Chronic diseases are defined broadly as conditions that last 1 year or more and require ongoing medical attention or limit activities of daily living or both. Chronic diseases such as heart disease, cancer, and diabetes are the leading causes of death and disability in the United States. They are also leading drivers of the nation’s $4.1 trillion in annual health care costs.

Many chronic diseases are caused by a short list of risk behaviors:

• Tobacco use and exposure to secondhand smoke.
• Poor nutrition, including diets low in fruits and vegetables and high in sodium and saturated fats.
• Physical inactivity.
• Excessive alcohol use.

In the United States, 24% of all adults, or 58.5 million people, have arthritis. It is a leading cause of work disability, with annual costs for medical care and lost earnings of $303.5 billion.

The most common form of arthritis is osteoarthritis. Other forms include gout, rheumatoid arthritis, and lupus. Symptoms of arthritis are pain, aching, stiffness, and swelling in or around the joints. Rheumatoid arthritis and lupus can affect multiple organs and cause widespread symptoms.

More than half of US adults (57.3%) with arthritis are of working age (18 to 64 years). Arthritis can limit the type of work they are able to do or keep them from working at all. In fact, 8 million working-age adults report that their ability to work is limited because of their arthritis. For example, they may have a hard time climbing stairs or walking from a parking deck to their workplace.

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Cancer is the second leading cause of death in the United States, but many kinds of cancer can be prevented or caught early. Leading risk factors for preventable cancers are smoking, getting too much ultraviolet (UV) radiation from the sun or tanning beds, being overweight or having obesity, and drinking too much alcohol.

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Preventable Risk Factors

Cigarette Smoking and Secondhand smoke Exposure

Smoking and secondhand smoke cause about 80% to 90% of lung cancer deaths in the United States. Smoking also causes cancer of the voice box (larynx), mouth and throat, esophagus, urinary bladder, kidney, pancreas, cervix, colon, rectum, liver, and stomach, as well as a type of blood cancer called acute myeloid leukemia. About 34 million US adults smoke cigarettes, and every day, about 1,600 young people under age 18 try their first cigarette.

People who don’t smoke but are exposed to secondhand smoke at home or at work have a 20% to 30% higher risk of lung cancer. Secondhand smoke causes more than 7,300 lung cancer deaths in this population each year. In the United States, 58 million people who don’t smoke are exposed to secondhand smoke every year.

Exposure to Sun and Tanning Beds

Skin cancer is the most common cancer in the United States. Most cases of melanoma, the deadliest kind of skin cancer, are caused by exposure to UV light from the sun or tanning beds. Although use of sun protection has increased slightly and use of tanning beds has decreased in recent years, sunburn is common in the United States. About one-third of adults and over half of high school students get sunburned each year.

Overweight and Obesity

Overweight and obesity are associated with at least 13 types of cancer, including endometrial (uterine) cancer, breast cancer in postmenopausal women, and colorectal cancer. In the United States, 42% of adults have obesity, and nearly 74% are overweight or have obesity.

Excessive Alcohol Use

Excessive alcohol use, either in the form of binge drinking (5 or more drinks on an occasion for men or 4 or more drinks on an occasion for women) or heavy drinking (15 or more drinks per week for men or 8 or more drinks per week for women), increases the risk of cancer of the breast (in women), liver, colon, rectum, mouth, pharynx, larynx, and esophagus. For some types of cancer, the risk increases even at low levels of alcohol consumption (less than 1 drink in a day). The less alcohol you drink, the lower your risk for cancer.

Infectious Disease

Human papillomavirus (HPV) causes most cervical cancers, as well as some cancers of the vagina, vulva, penis, anus, and oropharynx (cancers of the back of the throat, including the base of the tongue and tonsils). The HPV vaccine helps prevent most of these cancers. It is most effective when given in two doses about 6 to 12 months apart, starting at age 11 or 12. Nationwide, 77% of females and 73% of males aged 13–17 have received at least one dose of the HPV vaccine. That means many preteens have not been vaccinated against the virus, leaving them at higher risk of cancers caused by HPV infections.

Many liver cancer cases are related to the hepatitis B or hepatitis C viruses. The hepatitis B vaccine is a safe and effective way to lower liver cancer risk. The vaccine is recommended for all infants and unvaccinated children and some groups of unvaccinated adults. While there is no vaccine for hepatitis C, there is a safe and effective treatment that can eliminate the virus from the body and prevent further liver damage. Many Americans with hepatitis C are not aware they have it. CDC recommends that all adults aged 18 or older get tested at least once for hepatitis C and that all pregnant women get tested for hepatitis B and C during each pregnancy.

Screening to Prevent or Catch Cancer Early

Getting recommended screening tests can help prevent colorectal and cervical cancers. Screening for adults at normal risk can also find breast, cervical, and colon cancers early, when treatment works best. However, screening rates for these cancers remain below national targets set by Healthy People 2030, the nation’s agenda for improving the health of all Americans.

Lung cancer screening is recommended for adults who smoke now or have quit within the past 15 years, have a 20 pack-year or more smoking history, and are between 50 and 80 years old.

More than 37 million people in the United States have diabetes. People with diabetes are also at higher risk of heart disease, stroke, and other serious complications like kidney failure, blindness, and amputation of a toe, foot, or leg. People with diabetes spend more on health care and miss more workdays compared to people who don’t have diabetes.

Some people are at higher risk of type 2 diabetes, including those who:

• Are overweight or have obesity.
• Are age 45 or older.
• Have a parent, brother, or sister with type 2 diabetes.
• Are physically active less than 3 times a week.
• Had gestational diabetes (diabetes during pregnancy) or gave birth to a baby who weighed more than 9 pounds.
• Are an African American, Hispanic or Latino, American Indian, Alaska Native, Pacific Islander, or Asian American person.

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Preventable Risk Factors

Some risk factors for type 2 diabetes can’t be changed, such as age and family history, but some can, such as having prediabetes, being overweight, eating unhealthy food, being inactive, and smoking. CDC works to help people reduce those modifiable risk factors so they can prevent or delay type 2 diabetes and improve their overall health.

Prediabetes

Prediabetes is a serious health condition in which blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes. A person with prediabetes is at high risk of type 2 diabetes, heart disease, and stroke. An estimated 96 million US adults—more than 1 in 3—have prediabetes, and more than 8 in 10 of them don’t know they have it.

Overweight and Lack of Physical Activity

People who have overweight or obesity are at increased risk of type 2 diabetes. In the United States, nearly 74% of adults have overweight or obesity. Although the rate of new diabetes cases has decreased in recent years, the number of adults with diagnosed diabetes has nearly doubled in the last 2 decades as the US population has increased, aged, and become more overweight.

Not getting enough physical activity can raise the risk of type 2 diabetes. That’s because physical activity helps control blood sugar, weight, and blood pressure, as well as raise “good” cholesterol and lower “bad” cholesterol. It can also help people with diabetes prevent heart and blood flow problems, reducing the risk of heart disease and nerve damage. However, only 24% of adults and 16.5% of high school students meet the guidelines for aerobic and muscle-strengthening activity.

Smoking

The risk of developing type 2 diabetes is 30% to 40% higher for people who currently smoke than for those who don’t. Evidence shows that smoking is associated with increased belly fat, a known risk factor for type 2 diabetes. The more cigarettes a person smokes, the higher their risk of developing type 2 diabetes. People with diabetes who smoke are more likely than people who don’t smoke to have trouble managing their blood sugar.

People with diabetes who smoke also have higher risks of serious complications, such as heart disease, kidney disease, and poor blood flow in the legs and feet that can lead to infections, ulcers, and amputations. Other complications include retinopathy (eye disease that can cause blindness) and peripheral neuropathy (nerve damage in the arms and legs that causes numbness, pain, weakness, and poor coordination).

About 34 million US adults smoke cigarettes, and 58 million people who don’t smoke are exposed to secondhand smoke.

Diabetes Complications

CDC strives to safeguard the health and improve the quality of life of all people with diabetes. Central to that effort is helping them prevent or reduce the severity of diabetes complications, including heart disease (the leading cause of early death among people with diabetes), kidney disease, blindness, and nerve damage that can lead to lower-limb amputations.

Epilepsy, also known as seizure disorder, is a common brain condition that causes repeated seizures. In the United States, about 3 million adults and 470,000 children and teens younger than 18 have epilepsy.

Causes of Epilepsy

Epilepsy can be caused by many different conditions that affect a person’s brain. Examples include stroke, head injury, childbirth complications, infections (like meningitis or cysticercosis), and some genetic disorders. Often, no definite cause can be found.

Children and older adults are more likely to have epilepsy because risk factors are more common in these groups.

Health and Economic Impact of Epilepsy

Adults with epilepsy report worse physical and mental health and are more likely to report being unable to afford different types of health care than adults without the disorder. In 2016, health care spending for epilepsy was $8.6 billion in direct costs, of which 63.4% was paid by public insurance.

Getting the wrong diagnosis or the wrong treatment can increase a person’s risk of later seizures, brain damage, injuries, disability, and early death. More than one-third of people with epilepsy continue to have seizures despite treatment. People with epilepsy often have other chronic conditions that need to be managed, such as depression, heart disease, and asthma.

Although epilepsy is widely recognized by the public, it is poorly understood, even among people who know someone with the disorder. Public misunderstanding and stigma can limit life opportunities for people with epilepsy.

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More than 877,500 Americans die of heart disease, stroke, or other cardiovascular diseases every year. Heart disease and stroke are the first and fifth leading causes of death in the United States.

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In the United States, cardiovascular diseases cause:

Preventable Risk Factors

Leading risk factors for heart disease and stroke are high blood pressure, high low-density lipoprotein (LDL) cholesterol, diabetes, smoking and secondhand smoke exposure, obesity, unhealthy diet, and physical inactivity.

High Blood Pressure and High Cholesterol

High blood pressure is a leading cause of heart disease and stroke because it damages the lining of the arteries, making them more susceptible to the buildup of plaque, which narrows the arteries leading to the heart and brain. About 116 million US adults (nearly 1 in 2) have high blood pressure, defined as 130/80 mm Hg or higher. Only about 1 in 4 of these people have their high blood pressure under control. About 7 in 10 people who have a first heart attack and 8 in 10 people who have a first stroke have high blood pressure.

Eating too much sodium can lead to high blood pressure. Americans aged 2 years or older consume an average of about 3,400 mg of sodium each day, well over the 2,300 mg recommended by the Dietary Guidelines for Americans. More than 70% of the sodium Americans consume is added outside the home (before purchase), not added as salt at the table or during home cooking.

High LDL cholesterol can double a person’s risk of heart disease. That’s because excess cholesterol can build up in the walls of arteries and limit blood flow to a person’s heart, brain, kidneys, other organs, and legs. Although nearly 86 million US adults could benefit from taking medicine to manage their high LDL cholesterol, only about half (55%) are doing so.

People can improve their blood pressure and cholesterol levels by eating a healthy diet that is low in sodium, being physically active, maintaining a healthy weight, and taking medicines as recommended.

Diabetes

Adults with diabetes are twice as likely to have heart disease or a stroke as people who do not have diabetes. Over time, high blood sugar from diabetes can damage blood vessels in the heart and block blood vessels leading to the brain, causing a stroke. More than 2 in 3 people with diabetes have high blood pressure. Diabetes also raises triglycerides and LDL cholesterol.

Smoking and Secondhand Smoke Exposure

Smoking is a major cause of heart disease and stroke and causes 1 in every 4 deaths from these conditions. Smoking can damage the body several ways by:

• Raising triglycerides (a type of fat in the blood) and lowering high-density lipoprotein (HDL) cholesterol, also called “good” cholesterol.
• Making blood sticky and more likely to clot, which can block blood flow to the heart and brain.
• Damaging cells that line the blood vessels.
• Increasing the buildup of plaque (fat, cholesterol, calcium, and other substances) in blood vessels.
• Causing thickening and narrowing of blood vessels.

About 34 million US adults smoke cigarettes, and every day, about 1,600 young people under age 18 try their first cigarette.

Obesity, Unhealthy Diet, and Physical Inactivity

Compared to those at a normal weight, people with overweight or obesity are at increased risk of heart disease and stroke and their risk factors, including high blood pressure, high LDL cholesterol, low HDL cholesterol, high triglycerides, and type 2 diabetes. In the United States, nearly 74% of adults have overweight or obesity.

A healthy diet can reduce a person’s chances of getting heart disease. A healthy diet emphasizes fruits and vegetables, whole grains, low-fat dairy products and lean proteins and limits saturated and trans fat, added sugars, and sodium.

Physical inactivity can also lead to heart disease—even for people who have no other risk factors. It can increase the chance of other risk factors, including obesity, high blood pressure, high cholesterol, and type 2 diabetes. Only 24% of adults and 16.5% of high school students meet the guidelines for aerobic and muscle-strengthening activity.

Lupus is a chronic autoimmune disease in which the immune system sees the body’s healthy cells as foreign invaders and attacks them, causing inflammation and harm to the affected organs. The most common type, systemic lupus erythematosus (SLE), affects about 200,000 US adults. Anyone can develop SLE, but it is more common in Black and Latina women and women of childbearing age (15–44 years).

The causes of SLE are unknown but are thought to be related to genetic, environmental, and hormonal factors. SLE is hard to diagnose because the symptoms are often mistaken for those of other diseases. Symptoms range from mild to severe, the most common being fatigue, skin rashes, fevers, and pain or swelling in the joints.

There is no cure for SLE, but symptoms can be managed. Treatment calms the immune system to prevent periods of increased SLE symptoms called “flares” and reduce or prevent joint and organ damage. Early diagnosis, effective treatments, and taking medicines as directed can help reduce the damaging effects of SLE.

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Many chronic diseases are caused by key risk behaviors. By making healthy choices, you can reduce your likelihood of getting a chronic disease and improve your quality of life.

Quit Smoking

Stopping smoking (or never starting) lowers the risk of serious health problems, such as heart disease, cancer, type 2 diabetes, and lung disease, as well as premature death—even for longtime smokers. Take the first step and call 1-800-QUIT-NOW for FREE support.

Eat Healthy

Eating healthy helps prevent, delay, and manage heart disease, type 2 diabetes, and other chronic diseases. A balanced, healthy dietary pattern includes a variety of fruits, vegetables, whole grains, lean protein, and low-fat dairy products and limits added sugars, saturated fats, and sodium.

Get Regular Physical Activity

Regular physical activity can help you prevent, delay, or manage chronic diseases. Aim for moderate intensity physical activity (like brisk walking or gardening) for at least 150 minutes a week, with muscle-strengthening activities 2 days a week.

Avoid Drinking Too Much Alcohol

ver time, excessive drinking can lead to high blood pressure, various cancers, heart disease, stroke, and liver disease. By not drinking too much, you can reduce these health risks.

Get Screened

To prevent chronic diseases or catch them early, visit your doctor regularly for preventive services.

Take Care of Your Teeth

Oral diseases—which range from cavities and gum disease to oral cancer—cause pain and disability for millions of Americans. To help prevent these problems, drink fluoridated water, brush with fluoride toothpaste twice a day, and floss daily. Visit your dentist at least once a year, even if you have no natural teeth or have dentures.

Get Enough Sleep

Insufficient sleep has been linked to the development and poor management of diabetes, heart disease, obesity, and depression. Adults should get at least 7 hours of sleep daily.

Know Your Family History

If you have a family history of a chronic disease, like cancer, heart disease, diabetes, or osteoporosis, you may be more likely to develop that disease yourself. Share your family health history with your doctor, who can help you take steps to prevent these conditions or catch them early.

Make Healthy Choices in School, at Work, and in the Community

By making healthy behaviors part of your daily life, you can prevent conditions such as high blood pressure or obesity, which raise your risk of developing the most common and serious chronic diseases. Learn more about healthy actions you or your loved ones can take.

Having a long-term, or chronic, illness can disrupt your life in many ways. You may often be tired and in pain. Your illness might affect your appearance or your physical abilities and independence. You may not be able to work, causing financial problems. For children, chronic illnesses can be frightening, because they may not understand why this is happening to them.

These changes can cause stress, anxiety, and anger. If they do, it is important to seek help. A trained counselor can help you develop strategies to regain a feeling of control. Support groups might help, too. You will find that you are not alone, and you may learn some new tips on how to cope.

You may be able to manage your illness better if learn more about it. It is important to evaluate the information that you find, to make sure that it is reliable. It is also important to find a health care provider that you can trust.

Almost anyone, at any age, can do some type of physical activity. You can still exercise even if you have a health condition like heart disease, arthritis, chronic pain, high blood pressure, or diabetes. In fact, physical activity may help. For most older adults, physical activities like brisk walking, riding a bike, swimming, weightlifting, and gardening are safe, especially if you build up slowly. You may want to talk with your doctor about how your health condition might affect your ability to be active.

Staying Physically Active: Alzheimer's Disease and Related Dementias

Researchers are assessing the benefit of exercise to delay mild cognitive impairment (MCI) in older adults and to improve brain function in older adults who may be at risk for developing Alzheimer’s disease. Older adults with MCI may be able to safely do more vigorous forms of exercise, similar to older adults without MCI, provided there are no other underlying health concerns.

Being active and getting exercise may help people with Alzheimer’s or another dementia feel better and can help them maintain a healthy weight and have regular toilet and sleep habits. If you are a caregiver, you can exercise together to make it more fun.

Exercising with Arthritis

For people with arthritis, exercise can reduce joint pain and stiffness. It can also help with losing weight, which reduces stress on the joints.

Flexibility exercises such as upper- and lower-body stretching and tai chi can help keep joints moving, relieve stiffness, and give you more freedom of movement for everyday activities.

Strengthening exercises, such as overhead arm raises, will help you maintain or add to your muscle strength to support and protect your joints.

Endurance exercises make the heart and arteries healthier and may lessen swelling in some joints. Try activities that don’t require a lot of weight on your joints, such as swimming and biking.

If you have arthritis, you may need to avoid some types of activity when joints are swollen or inflamed. If you have pain in a specific joint area, for example, you may need to focus on another area for a day or two.

Physical Activity and COPD (Chronic Obstructive Pulmonary Disease)

If you have COPD, talk with your healthcare provider or a pulmonary therapist to learn what he or she recommends. You may be able to learn some exercises to help your arms and legs get stronger and/or breathing exercises that strengthen the muscles needed for breathing.

Pulmonary rehabilitation is a program that helps you learn to exercise and manage your disease with physical activity and counseling. It can help you stay active and carry out your day-to-day tasks.

Exercising with Type 2 Diabetes

For people with diabetes, exercise and physical activity can help manage the disease and help you stay healthy longer. Walking and other forms of daily exercise can help improve glucose levels in older people with diabetes. Set a goal to be more active most days of the week, and create a plan for being physically active that fits into your life and that you can follow. Your healthcare team can help.

A few easy steps to be more active:

• Stretch during TV commercial breaks.
• Walk around when you talk on the phone.
• Take more steps by parking farther away from stores, movie theaters, or your office.

Exercise and Heart Health

Your heart keeps your body running. As you grow older, some changes in the heart and blood vessels are normal, but others are caused by disease. Choices you might make every day, such as eating healthy, maintaining a healthy weight, and aiming to be more physically active, can contribute to heart health. Inactive people are nearly twice as likely to develop heart disease as those who are active. A lack of physical activity can worsen other heart disease risk factors as well, such as high blood cholesterol and triglyceride levels, high blood pressure, diabetes and prediabetes, being overweight and obesity. Being physically active is one of the most important things you can do to keep your heart healthy. Aim for at least 150 minutes of moderate-intensity aerobic activity a week.

Exercising with Osteoporosis

Weight-bearing exercises, which force you to work against gravity, such as walking, jogging, or dancing three to four times a week, are best for building muscle and strengthening bones. Try some strengthening and balance exercises, too, to help avoid falls, which could cause a broken bone. Doing these exercises is good for bone health for people with osteoporosis and those who want to prevent it.

Exercising with Chronic Pain

Most people living with chronic pain can exercise safely, and it can assist with pain management. In fact, being inactive can sometimes lead to a cycle of more pain and loss of function. Talk to your doctor about what exercises/activities might be right for you. Each type of exercise—endurance, strength, balance, and flexibility—has its own benefits, so a combination may be best.

Exercise can help you maintain a healthy body weight, which may relieve knee or hip pain. Putting on extra weight can slow healing and make some pain worse. Remember to listen to your body when exercising and participating in physical activities. Avoid over-exercising on “good days.” If you have pain, swelling, or inflammation in a specific joint area, you may need to focus on another area for a day or two. If something doesn’t feel right or hurts, seek medical advice right away.

When unavoidable, relentless stress pervades your life, the health risks are wide-ranging and serious. Those who serve as caregivers to disabled family member, work in high-stress professions or experience prolonged traumatic events are at greatest risk. The physical evidence of stress appears in their cardiovascular system, brain, nerves, immune response, and psychological health.

Some of us have natural coping instincts that help us weather stress with fewer ill effects. Read below to see how factors such as our gender, age, and genes can help us deal with stress.

Gender Matters

Women have a tendency to respond to stress by caring for children, reaching out to other women, and engaging in other community forming behaviors. Men are less likely to respond in this way, which is not to say that men are incapable of tending and befriending in the face of stress. The hormonal equation, however, is not in men's favor for developing this coping mechanism. They experience a testosterone surge as part of the parasympathetic response to stressors, and this tends to override the “love” hormone oxytocin which (along with estrogen) is believed to account for women's nurturing response in times of stress. Similarly, some women will respond to stressors with more of a fight-or-flight reaction. Our inherent hormone biochemistry differs from person to person, and humans have a range of natural responses to stress.

Youth Helps

Being young seems to help us recover from any challenge more easily, and stress is no exception. As the images of pyramidal neurons from the brain show, younger people can recover their neuronal connections after dendrites retract after stressful events. The cumulative damage in an older brain is more likely to be permanent.

However, children are not impervious to stress. If you have children, there are ways to provide a lower-stress environment for them, and teach them coping strategies. Some to try:

• Don't allow kids to skip meals. The effects of stress are exacerbated by poor nutrition.
• Exercise! It helps everyone relieve stress. If your family exercises together, it could be an important, stabilizing factor in your family life.
• Set clear expectations and be consistent about discipline. Feeling that a punishment could come out of nowhere or that the rules aren't clear can be very confusing and stressful.
• Hug and touch your kids. Older kids may resist, but find a way to show your support and love physically. It's a great stress reliever.
• Listen to your child's account of his or her day with as much patience as possible. No need to respond, unless the child asks you a question. Simply listen.
• Don't be a “mistake cop.” Teach kids that everyone makes mistakes, including you. Be clear that everyone should try his or her best to do well in school and other pursuits, but that perfection is unattainable, and it's not expected in your family.

Your Genes Matter, Too

Decades ago, cardiologists identified the stress-prone “type A” personality. These people are constantly called out for their intensely competitive, aggressive, and impatient nature. However, the same cardiologists also identified the less-discussed “type B” personality. This group is the exact opposite of the type As—even-keeled, resilient, and quick to recover from stress.

More recent studies have identified another inherited trait, the levels of a substance called neuropeptide Y (NPY), as a determining factor in a person's ability to handle stress. NPY is a signaling molecule that alters emotional responses. Researchers took images of subjects' brains as they looked at photos of threatening facial expressions. Those who had low levels of NPY showed greater changes in the brain regions involved in processing emotions. Those with higher levels did not show such activity, nor other signs of anxiety. The low-NPY subjects also had a lower tolerance of physical pain, suggesting that NPY might have wide-ranging effects on our ability to process and recover from adversity.

Pain is a signal in your nervous system that something may be wrong. It is an unpleasant feeling, such as a prick, tingle, sting, burn, or ache. Pain may be sharp or dull. You may feel pain in one area of your body, or all over. There are two types: acute pain and chronic pain. Acute pain lets you know that you may be injured or a have problem you need to take care of. Chronic pain is different. The pain may last for weeks, months, or even years. The original cause may have been an injury or infection. There may be an ongoing cause of pain, such as arthritis or cancer. In some cases there is no clear cause. Environmental and psychological factors can make chronic pain worse.

Many older adults have chronic pain. Women also report having more chronic pain than men, and they are at a greater risk for many pain conditions. Some people have two or more chronic pain conditions.

Chronic pain is not always curable, but treatments can help. They include

• Pain Relievers and other medicines
• Acupuncture
• Electrical stimulation
• Surgery
• Physical therapy
• Psychotherapy
• Relaxation and meditation therapy
• Biofeedback