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, 2016

Description: The conditions with the highest period prevalence rates are fibromyalgia, chronic pain, and fatigue (18.5%), depressive disorders (16.9%), anxiety disorders (16.4%), and obesity (15.4%).

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, 2016 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: October 11, 2018

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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 2007 to 1.0% in 2016. 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, 2016 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: October 11, 2018

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Liver Conditions - Trends

Description: The period prevalence for hepatitis and liver disease 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, 2016 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: October 11, 2018

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Mental Health and Substance Use Conditions - Trends

Description: The period prevalence for depressive disorders has increased from 11.7% in 2007 to 16.9% in 2016. For anxiety, the increase was from 7.1% to 16.4% 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, 2016 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: October 11, 2018

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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 6.1% in 2007 to 12.5% in 2014, and increased more sharply starting in 2015 so that by 2016 the rate was 18.5% (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, 2016 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: October 11, 2018

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Neurological Conditions - Trends

Description: The period prevalence for Spina bifida and other congenital anomalies of the nervous system(SpinaBif), Traumatic brain injury and nonpsychotic mental disorders due to brain damage (BrainInj) and Spinal cord injury (SpineInj) have remained stable over time. The rate for Migraine and chronic headache (Migraine) has increased from 1.2% in 2007 to 2.9% in 2016; similarly, Epilepsy has increased from 1.5% to 2.7% over the same time period.

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, 2016 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: October 11, 2018

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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 4.6% in 2007 to 15.4% in 2016 and deafness and hearing impairment (Deaf), which increased 3.0% in 2007 to 5.4% in 2016.

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, 2016 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: October 11, 2018

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Medicare - Selected Conditions by Age Group, 2016

Description: The age distribution for selected chronic or potentially disabling conditions is displayed. Some conditions have a disproportionately young age distribution. For example, 49.0% of people treated for schizophrenia and other psychotic disorders, 29.5% of those treated for anxiety, 28.1% of people treated for depressive disorders, and 26.6% of those treated for fibromyalgia or chronic pain were less than 65 years of age. Peripheral vascular disease (PVD) and pressure ulcers are much more common in the oldest age group.

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, 2016 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: October 11, 2018

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Medicare - Selected Conditions by Racial Group, 2016

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 9.5% of the Medicare fee-for-service (FFS) population in 2016, they had disproportionately high rates of treatment for schizophrenia and other psychotic disorders (SchizPsychotic; 17.9%), obesity (13.3%), pressure ulcers (PressUlc; 12.0%), and peripheral vascular disease (PVD; 11.2%). The white racial group comprised 83.1% of the total FFS population, 87.2% of those treated for anxiety, and 86.1% 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, 2016 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: October 11, 2018

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Medicare - Selected Conditions by Sex, 2016

Description: The gender distribution of Medicare beneficiaries varies by condition. In Medicare fee-for-service (FFS) for 2016, 55% 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 67.5%, respectively). A slightly higher proportion of Males than expected were treated for liver disease and schizophrenia and psychotic disorders (46.3% and 46.9%, respectively).

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, 2016 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: October 11, 2018

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Medicare - Selected Conditions by Medicare Status Code, 2016

Description: The reason for Medicare entitlement varies by condition. In Medicare fee-for-service (FFS) for 2016, 16.1% 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 were disabled (49.0%). Higher proportions of disabled enrollees were treated for anxiety (29.5%), depressive disorders (28.1%), fibromyalgia and chronic pain (26.6%), compared to aged enrollees. The only conditions where disproportionately more aged were treated were peripheral vascular disease (PVD; 89.9%) and pressure ulcers (83.5%).

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, 2016 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: October 11, 2018

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Medicare - Selected Conditions by Dual Status, 2016

Description: A total of 18.7% of Medicare beneficiaries also had Medicaid coverage in 2016 – 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, 53.7% of people treated for schizophrenia and other psychotic disorders, 27.9% of those treated for pressure ulcers, and 27.1% 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, 2016 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: October 11, 2018

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Period Prevalence by State - Anxiety Disorders, 2016

Description: The number of Medicare fee-for-service (FFS) enrollees with anxiety disorders varied by state. Hawaii had the lowest rate (7.88%) and Kentucky had the highest (23.75%).

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, 2016 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: October 11, 2018

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Period Prevalence by State - Depressive Disorders, 2016

Description: The number of Medicare fee-for-service (FFS) enrollees with depressive disorders varied by state. Hawaii had the lowest rate (7.61%) and Rhode Island had the highest (21.78%).

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, 2016 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: October 11, 2018

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Period Prevalence by State - Fibromyalgia, Chronic Pain and Fatigue, 2016

Description: The number of Medicare fee-for-service (FFS) enrollees with fibromyalgia, chronic pain or fatigue varied by state. Hawaii had the lowest rate (10.77%) and Michigan and Oklahoma had the highest (22.16%).

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, 2016 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: October 11, 2018

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Period Prevalence by State - Liver Disease, Cirrhosis and Other Liver Conditions [except Hepatitis], 2016

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 (2.67%) and Hawaii had the highest (5.99%).

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, 2016 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: October 11, 2018

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