For use with the following charts and graphs, please reference the Other Chronic and Potentially Disabling Conditions Chart Legend for a list of all condition-related abbreviations on this webpage, along with their corresponding full titles. 

Medicare - Other Chronic or Disabling Conditions Period Prevalence, 2017

Description: The conditions with the highest period prevalence rates are fibromyalgia, chronic pain, and fatigue (21.5%), obesity (18.1%), anxiety disorders (17.4%), and depressive disorders (17.0%).

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 two year look back period. Please refer to the CCW website to obtain the algorithm criteria for these other chronic or potentially disabling conditions. 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 condition category.

Chart Date: November 25, 2019

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Congenital and Developmental Conditions - Trends

Description: The period prevalence for Learning disabilities (LearnDis), Intellectual disabilities IntDis), Cerebral palsy (CerPalsy), and Autism, have remained fairly stable over time in the Medicare fee-for-service population. The rate for Attention deficit, conduct disorders and hyperkinetic syndrome (ADHD) has increased gradually from 0.5% in 2008 to 1.0% in 2017. The rate for Cystic fibrosis (CysFibrs) increased slightly starting in 2015 (note that in October 2015, ICD-10-CM coding of diagnoses began).

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 two year look back period. Please refer to the CCW website to obtain the algorithm criteria for these other chronic or potentially disabling conditions. 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 condition category.

Chart Date: November 25, 2019

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Liver Conditions - Trends

Description: The period prevalence for hepatitis has remained fairly stable over time. Liver disease increased from 2.7% in 2008 to 4.6% 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 two year look back period. Please refer to the CCW website to obtain the algorithm criteria for these other chronic or potentially disabling conditions. 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 condition category.

Chart Date: November 25, 2019

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Mental Health and Substance Use Conditions - Trends

Description: The period prevalence for anxiety has increased from 7.6% in 2008 to 17.4% in 2017. For depressive disorders, the increase was from 12.2% to 17.0% over the same period of time. The rates for schizophrenia, schizophrenia and other psychotic disorders, personality disorders and post-traumatic stress disorder (PTSD) have remained fairly 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 two year look back period. Please refer to the CCW website to obtain the algorithm criteria for these other chronic or potentially disabling conditions. 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 condition category.

Chart Date: November 25, 2019

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Mobility Limitations and Chronic Pain Conditions - Trends

Description: The period prevalence for Muscular Dystrophy (MD), Multiple Sclerosis and Transverse Myelitis (MS), and mobility limitations have remained fairly stable over time. The rate of treatment for Fibromyalgia (which also includes chronic pain and fatigue) increased from 7.3% in 2008 to 12.5% in 2014, and increased more sharply starting in 2015 so that by 2017 the rate was 21.5% (note that in October 2015, ICD-10-CM coding of diagnoses began).

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 two year look back period. Please refer to the CCW website to obtain the algorithm criteria for these other chronic or potentially disabling conditions. 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 condition category.

Chart Date: November 25, 2019

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Neurological Conditions - Trends

Description: The period prevalence for Spina bifida and other congenital anomalies of the nervous system(SpinaBif), and Traumatic brain injury and nonpsychotic mental disorders due to brain damage (BrainInj) have remained stable over time. The rate for Migraine and chronic headache (Migraine) has increased from 1.3% in 2008 to 3.2% in 2017; similarly, Epilepsy has increased from 1.9% to 2.8% over the same time period. Spinal cord injury (SpineInj) was stable at 0.3% until 2015 when the prevalence increased to 0.4% - and then 0.8% by 2017 (note that in October 2015, ICD-10-CM coding of diagnoses began).

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 two year look back period. Please refer to the CCW website to obtain the algorithm criteria for these other chronic or potentially disabling conditions. 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 condition category.

Chart Date: November 25, 2019

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Other Chronic or Disabling Conditions - Trends

Description: The period prevalence for most of these other chronic or disabling conditions have remained fairly stable over time. The exceptions are obesity, which increased from 5.1% in 2008 to 18.1% in 2017, deafness and hearing impairment (Deaf), from 3.2% to 5.6%, and Peripheral vascular disease (PVD) from 11.7% to 12.7% from 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 two year look back period. Please refer to the CCW website to obtain the algorithm criteria for these other chronic or potentially disabling conditions. 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 condition category.

Chart Date: November 25, 2019

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Medicare - Selected Conditions by Age Group, 2017

Description: The age distribution for selected chronic or potentially disabling conditions is displayed. Some conditions have a disproportionately young age distribution. Although 15.6% of the Medicare population was less than 65 years of age, 52.4% of people treated for schizophrenia and other psychotic disorders, 49.7% of those treated for opioid use disorders (OUD), 28.0% of those treated for anxiety, 26.7% of people treated for depressive disorders, and 23.8% of those treated for fibromyalgia or chronic pain were less than 65. Peripheral vascular disease (PVD) and pressure ulcers are much more common in the 75 years or older age groups.

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 two year look back period. Please refer to the CCW website to obtain the algorithm criteria for these other chronic or potentially disabling conditions. 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 condition category. 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.

Chart Date: November 25, 2019

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Medicare - Selected Conditions by Racial Group, 2017

Description: The racial distribution of Medicare beneficiaries treated for selected conditions is displayed. There is racial variation in the prevalence of treatment for these conditions. Although the black racial group comprises 9.4% of the Medicare fee-for-service (FFS) population in 2017, they had disproportionately high rates of treatment for schizophrenia and other psychotic disorders (SchizPsychotic; 18.9%), alcohol use disorder (13.8%) , obesity (12.6%), pressure ulcers (PressUlc; 11.9%), opioid use disorders (OUD; 11.9%), and peripheral vascular disease (PVD; 11.1%). The white racial group comprised 83.0% of the total FFS population, 87.2% of those treated for anxiety, and 86.2% of those treated for depressive disorders (DeprDis).

Technical Notes: American Indian, Native American, Other, and Unknown races are grouped together due to small cell sizes. Beneficiaries with full or nearly full fee-for-service (FFS) coverage during the year who received treatment for the condition within the two year look back period. Please refer to the CCW website to obtain the algorithm criteria for these other chronic or potentially disabling conditions. 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 condition category.

Chart Date: November 25, 2019

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Medicare - Selected Conditions by Sex, 2017

Description: The gender distribution of Medicare beneficiaries varies by condition. In Medicare fee-for-service (FFS) for 2017, 54.9% of the population was female. A much higher than expected proportion of people treated for treated for anxiety and depressive disorders were female (68.4% and 67.4%, respectively). A higher proportion of males than expected were treated for alcohol use disorders (67.3%), schizophrenia and psychotic disorders (47.8%), pressure ulcers (46.9%), liver disease (46.3%), and peripheral vascular disease (PVD; 46.0%).

Technical Notes: Beneficiaries with full or nearly full fee-for-service (FFS) coverage during the year who received treatment for the condition within the two year look back period. Please refer to the CCW website to obtain the algorithm criteria for these other chronic or potentially disabling conditions. 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 condition category.

Chart Date: November 25, 2019

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Medicare - Selected Conditions by Medicare Status Code, 2017

Description: The reason for Medicare entitlement varies by condition. In Medicare fee-for-service (FFS) for 2017, 15.6% of the population were entitled to Medicare due to disability rather than age. A much higher than expected proportion of people treated for schizophrenia and other psychotic disorders (52.4%), opioid use disorder (OUD; 49.7%), or alcohol use disorder (41.6%) were disabled. Higher proportions of disabled enrollees were treated for anxiety (28.0%), depressive disorders (26.7%), or fibromyalgia and chronic pain (23.8%), compared to aged enrollees. The only condition where disproportionately more aged were treated was peripheral vascular disease (PVD; 90.1%).

Technical Notes: Classification used the Medicare status code, and combined ESRD and Disabled categories into the "Disabled" grouping. 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 two year look back period. Please refer to the CCW website to obtain the algorithm criteria for these other chronic or potentially disabling conditions. 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 condition category.

Chart Date: November 25, 2019

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Medicare - Selected Conditions by Dual Status, 2017

Description: A total of 18.4% of Medicare fee-for-service (FFS) beneficiaries also had Medicaid coverage in 2017– whether full dual coverage, or coverage for only partial benefits. The dual status for selected chronic or potentially disabling conditions is displayed. Some conditions have a disproportionately high dual enrollment distribution. For example, 57.1% of people treated for schizophrenia and other psychotic disorders, 31.9% of people treated for opioid use disorder (OUD), 29.8% of those treated for alcohol use disorder, 28.0% of those treated for pressure ulcers, and 26.6% of people treated for depressive disorders were Medicare-Medicaid enrolled for full dual benefits.

Technical Notes: The state-reported dual status code (variable called DUAL_STUS_CD_MM) is used to identify beneficiaries dually enrolled in Medicare and Medicaid. Dual coverage was defined as DUAL_STUS_CD_MM = 01, 02, 03, 04, 05, 06 or 08 for 11 or 12 months of the year, or until time of death. A beneficiary was considered a Full benefit dual if they had DUAL_STUS_CD_MM = 02, 04 or 08 for a minimum of one month during the year. All other duals were considered partial. 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 two year look back period. Please refer to the CCW website to obtain the algorithm criteria for these other chronic or potentially disabling conditions. 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 condition category.

Chart Date: November 25, 2019

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Period Prevalence by State - Anxiety Disorders, 2017

Description: The number of Medicare fee-for-service (FFS) enrollees with anxiety disorders varied by state. Hawaii had the lowest rate (8.47%) and Kentucky had the highest (24.63%).

Technical Notes: Period prevalence is calculated for these rates. Beneficiaries with full or nearly full FFS coverage during the year who received treatment for anxiety disorders within the 2-year look back period. Please refer to the Other Chronic and Potentially Disabling 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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Period Prevalence by State - Depressive Disorders, 2017

Description: The number of Medicare fee-for-service (FFS) enrollees with depressive disorders varied by state. Hawaii had the lowest rate (7.74%) and West Virginia had the highest (21.59%).

Technical Notes: Period prevalence is calculated for these rates. Beneficiaries with full or nearly full FFS coverage during the year who received treatment for depressive disorders within the 2-year look back period. Please refer to the Other Chronic and Potentially Disabling 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). Note that this depressive disorders category is defined somewhat differently than the CCW Depression category (see algorithm criteria).

Chart Date: November 25, 2019

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Period Prevalence by State - Fibromyalgia, Chronic Pain and Fatigue, 2017

Description: The number of Medicare fee-for-service (FFS) enrollees with fibromyalgia, chronic pain or fatigue varied by state. Hawaii had the lowest rate (12.94%) and Michigan and Oklahoma had the highest (25.62%).

Technical Notes: Period prevalence is calculated for these rates. Beneficiaries with full or nearly full FFS coverage during the year who received treatment for fibromyalgia, chronic pain and fatigue within the 2-year look back period. Please refer to the Other Chronic and Potentially Disabling 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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Period Prevalence by State - Liver Disease, Cirrhosis and Other Liver Conditions [except Hepatitis], 2017

Description: The number of Medicare fee-for-service (FFS) enrollees with liver disease, cirrhosis and other liver conditions (except for hepatitis) varied by state. Montana had the lowest rate (2.92%) and Hawaii had the highest (6.36%).

Technical Notes: Period prevalence is calculated for these rates. Beneficiaries with full or nearly full FFS coverage during the year who received treatment for liver disease, cirrhosis and other liver conditions (except for hepatitis) within the 2-year look back period. Please refer to the Other Chronic and Potentially Disabling 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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