A chronic condition (also known as chronic disease or chronic illness) is a health condition or disease that is persistent or otherwise long-lasting in its effects or a disease that comes with time. The term chronic is often applied when the course of the disease lasts for more than three months. Common chronic diseases include diabetes, functional gastrointestinal disorder, eczema, arthritis, asthma, chronic obstructive pulmonary disease, autoimmune diseases, genetic disorders and some viral diseases such as hepatitis C and acquired immunodeficiency syndrome. An illness which is lifelong because it ends in death is a terminal illness. It is possible and not unexpected for an illness to change in definition from terminal to chronic. Diabetes and HIV for example were once terminal yet are now considered chronic due to the availability of insulin for diabetics and daily drug treatment for individuals with HIV which allow these individuals to live while managing symptoms.
In medicine, chronic conditions are distinguished from those that are acute. An acute condition typically affects one portion of the body and responds to treatment. A chronic condition, on the other hand, usually affects multiple areas of the body, is not fully responsive to treatment, and persists for an extended period of time.
Chronic conditions may have periods of remission or relapse where the disease temporarily goes away, or subsequently reappears. Periods of remission and relapse are commonly discussed when referring to substance abuse disorders which some consider to fall under the category of chronic condition.
Chronic conditions are often associated with non-communicable diseases which are distinguished by their non-infectious causes. Some chronic conditions though, are caused by transmissible infections such as HIV/AIDS.
63% of all deaths worldwide are from chronic conditions. Chronic diseases constitute a major cause of mortality, and the World Health Organization (WHO) attributes 38 million deaths a year to non-communicable diseases. In the United States approximately 40% of adults have at least two chronic conditions. Living with two or more chronic conditions is referred to as multimorbidity.
Chronic conditions have often been used to describe the various health related states of the human body such as syndromes, physical impairments, disabilities as well as diseases. Epidemiologists have found interest in chronic conditions due to the fact they contribute to disease, disability, and diminished physical and/or mental capacity.
For example, high blood pressure or hypertension is considered to be not only a chronic condition itself but also correlated to diseases such as heart attack or stroke. Additionally, some socioeconomic factors may be considered as a chronic condition as they lead to disability in daily life. An important one that public health officials in the social science setting have begun highlighting is chronic poverty.
The list below includes these chronic conditions and diseases:
In 2015 the World Health Organization produced a report on non-communicable diseases, citing the four major types as:
- Cardiovascular diseases, including cerebrovascular disease, heart failure, and ischemic cardiopathy
- Chronic respiratory diseases, such as asthma and chronic obstructive pulmonary disease (COPD)
- Diabetes mellitus (type 1, type 2, pre-diabetes, gestational diabetes)
Other examples of chronic diseases and health conditions include:
- Alzheimer's disease
- Atrial fibrillation
- Attention deficit hyperactivity disorder
- Autoimmune diseases, such as ulcerative colitis, lupus erythematosus, Crohn's disease, coeliac disease, Hashimoto's thyroiditis, and relapsing polychondritis
- Cerebral palsy (all types)
- Chronic graft-versus-host disease
- Chronic hepatitis
- Chronic kidney disease
- Chronic osteoarticular diseases, such as osteoarthritis and rheumatoid arthritis
- Chronic pain syndromes, such as post-vasectomy pain syndrome and complex regional pain syndrome
- Dermatological conditions such as atopic dermatitis and psoriasis
- Deafness and hearing impairment
- Ehlers–Danlos syndrome (various types)
- Fetal alcohol spectrum disorder
- Hereditary spherocytosis
- Huntington's disease
- Mental illness
- Multiple sclerosis
- Myalgic encephalomyelitis (a.k.a. chronic fatigue syndrome)
- Parkinson's disease
- Periodontal disease
- Polycystic Ovarian Syndrome
- Postural orthostatic tachycardia syndrome
- Sickle cell anemia and other hemoglobin disorders
- Substance Abuse Disorders
- Sleep apnea
- Thyroid disease
- And many more.
Risk factors Edit
The examples and perspective in this section may not represent a worldwide view of the subject. (April 2015)
While risk factors vary with age and gender, many of the common chronic diseases in the US are caused by dietary, lifestyle and metabolic risk factors. Therefore, these conditions might be prevented by behavioral changes, such as quitting smoking, adopting a healthy diet, and increasing physical activity. Social determinants are important risk factors for chronic diseases. Social factors, e.g., socioeconomic status, education level, and race/ethnicity, are a major cause for the disparities observed in the care of chronic disease. Lack of access and delay in receiving care result in worse outcomes for patients from minorities and underserved populations. Those barriers to medical care complicate patients monitoring and continuity in treatment.
The majority of US health care and economic costs associated with medical conditions are incurred by chronic diseases and conditions and associated health risk behaviors. Eighty-four percent of all health care spending in 2006 was for the 50% of the population who have one or more common chronic medical conditions (CDC, 2014).
There are several psychosocial risk and resistance factors among children with chronic illness and their family members. Adults with chronic illness were significantly more likely to report life dissatisfaction than those without chronic illness. Compared to their healthy peers, children with chronic illness have about a twofold increase in psychiatric disorders. Higher parental depression and other family stressors predicted more problems among patients. In addition, sibling problems along with the burden of illness on the family as a whole led to more psychological strain on the patients and their families.
A growing body of evidence supports that prevention is effective in reducing the effect of chronic conditions; in particular, early detection results in less severe outcomes. Clinical preventive services include screening for the existence of the disease or predisposition to its development, counseling and immunizations against infectious agents. Despite their effectiveness, the utilization of preventive services is typically lower than for regular medical services. In contrast to their apparent cost in time and money, the benefits of preventive services are not directly perceived by patient because their effects are on the long term or might be greater for society as a whole than at the individual level.
Therefore, public health programs are important in educating the public, and promoting healthy lifestyles and awareness about chronic diseases. While those programs can benefit from funding at different levels (state, federal, private) their implementation is mostly in charge of local agencies and community-based organizations.
Studies have shown that public health programs are effective in reducing mortality rates associated to cardiovascular disease, diabetes and cancer, but the results are somewhat heterogeneous depending on the type of condition and the type of programs involved. For example, results from different approaches in cancer prevention and screening depended highly on the type of cancer. The rising number of patient with chronic diseases has renewed the interest in prevention and its potential role in helping control costs. In 2008, the Trust for America's Health produced a report that estimated investing $10 per person annually in community-based programs of proven effectiveness and promoting healthy lifestyle (increase in physical activity, healthier diet and preventing tobacco use) could save more than $16 billion annually within a period of just five years.
A 2017 review (updated in 2022) found that it is uncertain whether school-based policies on targeting risk factors on chronic diseases such as healthy eating policies, physical activity policies, and tobacco policies can improve student health behaviours or knowledge of staffs and students. The updated review in 2022 did determine a slight improvement in measures of obesity and physical activity as the use of improved strategies lead to increased implementation interventions but continued to call for additional research to address questions related to alcohol use and risk. Encouraging those with chronic conditions to continue with their outpatient (ambulatory) medical care and attend scheduled medical appointments may help improve outcomes and reduce medical costs due to missed appointments. Finding patient-centered alternatives to doctors or consultants scheduling medical appointments has been suggested as a means of improving the number of people with chronic conditions that miss medical appointments, however there is no strong evidence that these approaches make a difference.
Nursing can play an important role in assisting patients with chronic diseases achieve longevity and experience wellness. Scholars point out that the current neoliberal era emphasizes self-care, in both affluent and low-income communities. This self-care focus extends to the nursing of patients with chronic diseases, replacing a more holistic role for nursing with an emphasis on patients managing their own health conditions. Critics note that this is challenging if not impossible for patients with chronic disease in low-income communities where health care systems, and economic and social structures do not fully support this practice.
A study in Ethiopia showcases a nursing-heavy approach to the management of chronic disease. Foregrounding the problem of distance from healthcare facility, the study recommends patients increase their request for care. It uses nurses and health officers to fill, in a cost-efficient way, the large unmet need for chronic disease treatment. They led their health centers manned by nurses and health officers; so, there are specific training required for involvement in the programmed must be carried out regularly, to ensure that new staff is educated in administering chronic disease care. The program shows that community-based care and education, primarily driven by nurses and health officers, works. It highlights the importance of nurses following up with individuals in the community, and allowing nurses flexibility in meeting their patients' needs and educating them for self-care in their homes.
The epidemiology of chronic disease is diverse and the epidemiology of some chronic diseases can change in response to new treatments. In the treatment of HIV, the success of anti-retroviral therapies means that many patients will experience this infection as a chronic disease that for many will span several decades of their chronic life.
Some epidemiology of chronic disease can apply to multiple diagnosis. Obesity and body fat distribution for example contribute and are risk factors for many chronic diseases such as diabetes, heart, and kidney disease. Other epidemiological factors, such as social, socioeconomic, and environment do not have a straightforward cause and effect relationship with chronic disease diagnosis. While typically higher socioeconomic status is correlated with lower occurrence of chronic disease, it is not known is there is a direct cause and effect relationship between these two variables.
The epidemiology of communicable chronic diseases such as AIDS is also different from that of noncommunicable chronic disease. While Social factors do play a role in AIDS prevalence, only exposure is truly needed to contract this chronic disease. Communicable chronic diseases are also typically only treatable with medication intervention, rather than lifestyle change as some non-communicable chronic diseases can be treated.
United States Edit
As of 2003, there are a few programs which aim to gain more knowledge on the epidemiology of chronic disease using data collection. The hope of these programs is to gather epidemiological data on various chronic diseases across the United States and demonstrate how this knowledge can be valuable in addressing chronic disease.
In the United States, as of 2004 nearly one in two Americans (133 million) has at least one chronic medical condition, with most subjects (58%) between the ages of 18 and 64. The number is projected to increase by more than one percent per year by 2030, resulting in an estimated chronically ill population of 171 million. The most common chronic conditions are high blood pressure, arthritis, respiratory diseases like emphysema, and high cholesterol.
Based on data from 2014 Medical Expenditure Panel Survey (MEPS), about 60% of adult Americans were estimated to have one chronic illness, with about 40% having more than one; this rate appears to be mostly unchanged from 2008. MEPS data from 1998 showed 45% of adult Americans had at least one chronic illness, and 21% had more than one.
According to research by the CDC, chronic disease is also especially a concern in the elderly population in America. Chronic diseases like stroke, heart disease, and cancer were among the leading causes of death among Americans aged 65 or older in 2002, accounting for 61% of all deaths among this subset of the population. It is estimated that at least 80% of older Americans are currently living with some form of a chronic condition, with 50% of this population having two or more chronic conditions. The two most common chronic conditions in the elderly are high blood pressure and arthritis, with diabetes, coronary heart disease, and cancer also being reported among the elder population.
In examining the statistics of chronic disease among the living elderly, it is also important to make note of the statistics pertaining to fatalities as a result of chronic disease. Heart disease is the leading cause of death from chronic disease for adults older than 65, followed by cancer, stroke, diabetes, chronic lower respiratory diseases, influenza and pneumonia, and, finally, Alzheimer's disease. Though the rates of chronic disease differ by race for those living with chronic illness, the statistics for leading causes of death among elderly are nearly identical across racial/ethnic groups.
Chronic illnesses cause about 70% of deaths in the US and in 2002 chronic conditions (heart disease, cancers, stroke, chronic respiratory diseases, diabetes, Alzheimer's disease, mental illness and kidney diseases) were six of the top ten causes of mortality in the general US population.
Economic impact Edit
The examples and perspective in this section may not represent a worldwide view of the subject. (June 2015)
United States Edit
Chronic diseases are a major factor in the continuous growth of medical care spending. In 2002, the U.S. Department of Health and Human Services stated that the health care for chronic diseases cost the most among all health problems in the U.S. Healthy People 2010 reported that more than 75% of the $2 trillion spent annually in U.S. medical care are due to chronic conditions; spending are even higher in proportion for Medicare beneficiaries (aged 65 years and older). Furthermore, in 2017 it was estimated that 90% of the $3.3 billion spent on healthcare in the United States was due to the treatment of chronic diseases and conditions. Spending growth is driven in part by the greater prevalence of chronic illnesses and the longer life expectancy of the population. Also, improvement in treatments has significantly extended the lifespans of patients with chronic diseases but results in additional costs over long period of time. A striking success is the development of combined antiviral therapies that led to remarkable improvement in survival rates and quality of life of HIV-infected patients.
In addition to direct costs in health care, chronic diseases are a significant burden to the economy, through limitations in daily activities, loss in productivity and loss of days of work. A particular concern is the rising rates of overweight and obesity in all segments of the U.S. population. Obesity itself is a medical condition and not a disease, but it constitutes a major risk factor for developing chronic illnesses, such as diabetes, stroke, cardiovascular disease and cancers. Obesity results in significant health care spending and indirect costs, as illustrated by a recent study from the Texas comptroller reporting that obesity alone cost Texas businesses an extra $9.5 billion in 2009, including more than $4 billion for health care, $5 billion for lost productivity and absenteeism, and $321 million for disability.
Social and personal impact Edit
There have been recent links between social factors and prevalence as well as outcome of chronic conditions.
Mental health Edit
Specifically, the connection between loneliness and health and chronic condition has recently been highlighted. Some studies have shown that loneliness has detrimental health effects similar to that of smoking and obesity. One study found that feelings of isolation are associated with higher self reporting of health as poor, and feelings of loneliness increased the likelihood of mental health disorders in individuals. The connection between chronic illness and loneliness is established, yet oftentimes ignored in treatment. One study for example found that a greater number of chronic illnesses per individual were associated with feelings of loneliness. Some of the possible reasons for this listed are an inability to maintain independence as well as the chronic illness being a source of stress for the individual. A study of loneliness in adults over age 65 found that low levels of loneliness as well as high levels of familial support were associated with better outcomes of multiple chronic conditions such as hypertension and diabetes. There are some recent movements in the medical sphere to address these connections when treating patients with chronic illness. The biopsychosocial approach for example, developed in 2006 focuses on patients "patient's personality, family, culture, and health dynamics." Physicians are leaning more towards a psychosocial approach to chronic illness to aid the increasing number of individuals diagnosed with these conditions. Despite this movement, there is still criticism that chronic conditions are not being treated appropriately, and there is not enough emphasis on the behavioral aspects of chronic conditions or psychological types of support for patients.
The mental toll of chronic illness is often underestimated in society. Adults with chronic illness that restrict their daily life present with more depression and lower self-esteem than healthy adults and adults with non-restricting chronic illness. The emotional influence of chronic illness also has an effect on the intellectual and educational development of the individual. For example, people living with type 1 diabetes endure a lifetime of monotonous and rigorous health care management usually involving daily blood glucose monitoring, insulin injections, and constant self-care. This type of constant attention that is required by type 1 diabetes and other chronic illness can result in psychological maladjustment. There have been several theories, namely one called diabetes resilience theory, that posit that protective processes buffer the impact of risk factors on the individual's development and functioning.
Financial cost Edit
People with chronic conditions pay more out-of-pocket; a study of the United States found that people spent $2,243 more on average. The financial burden can increase medication non-adherence.
In some countries, laws protect patients with chronic conditions from excessive financial responsibility; for example, as of 2008 France limited copayments for those with chronic conditions, and Germany limits cost sharing to 1% of income versus 2% for the general public.
Within the medical-industrial complex, chronic illnesses can impact the relationship between pharmaceutical companies and people with chronic conditions. Life-saving drugs, or life-extending drugs, can be inflated for a profit. There is little regulation on the cost of chronic illness drugs, which suggests that abusing the lack of a drug cap can create a large market for drug revenue. Likewise, certain chronic conditions can last throughout one's lifetime and create pathways for pharmaceutical companies to take advantage of this.
Gender influences how chronic disease is viewed and treated in society. Women's chronic health issues are often considered to be most worthy of treatment or most severe when the chronic condition interferes with a woman's fertility. Historically, there is less of a focus on a woman's chronic conditions when it interferes with other aspects of her life or well-being. Many women report feeling less than or even "half of a woman" due to the pressures that society puts on the importance of fertility and health when it comes to typically feminine ideals. These kinds of social barriers interfere with women's ability to perform various other activities in life and fully work toward their aspirations.
Socioeconomic class and race Edit
Race is also allegedly implicated in chronic illness, although there may be many other factors involved. Racial minorities are 1.5-2 times more likely to have most chronic diseases than white individuals. Non-Hispanic blacks are 40% more likely to have high blood pressure that non-Hispanic whites, diagnosed diabetes is 77% higher among non-Hispanic blacks, and American Indians and Alaska Natives are 60% more likely to be obese than non-Hispanic whites. Some of this prevalence has been suggested to be in part from environmental racism. Flint, Michigan, for example, had high levels of lead poisoning in their drinkable water after waste was dumped into low-value housing areas. There are also higher rates of asthma in children who live in lower income areas due to an abundance of pollutants being released on a much larger scale in these areas.
Advocacy and research organizations Edit
In Europe, the European Chronic Disease Alliance was formed in 2011, which represents over 100,000 healthcare workers.
In the United States, there are a number of nonprofits focused on chronic conditions, including entities focused on specific diseases such as the American Diabetes Association, Alzheimer's Association, or Crohn's and Colitis Foundation. There are also broader groups focused on advocacy or research into chronic illness in general, such as the National Association of Chronic Disease Directors, Partnership to Fight Chronic Disease, the Chronic Disease Coalition which arose in Oregon in 2015, and the Chronic Policy Care Alliance.
- Final Negotiations: A Story of Love, Loss, and Chronic Illness by Carolyn Ellis
- Beyond Words: Illness and the Limits of Expression by Kathlyn Conway
- Ordinary Life: A Memoir of Illness by Kathlyn Conway
- The Wounded Storyteller: Body, Illness, and Ethics by Arthur W. Frank
- Tender Points by Amy Berkowitz
- Illness as Metaphor by Susan Sontag
- Regarding the Pain of Others by Susan Sontag
- Bodies in Protest: Environmental Illness and the Struggle Over Medical Knowledge by Steve Kroll-Smith and H. Hugh Floyd
- Inside Chronic Pain: An Intimate and Critical Account by Louis Heshusius and Scott M. Fishman
- The Nearness of Others: Searching for Tact and Contact in the Age of HIV by David Caron
- Narrative Medicine: Honoring the Stories of Illness by Rita Charon
- Good Days, Bad Days: The Self in Chronic Illness and Time by Kathy Charmaz
See also Edit
- Chronic care management
- Chronic disease in China
- Chronic disease in Northern Ontario
- Chronic Illness (journal)
- Chronic pain
- Long COVID
- Course (medicine)
- Disability studies
- Disease management (health)
- Dynamic treatment regimes
- Medical tattoo
- Natural history of disease
- Virtual Wards (a UK term)
- Bernell S, Howard SW (2016-08-02). "Use Your Words Carefully: What Is a Chronic Disease?". Frontiers in Public Health. 4: 159. doi:10.3389/fpubh.2016.00159. PMC 4969287. PMID 27532034.
- Jaeger J, Borod JC, Peselow E (September 1996). "Facial expression of positive and negative emotions in patients with unipolar depression". Journal of Affective Disorders. 11 (1): 43–50. doi:10.1097/00006416-199609000-00014. PMC 2944927. PMID 2944927.
- Dennis M, Scott CK (December 2007). "Managing addiction as a chronic condition". Addiction Science & Clinical Practice. 4 (1): 45–55. doi:10.1151/ascp074145. PMC 2797101. PMID 18292710.
- "WHO | Noncommunicable diseases country profiles 2011". WHO. Archived from the original on March 28, 2013. Retrieved 2020-09-11.
- "Noncommunicable diseases. Fact sheet". World Health Organization. January 2015. Retrieved April 5, 2016.
- Gerteis J, Izrael D, Deitz D, et al.Multiple Chronic Conditions Chart-book. Rockville, MD: Agency for Healthcare Research and Quality;2014
- "Chronic Diseases in America". Center for Disease Control. 1999. Retrieved 10 August 2020.
- "Multiple long-term conditions (multimorbidity): making sense of the evidence". NIHR Evidence. 2021-03-30. doi:10.3310/collection_45881. S2CID 243406561.
- "Condition". MedicineNet. Retrieved 2016-04-13.
- Hulme D, Shepherd A (2003-03-01). "Conceptualizing Chronic Poverty". World Development. Chronic Poverty and Development Policy. 31 (3): 403–423. doi:10.1016/S0305-750X(02)00222-X.
- Harrell SP (January 2000). "A multidimensional conceptualization of racism-related stress: implications for the well-being of people of color". The American Journal of Orthopsychiatry. 70 (1): 42–57. doi:10.1037/h0087722. PMID 10702849.
- Hulme, D. (2003). "Chronic Poverty and Development Policy: An Introduction". World Development. 31 (3): 399–402. doi:10.1016/s0305-750x(02)00214-0.
- "Chronic Conditions: Making the Case for Ongoing Care". Robert Wood Johnson Foundation & Partnership for Solutions. Baltimore, MD: Johns Hopkins University. September 2004. Archived from the original on 2012-04-23. Retrieved 2009-12-07.
- Noncommunicable diseases, World Health Organization, retrieved April 5, 2016
- Danaei G, Ding EL, Mozaffarian D, Taylor B, Rehm J, Murray CJ, Ezzati M (April 2009). "The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors". PLOS Medicine. 6 (4): e1000058. doi:10.1371/journal.pmed.1000058. PMC 2667673. PMID 19399161.
- Braveman PA, Cubbin C, Egerter S, Williams DR, Pamuk E (April 2010). "Socioeconomic disparities in health in the United States: what the patterns tell us". American Journal of Public Health. 100 (Suppl 1): S186–96. doi:10.2105/AJPH.2009.166082. PMC 2837459. PMID 20147693.
- Mead H, Cartwright-Smith L, Jones K, Ramos C, Woods K, Siegel B (March 2008). Racial and ethnic disparities in US health care: A chartbook. New York, NY: The Commonwealth Fund.
- Sondik EJ, Huang DT, Klein RJ, Satcher D (2010). "Progress toward the healthy people 2010 goals and objectives". Annual Review of Public Health. 31: 271–81 4 p folliwng 281. doi:10.1146/annurev.publhealth.012809.103613. PMID 20070194.
- Strine TW, Chapman DP, Balluz LS, Moriarty DG, Mokdad AH (February 2008). "The associations between life satisfaction and health-related quality of life, chronic illness, and health behaviors among U.S. community-dwelling adults". Journal of Community Health. 33 (1): 40–50. doi:10.1007/s10900-007-9066-4. PMID 18080207. S2CID 25099848.
- Cadman D, Boyle M, Offord DR (June 1988). "The Ontario Child Health Study: social adjustment and mental health of siblings of children with chronic health problems". Journal of Developmental and Behavioral Pediatrics. 9 (3): 117–21. doi:10.1097/00004703-198806000-00001. PMID 3403727. S2CID 26986024.
- Daniels D, Moos RH, Billings AG, Miller JJ (June 1987). "Psychosocial risk and resistance factors among children with chronic illness, healthy siblings, and healthy controls". Journal of Abnormal Child Psychology. 15 (2): 295–308. doi:10.1007/BF00916356. PMID 3497186. S2CID 32785209.
- Kenkel DS "Prevention" "Handbook Of Health Economics"
- Halverson PK, Miller CA, Kaluzny AD, Fried BJ, Schenck SE, Richards TB (1996). "Performing public health functions: the perceived contribution of public health and other community agencies". Journal of Health and Human Services Administration. 18 (3): 288–303. PMID 10158617.
- Mays GP, Smith SA (August 2011). "Evidence links increases in public health spending to declines in preventable deaths". Health Affairs. 30 (8): 1585–93. doi:10.1377/hlthaff.2011.0196. PMC 4019932. PMID 21778174.
- Cutler DM (2008). "Are we finally winning the war on cancer?". The Journal of Economic Perspectives. 22 (4): 3–26. doi:10.1257/jep.22.4.3. PMID 19768842.
- "Prevention for a Healthier America". Trust for America's Health. July 2008. Retrieved April 5, 2016.
- Wolfenden, Luke; McCrabb, Sam; Barnes, Courtney; O'Brien, Kate M.; Ng, Kwok W.; Nathan, Nicole K.; Sutherland, Rachel; Hodder, Rebecca K.; Tzelepis, Flora; Nolan, Erin; Williams, Christopher M.; Yoong, Sze Lin (2022-08-29). "Strategies for enhancing the implementation of school-based policies or practices targeting diet, physical activity, obesity, tobacco or alcohol use". The Cochrane Database of Systematic Reviews. 8 (8): CD011677. doi:10.1002/14651858.CD011677.pub3. ISSN 1469-493X. PMC 9422950. PMID 36036664.
- Whear, Rebecca; Thompson-Coon, Joanna; Rogers, Morwenna; Abbott, Rebecca A.; Anderson, Lindsey; Ukoumunne, Obioha; Matthews, Justin; Goodwin, Victoria A.; Briscoe, Simon; Perry, Mark; Stein, Ken (April 2020). "Patient-initiated appointment systems for adults with chronic conditions in secondary care". The Cochrane Database of Systematic Reviews. 2020 (4): CD010763. doi:10.1002/14651858.CD010763.pub2. ISSN 1469-493X. PMC 7144896. PMID 32271946.
- Salmond SW, Echevarria M (2017). "Healthcare Transformation and Changing Roles for Nursing". Orthopedic Nursing. 36 (1): 12–25. doi:10.1097/NOR.0000000000000308. PMC 5266427. PMID 28107295.
- Wilkinson A, Whitehead L (August 2009). "Evolution of the concept of self-care and implications for nurses: a literature review". International Journal of Nursing Studies. 46 (8): 1143–7. doi:10.1016/j.ijnurstu.2008.12.011. PMID 19200992.
- Mamo Y, Seid E, Adams S, Gardiner A, Parry E (June 2007). "A primary healthcare approach to the management of chronic disease in Ethiopia: an example for other countries". Clinical Medicine. 7 (3): 228–31. doi:10.7861/clinmedicine.7-3-228. PMC 4952696. PMID 17633941.
- Deeks SG, Lewin SR, Havlir DV (November 2013). "The end of AIDS: HIV infection as a chronic disease". Lancet. 382 (9903): 1525–33. doi:10.1016/S0140-6736(13)61809-7. PMC 4058441. PMID 24152939.
- Baumgartner RN, Heymsfield SB, Roche AF (January 1995). "Human body composition and the epidemiology of chronic disease". Obesity Research. 3 (1): 73–95. doi:10.1002/j.1550-8528.1995.tb00124.x. PMID 7712363.
- Lowry R, Kann L, Collins JL, Kolbe LJ (September 1996). "The effect of socioeconomic status on chronic disease risk behaviors among US adolescents". JAMA. 276 (10): 792–7. doi:10.1001/jama.276.10.792. PMID 8769588.
- Solomons N, Kruger HS, Puoane TR (2017-10-10). "Adherence challenges encountered in an intervention programme to combat chronic non-communicable diseases in an urban black community, Cape Town" (PDF). Health SA Gesondheid. 22. doi:10.4102/hsag.v22i0.970. ISSN 2071-9736.
- Remington PL, Simoes E, Brownson RC, Siegel PZ (July 2003). "The role of epidemiology in chronic disease prevention and health promotion programs". Journal of Public Health Management and Practice. 9 (4): 258–65. doi:10.1097/00124784-200307000-00003. PMID 12836507.
- Buttorff C, Ruder T, Bauman M (2017). "Multiple Chronic Conditions in the United States". www.rand.org. Retrieved 2019-06-13.
- Anderson G, Horvath J (2004). "The growing burden of chronic disease in America". Public Health Reports. 119 (3): 263–70. doi:10.1016/j.phr.2004.04.005. PMC 1497638. PMID 15158105.
- Centers for Disease Control and Prevention."The state of aging and health in america 2007"
- "Common Chronic Conditions and Aging at Home"
- National Center for Health Statistics. " Health, United States" / 2004.
- Roehrig C, Miller G, Lake C, Bryant J (2009). "National health spending by medical condition, 1996-2005". Health Affairs. 28 (2): w358–67. doi:10.1377/hlthaff.28.2.w358. PMID 19240056.
- "Welcome to CDC stacks | The Burden of chronic diseases and their risk factors; national and state perspectives - 11317 | Stephen B. Thacker CDC Library collection". stacks.cdc.gov. Retrieved 2019-06-30.
- Kelly, Cheryl; Clennin, Morgan N.; Barela, Breanne A.; Wagner, Andrea (March 2021). "Practice-Based Evidence Supporting Healthy Eating and Active Living Policy and Environmental Changes". Journal of Public Health Management and Practice. 27 (2): 166–172. doi:10.1097/PHH.0000000000001099. ISSN 1078-4659. PMID 31688744. S2CID 207893468.
- Buttorff C, Ruder T, Bauman M.Multiple Chronic Conditions in theUnited States. Santa Monica, CA: RAND Corporation; 2017.
- Texas Comptroller of Public Accounts "Gaining Costs, Losing Time: The Obesity Crisis in Texas". Special Report, Austin, Texas, February 2011, Publication# 96-1360.
- Tiwari SC (October 2013). "Loneliness: A disease?". Indian Journal of Psychiatry. 55 (4): 320–2. doi:10.4103/0019-5545.120536. PMC 3890922. PMID 24459300.
- Coyle CE, Dugan E (December 2012). "Social isolation, loneliness and health among older adults". Journal of Aging and Health. 24 (8): 1346–63. doi:10.1177/0898264312460275. PMID 23006425. S2CID 25329890.
- Theeke LA (October 2009). "Predictors of loneliness in U.S. adults over age sixty-five". Archives of Psychiatric Nursing. 23 (5): 387–96. doi:10.1016/j.apnu.2008.11.002. PMID 19766930.
- Sperry L (2006). "Psychological treatment of chronic illness: The biopsychosocial therapy approach". American Psychological Association.
- Sperry L (2009). Treatment of chronic medical conditions: cognitive-behavioral therapy strategies and integrative treatment protocols. American Psychological Association. ISBN 9781433803895. OCLC 213375853.
- Clark NM, Gong M (February 2000). "Management of chronic disease by practitioners and patients: are we teaching the wrong things?". BMJ. 320 (7234): 572–5. doi:10.1136/bmj.320.7234.572. PMC 1117606. PMID 10688569.
- Huurre TM, Aro HM (April 2002). "Long-term psychosocial effects of persistent chronic illness. A follow-up study of Finnish adolescents aged 16 to 32 years". European Child & Adolescent Psychiatry. 11 (2): 85–91. doi:10.1007/s007870200015. PMID 12033749. S2CID 22198568.
- Turner J, Kelly B (February 2000). "Emotional dimensions of chronic disease". The Western Journal of Medicine. 172 (2): 124–8. doi:10.1136/ewjm.172.2.124. PMC 1070773. PMID 10693376.
- Hilliard ME, Harris MA, Weissberg-Benchell J (December 2012). "Diabetes resilience: a model of risk and protection in type 1 diabetes". Current Diabetes Reports. 12 (6): 739–48. doi:10.1007/s11892-012-0314-3. PMID 22956459. S2CID 41753257.
- Lee DC, Shi L, Pierre G, Zhu J, Hu R (November 2014). "Chronic conditions and medical expenditures among non-institutionalized adults in the United States". International Journal for Equity in Health. 13 (1): 105. doi:10.1186/s12939-014-0105-3. PMC 4260199. PMID 25424127.
- Sum G, Hone T, Atun R, Millett C, Suhrcke M, Mahal A, et al. (2018-02-01). "Multimorbidity and out-of-pocket expenditure on medicines: a systematic review". BMJ Global Health. 3 (1): e000505. doi:10.1136/bmjgh-2017-000505. PMC 5859814. PMID 29564155.
- Larkin J, Foley L, Smith SM, Harrington P, Clyne B (December 2020). "The experience of financial burden for people with multimorbidity: A systematic review of qualitative research". Health Expectations. 24 (2): 282–95. doi:10.1111/hex.13166. ISSN 1369-6513. PMC 8077119. PMID 33264478.
- Schoen C, Osborn R, How SK, Doty MM, Peugh J (2009-01-01). "In chronic condition: experiences of patients with complex health care needs, in eight countries, 2008". Health Affairs. 28 (1): w1-16. doi:10.1377/hlthaff.28.1.w1. PMID 19008253.
- Grouse, Lawrence. "Cost-Effective Medicine Vs. the Medical-Industrial Complex." Journal of Thoracic Disease 6, no. 9 (2014): E203-E206.
- Lexchin J, Grootendorst P. Effects of Prescription Drug User Fees on Drug and Health Services Use and on Health Status in Vulnerable Populations: A Systematic Review of the Evidence. International Journal of Health Services. 2004;34(1):101-122. doi:10.2190/4M3E-L0YF-W1TD-EKG0
- Wohl, Stanley. The Medical Industrial Complex / Stanley Wohl. First edition. New York: Harmony Book, 1984: 85-98
- Manderson L, Smith-Morris C (2010). Chronic conditions, fluid states: Chronicity and the anthropology of illness. Rutgers University Press. OCLC 852507893.
- "Racial and Ethnic Approaches to Community Health (REACH)".
- Pulido L (2016). Flint, environmental racism, and racial capitalism. pp. 1–16.
- Brown P, Mayer B, Zavestoski S, Luebke T, Mandelbaum J, McCormick S (August 2003). "The health politics of asthma: environmental justice and collective illness experience in the United States". Social Science & Medicine. 57 (3): 453–64. doi:10.1016/S0277-9536(02)00375-1. PMID 12791488.
- Pastor Jr M, Sadd JL, Morello-Frosch R (March 2002). "Who's minding the kids? Pollucion, public schools, and environmental justice in Los Angeles". Social Science Quarterly. 83 (1): 263–80. doi:10.1111/1540-6237.00082.
- Capewell S, Andersen K (October 2011). "The ESC goes global: policies to prevent all chronic diseases". European Heart Journal. 32 (19): 2333–2340. doi:10.1093/eurheartj/ehr271. PMID 22066144.
- "Chronic Disease Sufferers and Health-Care Advocates Form Chronic Disease Coalition to Protect Patients' Rights". finance.yahoo.com. 19 November 2015. Retrieved 2019-06-13.
- "Has your insurer denied a medical claim? Stand up for your rights". STAT. 2019-05-17. Retrieved 2019-06-13.
- "Temple University Press". tupress.temple.edu. Retrieved 2019-03-25.
- "Beyond Words". University of New Mexico Press. 2017-09-27. Retrieved 2019-03-25.
- "Ordinary Life | Kathlyn Conway | Macmillan". US Macmillan. Retrieved 2019-03-25.
- The Wounded Storyteller. University of Chicago Press – via press.uchicago.edu.
- "Tender Points". www.spdbooks.org. Archived from the original on 2019-03-27. Retrieved 2019-03-25.
- "llness as Metaphor and AIDS and its Metaphors". Susan Sontag Foundation. Retrieved 2019-03-25.
- "Regarding the Pain Of Others". Susan Sontag Foundation. Retrieved 2019-03-25.
- Kroll-Smith S, Floyd HH (1997). Bodies in Protest: Environmental Illness and the Struggle Over Medical Knowledge. NYU Press. JSTOR j.ctt9qg6hq.
- Heshusius L (2009-08-20). Inside Chronic Pain: An Intimate and Critical Account. The Culture and Politics of Health Care Work. Ithaca, NY: Cornell University Press. ISBN 9780801447969.
- "The Nearness of Others". University of Minnesota Press.
- Narrative Medicine: Honoring the Stories of Illness. Oxford, New York: Oxford University Press. 2008-01-29. ISBN 9780195340228.
- Charmaz K (1991). Good days, bad days: the self in chronic illness and time. New Brunswick, N.J: Rutgers University Press. ISBN 9780813517117.
- List of Chronic Human Diseases Linked to Infectious Pathogens
- Bone Marrow Transplantation journal
- Center for Managing Chronic Disease, University of Michigan
- CHRODIS: EU Joint Action on Chronic Diseases and Promoting Healthy Ageing Across the Life-Cycle
- MEDICC Review theme issue on Confronting Chronic Diseases With longer life expectancies in most countries and the globalization of "Western" diets and sedentarism, the main burden of disease and death from these conditions is falling on already-disadvantaged developing countries and poor communities everywhere.
- Public Health Agency of Canada: Chronic Disease
- World Health Organization: Chronic Disease and Health Promotion