Medicare - CCW Condition Period Prevalence, 2017

Description: The conditions with the highest period prevalence rates are hypertension (58.7%) and hyperlipidemia (48.3%). Approximately one-third of the population has been treated for rheumatoid/osteo-arthritis (34.2%), ischemic heart disease (27.8%), and/or diabetes (28%).

Technical Notes: Period prevalence is calculated for these rates. Beneficiaries with full or nearly full fee-for-service (FFS) coverage during the year who received treatment 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, 2017 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: November 25, 2019

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Cardiovascular Conditions - Trends, 2008 - 2017

Description: The rates for several of the cardiovascular conditions have been fairly stable over time, with a slight decrease in ischemic heart disease (from 32.0% in 2008 to 27.80% in 2017) and heart failure (16.9% in 2008 and 14.4% in 2017). Atrial fibrillation has increased slightly, from 7.8% in 2008 to 8.7% in 2017.

Technical Notes: Period prevalence is calculated for these rates. Beneficiaries with full or nearly full fee-for-service (FFS) coverage during the year who received treatment 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, 2017 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: November 25, 2019

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Cancer - Trends, 2008 - 2017

Description: The rate for female breast cancer has risen slowly over time – from 4.9% in 2008 to 5.8% in 2017. The rate for prostate cancer fluctuated somewhat – from a high of 7.5% in 2011 to 7.2% in 2017. Endometrial cancer showed a small gradual increase over time from 0.4% in 2008 to 0.7% in 2017. 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 received treatment 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, 2017 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: November 25, 2019

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Endocrine and Renal Conditions - Trends, 2008 - 2017

Description: There has been a large increase over time for each of the endocrine and renal conditions. The proportion of the population being treated for diabetes increased from 26.8% in 2008 to 28.0% in 2017. The period prevalence rate of chronic kidney disease has risen from 12.7% in 2008 to 24.8% in 2017; 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 12.3% in 2008 to 15.9% in 2017.

Technical Notes: Period prevalence is calculated for these rates. Beneficiaries with full or nearly full fee-for-service (FFS) coverage during the year who received treatment 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, 2017 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: November 25, 2019

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Cognitive and Mental Health Conditions - Trends, 2008 - 2017

Description: The rate of treatment for depression has increased over time – from 13.1% in 2008 to 18.4% in 2017. 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 47.7% in 2008 and began to decline after 2010. By 2017, Alzheimer's disease comprised 37.8% 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 received treatment 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, 2017 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: November 25, 2019

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Musculoskeletal and Joint Conditions - Trends, 2008 - 2017

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 28.0% to 34.2% (2008 to 2017, respectively).

Technical Notes: Period prevalence is calculated for these rates. Beneficiaries with full or nearly full fee-for-service (FFS) coverage during the year who received treatment 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, 2017 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: November 25, 2019

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Pulmonary Conditions - Trends, 2008 - 2017

Description: The period prevalence for asthma has increased over time - from 4.5% in 2008 to 5.3% in 2017. Prevalence of treatment for chronic obstructive pulmonary disease (COPD) has been fairly stable - from 11.8% to 12.1% (2008 through 2017).

Technical Notes: Period prevalence is calculated for these rates. Beneficiaries with full or nearly full fee-for-service (FFS) coverage during the year who received treatment 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, 2017 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: November 25, 2019

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Opthalmic Conditions - Trends, 2008 - 2017

Description: The proportion of Medicare beneficiaries with a cataract procedure has been gradually decreasing over time. The rate of cataract procedures declined from 21.0% in 2008 to 17.8% in 2017. The proportion of beneficiaries identified as having treatment for glaucoma decreased from 10.3% in 2008 to 9.6% in 2017 (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 received treatment 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, 2017 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: November 25, 2019

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Other Conditions - Trends, 2008 - 2017

Description: The period prevalence of hypertension and hyperlipidemia has increased over time. In 2008, 56.4% of beneficiaries were being treated for hypertension compared to 58.7% in 2017. For hyperlipidemia treatment the increase was also significant – 43.0% in 2008 to 48.3% in 2017. Anemia has fluctuated slightly over time – it increased from 23.6% in 2007 to 24.9% in 2011, and then decreased to 22.5% in 2017. Benign prostatic hyperplasia has increased over time – from 12.7% in 2008 to 16.8% in 2017.

Technical Notes: Period prevalence is calculated for these rates. Beneficiaries with full or nearly full fee-for-service (FFS) coverage during the year who received treatment 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, 2017 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: November 25, 2019

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Medicare - Selected Chronic Conditions by Age Group, 2017

Description: The age distribution of Medicare beneficiaries with selected chronic conditions is shown. Some conditions are comprised largely of older Medicare beneficiaries. For example, 76.3% of people receiving treatment for Alzheimer's and related senile dementia were 75 years of age or older; similarly, 60.7% of people with heart failure, 58.4% of those with stroke, and 58.4% of those with colorectal cancer treatment were 75 or older. Other conditions, such as depression, are comprised largely of younger beneficiaries (62.8% 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 received treatment 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, 2017 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: November 25, 2019

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Medicare - Selected Chronic Conditions by Racial Group, 2017

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 83.0% of the Medicare FFS population in 2017, they comprised 86.7% of the subpopulation with treatment for chronic obstructive pulmonary disease, 86.0% of the population with depression, and 85.0% of the population with colorectal cancer. In 2017, although the black racial group comprised 9.4% of the total Medicare FFS population, they comprised 13.1% of the subpopulation with diabetes, 12.7% of those with treatment for chronic kidney disease (CKD), 12.6% of those with stroke, and 11.7% 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 received treatment 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, 2017 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: November 25, 2019

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Medicare - Selected Chronic Conditions by Sex, 2017

Description: The gender distribution of Medicare beneficiaries varies by condition. Overall, in 2017 Medicare fee-for-service (FFS), 54.9% of the population was female. For depression and Alzheimer's and related senile dementia, 67.1 and 62.3% of the subpopulation, respectively, was female. For chronic kidney disease (CKD) and colorectal cancer, we have a higher proportion of males treated than we would have expected based on the overall population distribution of males - 48.2% with CKD and 48.0% with colorectal cancer were male vs. 45.1% of total Medicare FFS population 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 received treatment 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, 2017 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: November 25, 2019

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Medicare - Selected Chronic Conditions by Medicare Status Code, 2017

Description: The reason for Medicare entitlement varies by condition. In Medicare fee-for-service (FFS) overall, 15.6% of the population were entitled to Medicare due to disability rather than age in 2017. A higher than expected proportion of people with treatment for depression were disabled (27.4%). For some conditions, a much higher proportion of the subpopulation were aged – for example, Alzheimer's and related senile dementia and colorectal cancer, with 93.7% and 92.2% 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 received treatment 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, 2017 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: November 25, 2019

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Diabetes Period Prevalence, 2017

Description: The number of Medicare fee-for-service (FFS) enrollees with diabetes varied by state. Colorado had the lowest rate (19.15%) and New York had the highest (32.68%).

Technical Notes: Period prevalence is calculated for these rates. Beneficiaries with full or nearly full FFS coverage during the year who received treatment 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, 2017 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: November 25, 2019

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Alzheimer's/Dementia Period Prevalence, 2017

Description: The number of Medicare fee-for-service (FFS) enrollees with Alzheimer's disease or related senile dementia varied by state. Wyoming had the lowest rate (8.08%) and Washington, D.C. had the highest (14.62%).

Technical Notes: Period prevalence is calculated for these rates. Beneficiaries with full or nearly full FFS coverage during the year who received treatment 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, 2017 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: November 25, 2019

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Depression Period Prevalence, 2017

Description: The number of Medicare fee-for-service (FFS) enrollees with depression varied by state. Hawaii had the lowest rate (8.95%) and Maine had the highest (23.06%).

Technical Notes: Period prevalence is calculated for these rates. Beneficiaries with full or nearly full FFS coverage during the year who received treatment 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, 2017 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: November 25, 2019

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