Chronic Disease in Western North Carolina

Why is Chronic Disease a key health issue in western North Carolina?

Chronic diseases are health conditions that last one year or more and require ongoing medical attention, limiting daily living activities, or both (CDC, 2022). Many chronic diseases are caused by a short list of risk behaviors which include tobacco use and exposure to secondhand smoke, poor nutrition, physical inactivity, and excessive alcohol use. Cancer, heart disease, stroke, chronic lung disease, and unintentional injuries make up the leading causes of death in North Carolina (NC Division of Public Health, 2021). Chronic diseases, of any kind, are the leading drivers of the nation’s $4.1 trillion annual healthcare cost (CDC, 2022).

For more information on chronic disease risk factors please visit the Substance Misuse and Healthy Living data story pages. For more information on the numbers behind chronic disease in Western North Carolina please see the WNC Dataset.

Heart Disease

What is heart disease?

The term heart disease is associated with several types of heart issues.” The most common heart issue is coronary artery disease. Heart disease affects the blood flow to the heart which can then cause heart attacks, plaque buildup, and stroke. The key risk factors for heart disease are high blood pressure, high cholesterol, and smoking (CDC, 2022). The percent of adults in WNC diagnosed with heart disease has risen from 6.5% in 2015 to 8% in 2018 and 2021.

(WNCHN – WNC Healthy Impact Community Health Survey, 2021).

Percent of Adults in WNC with Heart Disease, by Year

Source: WNC Healthy Impact Community Health Survey, 2015-2021

Survey Question: Has a doctor, nurse, or other health professional EVER told you that you had any of the following: A heart attack, also called a Myocardial Infarction, Angina, or Coronary Heart Disease? (Yes/No)

Stroke

What is a stroke?

A stroke is a disease affecting the arteries that lead to and are within, the brain (American Stroke Association, 2022). A stroke happens when the blood vessels carrying oxygen and nutrients to the brain are blocked by a clot or are ruptured. This means the brain is not getting the blood it needs which results in brain cells dying. 

 As of 2021, 3.9% of WNC had been told by a doctor, nurse, or other healthcare professional that they had had a stroke. This is lower than the state average (4.5%) as well as the United States average (4.3%).

(WNCHN – WNC Healthy Impact Community Health Survey, 2021)

What do the numbers say about heart disease and stroke?

Western North Carolina (WNC) Data:

Eight percent (8%) of adults in WNC have been diagnosed with heart disease in 2021. The following adult populations were significantly more likely to be diagnosed with heart disease in WNC:

  • Men (10.7%)
  • Adults aged 65+ (16.6%)
  • Very Low Income (10.5%)
  • Those identifying as either American Indian/Alaska Native, Indigenous (13.5%)

(WNCHN – WNC Healthy Impact Community Health Survey, 2021)

Differences in health outcomes across social groups, economic status, and racial/ethnic identity are closely linked with disparities in social determinants of health, which disproportionately burden individuals and communities who experience systemic disadvantage and/or discrimination. See our data story on the Social Determinants of Health to learn more about how the conditions in which people are born, live, work, play, learn, worship, and age can influence their ability to achieve good health for themselves and their families.

Since 2012, the percentage of adults in WNC diagnosed with high blood pressure has been consistently higher than the percentages for North Carolina and the United States.

(WNCHN – WNC Healthy Impact Community Health Survey, 2021)

Percent of Adults in WNC with High Blood Pressure per County, by Year

Source: WNC Healthy Impact Community Health Survey, 2012-2021

1 in 3 adults in WNC have been diagnosed with high cholesterol in 2021.

(WNCHN – WNC Healthy Impact Community Health Survey, 2021)

Percent of Adults in WNC with High Cholesterol per County, by Year

Source: WNC Healthy Impact Community Health Survey, 2012-2021

State and National Findings:

Every year about 805,000 people in the United States experience a heart attack.

(CDC, 2022)

From 2017-2018, heart disease cost the United States roughly $229 billion.

(CDC, 2022)

In 2017, there were 18,808 deaths in North Carolina due to heart disease; with a rate of 156.5. This is slightly less than the rate for the United States at 165.0 in 2017.

(CDC, 2018) 

In 2017, there were 5,098 deaths due to strokes in North Carolina with a rate of 43.0. The United States rate was slightly lower at 37.6 in 2017.

(CDC, 2018) 

Diabetes

What is Diabetes?

Diabetes is a chronic health condition affecting how the body turns food into energy (CDC, 2022). Diabetes is caused by the body not making enough insulin (Type 1), or when the body cannot use the insulin it is making effectively (Type 2). Some people develop diabetes when pregnant which is called gestational diabetes. When the body does not have enough insulin or is not able to effectively use it, this leads to elevated levels of sugar in the bloodstream, potentially resulting in severe health complications associated with heart and kidney diseases. Someone who has a diagnosis of prediabetes has elevated blood sugar levels, but they are not high enough to be considered diabetic. Prediabetes increases risk for type 2 diabetes (CDC, 2022).

In 2021, 4.6% of WNC were told that they were borderline or prediabetic. 

(WNCHN – WNC Healthy Impact Community Health Survey, 2021)

Borderline or Pre-Diabetes Prevalence per County, by Year

Source: WNC Healthy Impact Community Health Survey, 2012-2021

In 2021, 14.1% of WNC had been told that they had diabetes which is higher than the state (11.8%) and national averages (13.8%).

(WNCHN- WNC Health Impact Community Health Survey, 2021).

Diabetes Prevalence per County, by Year

Source: WNC Healthy Impact Community Health Survey, 2012-2021

What do the numbers say about Diabetes?

Western North Carolina (WNC) Data:

Approximately 14% of adults in WNC have been diagnosed with diabetes. The following adult populations were significantly more likely to have been diagnosed with diabetes in 2021:

  • Adults aged 65+ (22.5%)
  • Very low income (18.6%)
  • Those identifying as American Indian/Alaska Native, Indigenous (37.5%)

(WNCHN – WNC Healthy Impact Community Health Survey, 2021)

Differences in health outcomes across social groups, economic status, and racial/ethnic identity are closely linked with disparities in Social Determinants of Health, which disproportionately burden individuals and communities who experience systemic disadvantage and/or discrimination. See our data story on the social determinants of health to learn more about how the conditions in which people are born, live, work, play, learn, worship, and age can influence their ability to achieve good health for themselves and their families.

State and National Findings:

As of 2022, 37.3 million people in the United States were diagnosed with Diabetes. 

(CDC, 2022)

Diabetes was the leading cause of death in the United States in 2020.

(America’s Health Ranking, 2021)

By 2025, it is estimated that diabetes will cost government and private insurers in North Carolina $17 Billion dollars a year.

(NC Department of State Treasurer, 2020)

For more information on Obesity and Healthy Lifestyles please visit the linked page.

Chronic Lung Disease

Chronic Lower Respiratory Disease includes four chronic lung diseases: chronic obstructive pulmonary disease (COPD), chronic bronchitis, emphysema, and asthma (Oelsner et al., 2016). The percentage of adults diagnosed with COPD is slightly higher in WNC (8.5%) than in North Carolina (7.8%) or the United States (6.4%). The populations most likely to have ever been diagnosed with COPD in 2021 are people aged 65+ (12.9%), people who are very low income (18.7%), and people identifying as American Indian/Alaskan Native/Indigenous(16%) (WNCHN – WNC Healthy Impact Community Health Survey, 2021)

Asthma is a chronic (long-term) condition that affects the airways of the lungs (National Heart Lung, and Blood Institute, 2022). “Asthma triggers” typically include tobacco smoke, dust mites, outdoor air pollution, pests, pets, and molds. However, these triggers can vary between different individuals (CDC, 2022). In Western North Carolina, the percent of adults diagnosed with asthma has declined from 11.4% in 2017 to 10% in 2021. The populations most likely to have ever been diagnosed with asthma in 2021 were adults aged 18-39, people who have a very low income, and people identifying as Hispanic or Latino (WNCHN – WNC Healthy Impact Community Health Survey, 2021).

For more information on Chronic Lung Disease and Asthma please visit the linked pages or visit the WNC Data page to download the WNC Data Workbook.

What’s Helping?

  • Increased access to care/screenings
  • Community Support
  • Education
  • Healthy Resources (foodbanks, trails, parks)
  • Policies

What’s Hurting?

  • Transportation
  • Not enough collaboration between professionals
  • Poverty
  • Stigma/Denial
  • High medical costs

The items below are paraphrased themes that emerged from a 2021 regional survey of key informants. These responses do not necessarily:

  • Reflect accurate or scientifically validated information about health determinants, outcomes, and/or strategies for change.
  • Represent an exhaustive list of factors that can help or hurt efforts to address this key regional health issue.

( WNCHN- Online Key Informant Survey, 2021)

The information in this section should be interpreted and used with care. It should be used only to help local health departments and agencies begin to understand community perceptions about local health issues. Communities are strongly encouraged to collect their own, local-level data to inform local planning and evaluation activities.

What we are hearing:

“This community is supported by having health screenings at various locations that help people who are low income or have jobs with challenging schedules. Having health screenings set up at places that people frequent is key.”

“Access to affordable healthcare supports the health and wellbeing of our community.”

“Strong community supports- people and organizations that recognize concerns and provide resources to address them. A community that focuses on identifying issues and treating them upstream. Rather than fixing concerns after they occur, let’s focus on fixing the problems that create the concerns. Prevention!”

“Low cost or free programs available from various providers in the area provide free primary health care and chronic disease management, to the low income, uninsured and underinsured members of our community.”

How is the region prioritizing this issue?

The western North Carolina region includes 17 communities: 16 counties and the Eastern Band of Cherokee Indians (EBCI)