronic condition.
The reasons for the above-average burden of chronic disease in the United States are complicated. Some of these reasons may include differences in the United States compared to other countries in how public health and health care is managed. Unlike other high-income countries, the U.S. does not have universal health coverage. Economic factors, such as higher poverty in the U.S. may also influence health outcomes. Diet and exercise differences are also likely contributors. These and other factors likely help explain differences in chronic disease rates between the U.S. and other countries.
Despite these challenges, meaningful progress has been made in slowing the progression or even reversing these diseases, and there is substantial research documenting these interventions. For example, while overall cases are increasing, there are decreasing numbers of new cases of diabetes. New cancer treatment and prevention methods such as a vaccine to prevent cervical cancer, have led to decreasing deaths in the U.S. due to cancer.
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Although the country continues to face public health challenges such as the impacts of the opioid crisis, Americans now are living longer than they did 30 years ago while managing chronic illnesses.
Many people in the U.S. have a chronic illness, with obesity as the most common
Obesity is the most prevalent chronic illness in the U.S., affecting 42% of the population in 2022. Hypertension, or high blood pressure, ranks closely behind, impacting about 32% of the population in 2019.
Many chronic conditions or risk factors can interact or contribute to one another, resulting in multiple morbidities. Conditions are not mutually exclusive, someone can have multiple conditions at once, each potentially exacerbating the others. For example, among people with diabetes, 11% also have major depressive disorder, and among adults (40-64 years) with obesity, over 60% have hypertension and 30% have type 2 diabetes; comorbidities also increase with age.
The U.S. obesity rate is twice that of peer nations
Obesity is defined as having a bodyweight mass index (BMI) over 30, which for a 5-foot 6-inch-tall person means a weight above 186 pounds. Obesity is the most common chronic disease in the U.S. and increases a person’s risk of many other chronic diseases, including hypertension , diabetes , and asthma. Obesity is a risk factor for numerous illnesses. In addition to biological underlying causes of obesity, numerous structural factors can contribute to obesity, including stress, food insecurity, and lack of time for and access to leisure and recreation.
The obesity rate in the U.S. is more than twice as high as that in comparable countries. In 2022, 42.0% of U.S. adults were classified as obese, whereas the average obesity rate among adults in comparable countries was 17.8%.
Rates of hypertension have remained steady in the U.S. but have been decreasing slowly in comparable countries
Hypertension, or high blood pressure, is the single most modifiable factor impacting mortality and affects one in three Americans (30-79 years old). Factors that raise an individual’s risk of hypertension include increasing age, family history, high-salt diet, physical inactivity, tobacco use, excessive alcohol use, and other medical conditions such as chronic kidney disease, diabetes, obesity, and some tumors. Uncontrolled hypertension can lead to serious cardiovascular disease, including heart attack, stroke, heart failure, and chronic kidney disease.
Rates of hypertension in the U.S. have remained steady over the past thirty years at 32% while slowly declining on average, in other countries to 28.6%.
Diabetes prevalence among adult population increasing globally, with U.S. growing faster than its peers
Diabetes mellitus is a chronic, progressive condition that impairs the body’s ability to regulate blood sugar through the hormone insulin. Chronic diabetes consists of two types: type 1 diabetes, an autoimmune disorder, and type 2 diabetes, a long-term process in which the body becomes insulin resistant. Both genetics and lifestyle factors (e.g., poor diet, physical inactivity, obesity) increase the risk for type 2 diabetes, with family history being a larger risk factor for type 2 diabetes than type 1 diabetes. Individuals with diabetes are at higher risk for developing other chronic conditions including, but not limited to, chronic kidney disease, nerve damage, vision loss, hypertension, and cardiovascular disease.
Diabetes, the majority of which is type 2, is one of the top 10 leading causes of death globally.
In 2022, the U.S. had the highest percent of adults with diabetes at 12.5% compared to the average of 6.1% among peer nations. From 2012 to 2022, the U.S. has seen a 26% increase in the percent of adults with diabetes whereas, on average, peer countries have seen an increase of 15%.
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The U.S. has almost double the rate of asthma in comparison to its peers
Asthma is a chronic inflammatory condition that impacts the airways in the lungs, making it harder for air to flow out of the airways. Exposure to allergens, mold, respiratory infections, exercise, and air pollutants can worsen symptoms and trigger asthma attacks, which present with shortness of breath, wheezing, coughing, and chest tightness. Obesity has been associated with an increased risk of developing asthma.
Asthma rates in the U.S. and other countries had been declining until around 2005, when they started to increase in the U.S., but not worldwide. Since 2017, the U.S. has had the highest rate of asthma among peer nations. Now, the U.S. has almost twice the prevalence of asthma (11.0% in 2021) compared to the comparable country average (6.6%).
Chronic kidney disease in the U.S. is slightly more common than in peer countries
Chronic kidney disease (CKD) is a progressive condition in which the kidneys become damaged and gradually lose their ability to remove waste and excess fluids from the blood, among other functions. The primary causes of CKD are diabetes and high blood pressure, though age, obesity, smoking, certain autoimmune diseases, and heart disease are also important risk factors.
In 1990, the U.S. had a CKD prevalence of 8.1%, roughly 21% higher than the average of peer nations (6.7%). The U.S. has continued to outpace the comparable country average since then, with the gap expanding post-2005. Generally, the prevalence of CKD has remained relatively steady in most comparable countries. In 2021, the latest year with available data, the prevalence of CKD in the U.S. was 24% higher than the average of comparable countries (8.2% versus 6.6%). From 1990 to 2021, Japan was the only peer nation with higher rates of CKD than the U.S.
Following the COVID-19 pandemic, rates of depressive disorder have increased in both the U.S. and peer nations
Mental health disorders carry a substantial burden of disease and can encompass a variety of conditions. Depression is characterized by persistent feelings of sadness or disinterest that interferes with everyday life.
Across all countries, the share of the population with depressive disorder drastically increased during the early parts of the COVID-19 pandemic, increasing by 22% and reaching 6.0% in the U.S., and up 16% to 4.7% in comparable countries on average in 2021.
While these measures of depressive disorder prevalence are comparable across countries, depression may manifest differently across the life course and cultures.
Rates of chronic obstructive pulmonary disease have remained fairly constant over time across all countries
Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death worldwide, causing difficulty breathing, chronic cough, and increased vulnerability to respiratory infections. The most significant risk factor is chronic smoking, although prolonged exposure to poor air quality can also lead to COPD.
Rates of COPD have remained somewhat constant over the past 20 years in both the U.S. (3.7%) and in other comparable countries (2.6%).
Cancer rates in the U.S. are about 15% higher compared to similar countries
Cancers include a large number of diseases characterized by the development and uncontrolled growth of abnormal cells. Various factors can increase one’s risk of cancer, including age, lifestyle, family history, health conditions, and the environment.
Cancer is a leading cause of death worldwide, accounting for nearly one in six deaths. While most new cancers are breast and prostate, cancer deaths are mostly due to lung, colorectal, or pancreatic cancers, causing over 226,000 deaths each year in the United States.
Cancer rates in the U.S. are 15% higher than the average rate in peer nations. In 2022, the U.S. had a cancer rate of 367.0 per 100,000 population, compared to an average of 320.3 per 100,000 population for comparable nations. Of the countries studied, only Australia had a higher prevalence of cancer than the U.S.
The Peterson Center on Healthcare and KFF are partnering to monitor how well the U.S. healthcare system is performing in terms of quality and cost.
