Contributor: The Majority (57.5%) of Commercially Insured Patients Had 1 or More Chronic Conditions in 2024

The majority (57.5%) of commercially insured patients had at least 1 chronic condition in 2024 (Figure 1). The average allowed amount¹ for a patient with no chronic conditions was $1590, whereas the average allowed amount for a patient with 1 chronic condition was nearly double ($3039). Of 44 common chronic conditions studied, hyperlipidemia, or high cholesterol, was the most common, with a crude prevalence² of 21.2%. These and other findings are reported in a new FAIR Health white paper: Chronic Conditions in the United States: A Study of Commercial Claims.

Chronic diseases or conditions are the leading cause of illness, disability, and death in the US. FAIR Health Atlas, an epidemiological reporting platform to be launched in 2026, uses FAIR Health’s repository of commercial health care claim records—the largest in the nation—to measure prevalence and costs associated with chronic conditions. This study of common chronic conditions in the commercially insured population in the United States in 2024 draws on that platform. The study focuses on prevalence, co-occurring conditions, costs, geography, and correlation of prevalence rates to the poverty rate. The key findings, all from 2024, include the following:

Many patients had more than 1 chronic condition. For example, 11.5% of patients had 2 conditions, and 9.1% had 3.

Some chronic conditions frequently co-occur. In the commercially insured population, 33.4% of patients had hyperlipidemia, hypertension, obesity, or some combination of these, and 4.3% had all 3 (Figure 2).³ Half the patients with any one of these conditions had more than 1.

The number of chronic conditions per commercially insured patient per year drives health care spending. The average allowed amount rose per number of chronic conditions, reaching $21,730 for 10 or more chronic conditions—13.7 times higher than for a patient with no chronic conditions.

Chronic conditions vary in their median and average number of co-occurring chronic conditions and average allowed amount per year. Of the 44 chronic conditions studied in the commercially insured population, lung cancer had the highest average allowed amount per year ($22,740) and ADHD the lowest ($4175).⁴ Acute myocardial infarction, non-Alzheimer dementia, and Alzheimer disease had the highest median number of comorbidities (6), and pneumonia and autism had the lowest (1). Acute myocardial infarction had the highest average number of co-occurring chronic conditions (6.19), and autism the lowest (1.63).

When analyzed in pairs, the crude prevalence rates of hypertension, hyperlipidemia, obesity, and diabetes⁵ had a moderate to strong positive correlation.⁶ The prevalence rates of hypertension and diabetes had the strongest positive correlation (86.0%); those of obesity and hyperlipidemia had the weakest (45.0%).

Some clusters of chronic conditions—such as the cluster of hypertension, diabetes, obesity, chronic kidney disease, and hyperlipidemia—are more strongly correlated to the poverty rate than others. The prevalence rates of all of the conditions in the cluster just mentioned had a positive correlation to the county-level poverty rate. By contrast, the cancers studied all had negative correlations to the poverty rate, with breast cancer showing a –24.3% correlation.

The findings in this report have implications for stakeholders across the health care spectrum, including patients, providers, payors, policy makers, and researchers. The report also demonstrates some of the capabilities of the forthcoming FAIR Health Atlas on which it is based. Among those capabilities are measuring chronic condition prevalence, comorbidities, and costs in the commercially insured population; mapping the prevalence of chronic conditions; using correlations to measure how closely chronic condition prevalence rates are related; and using correlations to measure how closely chronic conditions are related to risk factors such as poverty.

For the complete white paper, click here.

Footnotes

1. An allowed amount (also known as an eligible expense) is the maximum amount an insurance plan will pay for a covered health care service before the application of deductibles or coinsurance. This study includes both in- and out-of-network allowed amounts.

2. Crude prevalence is the proportion of the commercially insured population receiving medical services who had a specific condition at a given time, not adjusted for factors such as age and gender.

3. Patients can have additional chronic conditions beyond these 3.

4. The average allowed amount for a condition, such as lung cancer, is based on the overall spending for all the treatments received by patients with that condition, not just spending for the individual condition.

5. “Diabetes” in this paper includes both type 1 and type 2 diabetes.

6. A correlation is positive when 1 variable increases as the other increases; it is negative when 1 decreases as the other increases. In this paper, a correlation is regarded as strong if it is 60% or higher in either the positive or negative direction, moderate if it is 40% to 59%, and weak if it is 39% or lower. Complete absence of correlation is 0%.