are common, and along with peripheral vascular disease, can result in damage to lower extremities (e.g., ulcers, infections) that necessitates amputations. Infection rates are higher, as are periodontal disease rates. Women with type 1 diabetes who become pregnant may see a worsening of any existing eye or kidney damage, and they are at increased risk of spontaneous abortion, preterm delivery, and birth defects.
The financial cost of type 1 diabetes is high. People with this disease are more likely to experience work disability, and they make greater than average use of health care services. A 1988 paper estimated treatment cost for a patient through age 40 at $40,000 (LaPorte et al., 1995). Health expenses and office visits for diabetics exceed those of nondiabetics.7 For example, the estimated annual cost of physician visits for a diabetic was nearly twice that for a nondiabetic ($1,045 versus $554). Costs of prescriptions and medical supplies are over five times as expensive for diabetics as for nondiabetics ($1,056 versus $201). Increased costs in overall health expenses also affect diabetics far more than nondiabetics ($11,157 versus $2,604 annually) (Javitt and Chiang, 1995).
Allergic disorders—including asthma, rhinitis, and dermatitis—are the sixth most common chronic disease in the United States. Together, they result in $18 billion in health care costs annually (AAAAI, 2000). For this report the committee focused on asthma.
A serious allergic disease, asthma was estimated to have affected 14.6 million adults in 2000 (CDC, 2001b) and about 4 million children in 1998 (CDC, 2001a). The prevalence rates of self-reported asthma appear to have increased overall by 74 percent between 1980 and 1994 (Mannino et al., 1998). For children age 0 to 4 years, rates increased by 159 percent during this period (from 22.0 per 1,000 to 57.4 per 1,000). Increases in asthma prevalence were seen in all race, sex, age, and regional groups. The reasons for the increasing prevalence are unclear, although changes in environmental or behavioral factors are considered likely (IOM, 2000).
Symptoms of asthma include shortness of breath, coughing, wheezing, and chest tightness. Some people experience these symptoms only occasionally, but in the most severe cases, symptoms are continuous. Even when the general level of disease is mild or moderate, individual episodes can be severe and may require hospital or emergency department care. Without proper treatment, severe episodes can be life-threatening. Management of the disease includes limiting exposure to environmental triggers (e.g., allergens, tobacco smoke, exercise, viral infections) and appropriate use of medications in response to the underlying level of symptoms and any acute changes. Daily use of medications may be