The Chronic Disease Epidemic: Visible & Invisible

The Visible Chronic Disease Epidemic

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The chronic disease population has grown substantially in recent years since modern medicine has extended the human lifespan. Depending on sources, 40-60% of Americans (128-140M people) have one or more chronic health conditions. Moreover, the Milken Institute estimates a $1.1T expenditure for chronic disease in 2018.

The visible chronic disease epidemic is composed of five disease categories. These have attracted significant virtual-first care (V1C) and digital health investments in the past 10 years. Foremost, the metabolic cluster is the largest, including 100M people with obesity, and 28.7M with diabetes (and complications, like peripheral circulation, kidney, and eye disease). 95% of the diabetic group has Type 2, and the other 1.6M has Type 1 diabetes (an autoimmune disease). Musculoskeletal (MSK), oral, and gastrointestinal (GI) diseases increase with age and affect many people who consider themselves healthy. With fewer smokers, lung diseases are less prevalent than 50 years ago, but still substantial, with asthma on the rise in children.

The Visible Chronic Disease Epidemic: Cancer

A well-recognized visible chronic disease epidemic comprises many different kinds of cancers. Cancer presents a fascinating contrast to AIIDs. The total prevalence burden of cancer (~17M) is less than AIIDs (~24-50M), but that is mostly unrecognized. Why?

Cancer, like autoimmune, is a category that includes more than a hundred different diseases, also mostly defined by body part (e.g., breast, lung, prostate, blood). By the beginning of the 19th Century, medical scientists understood cancer as rogue cells growing uncontrollably. They knew this growth was driven by factors like genetics and exposure to soot.

Since then, immunology has advanced our understanding of cancer. Our immune systems usually kill rogue cells before they spread, but in cancer, some cells evolve to escape immune surveillance and reproduce unchecked. This early understanding of a common mechanism meant that a single medical specialty–oncology–developed to study & treat all cancers.

Autoimmune, by contrast, is a far more recent concept. Although people observed diseases like rheumatoid arthritis (RA) and ankylosing spondylitis (AS) centuries ago, they struggled to uncover their causes. Only some 100 years after the 19th-century discovery of immunology was the role of the immune system in causing disease recognized. Early 20th-century clinical research on RA & SLE (systemic lupus erythematosus) showed that rogue immune cells were causing damage to normal, self-cells & tissues.

But it was only at the end of the 20th Century with the development of biotechnology that the medical-scientific community realized that some 100+ known diseases fell into a single autoimmune category (the terminology is still in flux!). This meant that the treatment of these diseases was already scattered across many medical specialties focused on different body systems. 

The Invisible Chronic Disease Epidemic

The counterpart to the visible disease epidemic is the invisible chronic disease epidemic, consisting of autoimmune & autoinflammatory diseases (AIIDs), post-infection syndromes, and other contentious illnesses. For example, the CDC doesn’t even mention autoimmune in its chronic disease page! This is because there has never been any national effort to collect and aggregate autoimmune data, as there has been for cancer for many decades. Some people are aware of a few higher-visibility conditions (“marquee diseases”), especially if they have one or know someone who does. However, most Americans are unaware there are 80-150 autoimmune diseases, nor that they affect at least as many people (24-50M) as cancer or heart disease. 

The advent of Long COVID is finally forcing attention to long-ignored post-viral syndromes, including infection-triggered autoimmune disease. Bacterial and viral infections are a significant trigger of AIIDs. Medical science and clinical practice have neglected post-infection syndromes, even rheumatic-fever-induced RA (rheumatism), recognized for more than 200 years. Recent research links Epstein-Barr Virus (EBV, “Mono”) infections to MS (multiple sclerosis), SLE, and other autoimmune conditions. However, practitioners and preventive measures have not yet applied this knowledge.

A third category, overlapping with the others, includes contentious inflammatory diseases. Some of these may be infection-triggered, but medical professionals have found them hard to characterize and diagnose. Until recently, physicians often dismissed them as psychosomatic. For example, fibromyalgia, which mostly affects women (prevalence 4 million US), has only recently gained widespread recognition as a chronic physical illness. Recent (2019) studies suggest it may be an autoimmune disease targeting nerve pain receptors, explaining the diffuse, fluctuating chronic pain with no visible cause.

Read Our Other 2023 State of Autoimmunity Posts!

Authors: DrBonnie360, Ellen M Martin, & Ellie Duvall

We approach these thought-leadership posts from our multi-lens perspectives

  • DrBonnie360: Digital health consultant, clinical dentist, Wall Street analyst, patient & advocate.  
  • Ellen M Martin: Consultant, editor, life science finance/IR/marcomm, autoimmune caretaker.
  • Ellie Duvall: Digital health equity research intern, recent B.S. in Physiological Sciences from UCLA.

Strategic Consulting & Professional Services

We provide professional consulting services to investment, emerging, and established companies. Our work bridges silos and fills gaps to help our clients improve care for AIID patients while restraining costs. Informed by patient and caretaker perspectives, we show investors & clients how to integrate the best of digital, conventional, and lifestyle medicine into AIID care delivery.

  • We help our clients leverage digital innovations into virtual-first care (V1C) for AIID patients. 
  • Our subject matter expertise includes: Oral health, microbiome, patient engagement, competitive landscape analysis, strategic positioning & messaging, digital health, and self-hacking.
  • We have decades of experience in finance, marketing, communications and recruiting for healthcare and life sciences organizations, emerging and established.
  • Our backgrounds include clinical dentistry, osteology, biotech, IR/PR, marcomm, content creation, strategic consulting, and autoimmune advocacy.

Contact us to help you map your market landscape and understand patients’ unmet needs. We can help you clarify and articulate your company’s market position and differentiators. Long before COVID-19, we were facilitating virtual sessions. We create compelling content: articles, blog posts, collateral, e-books, web copy, and white papers, see examples on Autoimmune Connect/DrBonnie360 website.


On Key

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