Medicare - CCW Condition Period Prevalence, 2018

Description: The conditions with the highest period prevalence rates are hypertension (58.8%) and hyperlipidemia (49.1%). Approximately one-third of the population has been treated for rheumatoid/osteo-arthritis (34.7%), ischemic heart disease (27.7%), and/or diabetes (27.7%).

Technical Notes: Period prevalence is calculated for these rates. Beneficiaries with full or nearly full fee-for-service (FFS) coverage during the year who had claims for the condition within the condition-specified look back period. Chronic conditions have a 1 to 3 year look-back time period. Please refer to the CCW Chronic Condition Categories for algorithm criteria. Denominator is all who were enrolled in Medicare on or after January 1, 2018 and had full or nearly full FFS coverage (i.e., 11 or 12 months of Medicare Part A and B [or coverage until time of death] and one month or less of HMO coverage). Only females are included in the denominator for endometrial and female breast cancer; only males are included for prostate cancer and benign prostatic hyperplasia. Beneficiaries may be counted in more than one chronic condition category.

Chart Date: June 9, 2020

Back to Top

Cardiovascular Conditions - Trends, 2009 - 2018

Description: The rates for several of the cardiovascular conditions have been fairly stable over time, with a slight decrease in ischemic heart disease (from 31.9% in 2009 to 27.7% in 2018) and heart failure (16.6% in 2009 and 14.5% in 2018). Atrial fibrillation has increased slightly, from 7.9% in 2009 to 8.7% in 2018.

Technical Notes: Period prevalence is calculated for these rates. Beneficiaries with full or nearly full fee-for-service (FFS) coverage during the year who had claims for the condition within the condition-specified look back period. Chronic conditions have a 1 to 2 year look-back time period. Please refer to the CCW Chronic Condition Categories for algorithm criteria. Denominator is all who were enrolled in Medicare on or after January 1, 2018 and had full or nearly full FFS coverage (i.e., 11 or 12 months of Medicare Part A and B [or coverage until time of death] and one month or less of HMO coverage). Beneficiaries may be counted in more than one chronic condition category.

Chart Date: June 9, 2020

Back to Top

Cancer - Trends, 2009 - 2018

Description: The rate for female breast cancer has risen slightly over time – from 4.9% in 2009 to 6.0% in 2018. The rate for prostate cancer fluctuated somewhat – from a high of 7.5% in 2011, to a low of 7.0% in 2014, then to 7.3% in 2018. Endometrial cancer showed a small gradual increase over time from 0.4% in 2009 to 0.7% in 2018. The rates of lung and colorectal cancer were stable over time.

Technical Notes: Period prevalence is calculated for these rates. Beneficiaries with full or nearly full fee-for-service (FFS) coverage during the year who had claims for the condition within the condition-specified look back period. These conditions have a 1 year look-back time period. Please refer to the CCW Chronic Condition Categories for algorithm criteria. Denominator is all who were enrolled in Medicare on or after January 1, 2018 and had full or nearly full FFS coverage (i.e., 11 or 12 months of Medicare Part A and B [or coverage until time of death] and one month or less of HMO coverage). Only females are included in the denominator for endometrial and female breast cancer; only males are included for prostate cancer. Beneficiaries may be counted in more than one chronic condition category.

Chart Date: June 9, 2020

Back to Top

Endocrine and Renal Conditions - Trends, 2009 - 2018

Description: There has been an increase over time for each of the endocrine and renal conditions. The proportion of the population being treated for diabetes fluctuated a bit from a low of 27.4% in 2009, up to 28.5% in 2012, and to 27.7% in 2018. The period prevalence rate of chronic kidney disease has risen from 13.8% in 2009 to 25.3% in 2018; note that the large increase from 2014 to 2016 may be partially due to the conversion from ICD-9-CM to ICD-10-CM diagnosis codes on the claims. Acquired hypothyroidism increased from 12.9% in 2009 to 16.2% in 2018.

Technical Notes: Period prevalence is calculated for these rates. Beneficiaries with full or nearly full fee-for-service (FFS) coverage during the year who had claims for the condition within the condition-specified look back period. These conditions have a 1 to 2 year look-back time period. Please refer to the CCW Chronic Condition Categories for algorithm criteria. Denominator is all who were enrolled in Medicare on or after January 1, 2018 and had full or nearly full FFS coverage (i.e., 11 or 12 months of Medicare Part A and B [or coverage until time of death] and one month or less of HMO coverage). Beneficiaries may be counted in more than one chronic condition category.

Chart Date: June 9, 2020

Back to Top

Cognitive and Mental Health Conditions - Trends, 2009 - 2018

Description: The rate of treatment for depression has increased over time – from 13.8% in 2009 to 18.7% in 2018. The prevalence of treatment for Alzheimer’s disease decreased from 5.3% in 2009 to 4.1% in 2018. The prevalence of treatment for Alzheimer's disease or related senile dementia has been fairly stable over time. However, the proportion of treatment for Alzheimer's disease or related senile dementia that is comprised of Alzheimer's disease was 47.5% in 2009 and began to decline after 2010. By 2018, Alzheimer's disease comprised 36.5% of the Alzheimer's disease or related senile dementia period prevalence.

Technical Notes: Period prevalence is calculated for these rates. Beneficiaries with full or nearly full fee-for-service (FFS) coverage during the year who had claims for the condition within the condition-specified look back period. Chronic conditions have a 1 to 3 year look-back time period. Please refer to the CCW Chronic Condition Categories for algorithm criteria. Denominator is all who were enrolled in Medicare on or after January 1, 2018 and had full or nearly full FFS coverage (i.e., 11 or 12 months of Medicare Part A and B [or coverage until time of death] and one month or less of HMO coverage). Beneficiaries may be counted in more than one chronic condition category.

Chart Date: June 9, 2020

Back to Top

Musculoskeletal and Joint Conditions - Trends, 2009 - 2018

Description: The rates of hip fractures and treatment for osteoporosis have been stable over time. The rate of treatment for rheumatoid or osteoarthritis has increased from 28.9% to 34.7% (2009 to 2018, respectively); note that the relatively larger increase from 2014 to 2016 may be partially due to the conversion from ICD-9-CM to ICD-10-CM diagnosis codes on the claims.

Technical Notes: Period prevalence is calculated for these rates. Beneficiaries with full or nearly full fee-for-service (FFS) coverage during the year who had claims for the condition within the condition-specified look back period. These conditions have a 1 to 2 year look-back time period. Please refer to the CCW Chronic Condition Categories for algorithm criteria. Denominator is all who were enrolled in Medicare on or after January 1, 2018 and had full or nearly full FFS coverage (i.e., 11 or 12 months of Medicare Part A and B [or coverage until time of death] and one month or less of HMO coverage). Beneficiaries may be counted in more than one chronic condition category.

Chart Date: June 9, 2020

Back to Top

Pulmonary Conditions - Trends, 2009 - 2018

Description: The period prevalence for asthma has increased over time - from 4.7% in 2009 to 5.1% in 2018. Prevalence of treatment for chronic obstructive pulmonary disease (COPD) has been fairly stable - from 11.8% to 11.9% (2009 through 2018).

Technical Notes: Period prevalence is calculated for these rates. Beneficiaries with full or nearly full fee-for-service (FFS) coverage during the year who had claims for the condition within the condition-specified look back period. These conditions have a 1 year look-back time period. Please refer to the CCW Chronic Condition Categories for algorithm criteria. Denominator is all who were enrolled in Medicare on or after January 1, 2018 and had full or nearly full FFS coverage (i.e., 11 or 12 months of Medicare Part A and B [or coverage until time of death] and one month or less of HMO coverage). Beneficiaries may be counted in more than one chronic condition category.

Chart Date: June 9, 2020

Back to Top

Opthalmic Conditions - Trends, 2009 - 2018

Description: The proportion of Medicare beneficiaries with a cataract procedure has been gradually decreasing over time. The rate of cataract procedures declined from 20.7% in 2009 to 17.7% in 2018. The proportion of beneficiaries identified as having treatment for glaucoma decreased from 10.5% in 2009 to 9.6% in 2018 (note that the rate in 2016 was 7.3%, likely due to the conversion to ICD-10-CM coding of diagnoses which began in October 2015).

Technical Notes: Period prevalence is calculated for these rates. Beneficiaries with full or nearly full fee-for-service (FFS) coverage during the year who had claims for the condition within the condition-specified look back period. These conditions have a 1 year look-back time period. Please refer to the CCW Chronic Condition Categories for algorithm criteria. Denominator is all who were enrolled in Medicare on or after January 1, 2018 and had full or nearly full FFS coverage (i.e., 11 or 12 months of Medicare Part A and B [or coverage until time of death] and one month or less of HMO coverage). Beneficiaries may be counted in more than one chronic condition category.

Chart Date: June 9, 2020

Back to Top

Medicare - Selected Chronic Conditions by Age Group, 2018

Description: The age distribution of Medicare beneficiaries with selected chronic conditions is shown. Some conditions are comprised largely of older Medicare beneficiaries. For example, 76.1% of beneficiaries with claims for Alzheimer's and related senile dementia were 75 years of age or older; similarly, 60.7% of people with heart failure, 58.6% of those with stroke, and 58.2% of those with colorectal cancer treatment were 75 or older. Other conditions, such as depression, were comprised largely of younger beneficiaries (62.3% of beneficiaries treated for depression were 74 years of age or less).

Technical Notes: Age is calculated based on the age of the Medicare beneficiary as of December 31. If the beneficiary expired, the age is calculated based on age at time of death. Period prevalence is calculated for these rates. Beneficiaries with full or nearly full fee-for-service (FFS) coverage during the year who had claims for the condition within the condition-specified look back period. These conditions have a 1 to 3 year look-back time period. Please refer to the CCW Chronic Condition Categories for algorithm criteria. Denominator is all who were enrolled in Medicare on or after January 1, 2018 and had full or nearly full FFS coverage (i.e., 11 or 12 months of Medicare Part A and B [or coverage until time of death] and one month or less of HMO coverage). Beneficiaries may be counted in more than one chronic condition category.

Chart Date: June 9, 2020

Back to Top

Medicare - Selected Chronic Conditions by Racial Group, 2018

Description: There is racial variation in the prevalence of treatment for Medicare fee-for-service (FFS) beneficiaries with these conditions. Although the white racial group comprised 82.9% of the Medicare FFS population in 2018, they comprised 86.8% of the subpopulation with treatment for chronic obstructive pulmonary disease, 86.1% of the population with depression, and 85.0% of the population with colorectal cancer. In 2018, although the black racial group comprised 9.1% of the total Medicare FFS population, they comprised 12.8% of the subpopulation with diabetes, 12.3% of those with claims for chronic kidney disease (CKD), 12.3% of those with stroke, and 11.4% of the population with heart failure.

Technical Notes: American Indian, Native American, Other, and Unknown races are grouped together due to small cell sizes. Period prevalence is calculated for these rates. Beneficiaries with full or nearly full fee-for-service (FFS) coverage during the year who had claims for the condition within the condition-specified look back period. These conditions have a 1 to 3 year look-back time period. Please refer to the CCW Chronic Condition Categories for algorithm criteria. Denominator is all who were enrolled in Medicare on or after January 1, 2018 and had full or nearly full FFS coverage (i.e., 11 or 12 months of Medicare Part A and B [or coverage until time of death] and one month or less of HMO coverage). Beneficiaries may be counted in more than one chronic condition category.

Chart Date: June 9, 2020

Back to Top

Medicare - Selected Chronic Conditions by Sex, 2018

Description: The gender distribution of Medicare beneficiaries varies by condition. Overall, in 2018 Medicare fee-for-service (FFS), 54.8% of the population was female. For depression and Alzheimer's and related senile dementia, 67.0 and 62.0% of the subpopulation, respectively, was female. For chronic kidney disease (CKD), diabetes, and colorectal cancer, we observed a higher proportion of males with claims for the conditions than we would have expected based on the overall population distribution of males (which was 45.2% of the total Medicare FFS population) - 48.3% with CKD, 48.3% with diabetes, and 48.1% with colorectal cancer claims were male.

Technical Notes: Period prevalence is calculated for these rates. Beneficiaries with full or nearly full fee-for-service (FFS) coverage during the year who had claims for the condition within the condition-specified look back period. These conditions have a 1 to 3 year look-back time period. Please refer to the CCW Chronic Condition Categories for algorithm criteria. Denominator is all who were enrolled in Medicare on or after January 1, 2018 and had full or nearly full FFS coverage (i.e., 11 or 12 months of Medicare Part A and B [or coverage until time of death] and one month or less of HMO coverage). Beneficiaries may be counted in more than one chronic condition category.

Chart Date: June 9, 2020

Back to Top

Medicare - Selected Chronic Conditions by Medicare Status Code, 2018

Description: The reason for Medicare entitlement varies by condition. In Medicare fee-for-service (FFS) overall, 14.8% of the population were entitled to Medicare due to disability rather than age in 2018. A higher than expected proportion of people with treatment for depression were entitled due to disability (25.8%). For some conditions, a much higher proportion of the subpopulation were aged – for example, Alzheimer's and related senile dementia and colorectal cancer, with 93.8% and 92.3% of the subpopulations, respectively, entitled due to age.

Technical Notes: Classification used the Medicare status code, and combined ESRD and Disabled categories into the "Disabled" grouping. Beneficiaries with full or nearly full fee-for-service (FFS) coverage during the year who had claims for the condition within the condition-specified look back period. These conditions have a 1 to 3 year look-back time period. Please refer to the CCW Chronic Condition Categories for algorithm criteria. Denominator is all who were enrolled in Medicare on or after January 1, 2018 and had full or nearly full FFS coverage (i.e., 11 or 12 months of Medicare Part A and B [or coverage until time of death] and one month or less of HMO coverage). Beneficiaries may be counted in more than one chronic condition category.

Chart Date: June 9, 2020

Back to Top

Diabetes Period Prevalence, 2018

Description: The number of Medicare fee-for-service (FFS) enrollees with diabetes varied by state. Colorado had the lowest rate (18.94%) and New York had the highest (32.19%).

Technical Notes: Period prevalence is calculated for these rates. Beneficiaries with full or nearly full FFS coverage during the year who had claims for diabetes within the 2-year look back period. Please refer to the CCW Chronic Condition Categories for algorithm criteria. Denominator is all who were enrolled in Medicare on or after January 1, 2018 and had full or nearly full FFS coverage (i.e., 11 or 12 months of Medicare Part A and B [or coverage until time of death] and one month or less of HMO coverage).

Chart Date: June 9, 2020

Back to Top

Alzheimer's/Dementia Period Prevalence, 2018

Description: The number of Medicare fee-for-service (FFS) beneficiaries with Alzheimer's disease or related senile dementia varied by state. Wyoming had the lowest rate (8.04%) and Washington, D.C. had the highest (14.46%).

Technical Notes: Period prevalence is calculated for these rates. Beneficiaries with full or nearly full FFS coverage during the year who had claims for Alzheimer's disease or related senile dementia within the 3-year look back period. Please refer to the CCW Chronic Condition Categories for algorithm criteria. Denominator is all who were enrolled in Medicare on or after January 1, 2018 and had full or nearly full FFS coverage (i.e., 11 or 12 months of Medicare Part A and B [or coverage until time of death] and one month or less of HMO coverage).

Chart Date: June 9, 2020

Back to Top

Depression Period Prevalence, 2018

Description: The number of Medicare fee-for-service (FFS) enrollees with depression varied by state. Hawaii had the lowest rate (9.19%) and West Virginia had the highest (23.63%).

Technical Notes: Period prevalence is calculated for these rates. Beneficiaries with full or nearly full FFS coverage during the year who had claims for depression within the 1-year look back period. Please refer to the CCW Chronic Condition Categories for algorithm criteria. Denominator is all who were enrolled in Medicare on or after January 1, 2018 and had full or nearly full FFS coverage (i.e., 11 or 12 months of Medicare Part A and B [or coverage until time of death] and one month or less of HMO coverage).

Chart Date: June 9, 2020

Back to Top