Definition of chronic disease

The full name of chronic disease is chronic non-communicable disease. It is a general term for a type of disease that has an insidious onset, long course and protracted disease, lacks clear evidence of infectious biological causes, has complex causes or has not yet been fully confirmed. This is also the core reference standard for chronic disease management in domestic hospitals and community health service centers at all levels. Hypertension, diabetes, chronic obstructive pulmonary disease, and malignant tumors that we often talk about all fall within the scope of this definition.

Last week, I met 62-year-old Aunt Zhang at a community chronic disease follow-up point. She had been diagnosed with high blood pressure for almost half a year. She clutched the physical examination sheet and asked me, "Girl, I just get dizzy occasionally. If my blood pressure is high, I can just take a pill. How can it be considered a chronic disease?" ”You see, not only Aunt Zhang, many people's definition of chronic disease is still at the stage of serious disease that "needs to be bedridden and requires someone to take care of it". In fact, this is a big misunderstanding.

In practice, practitioners in different fields actually have somewhat different definitions of chronic diseases. For example, clinicians' judgment standards are more biased towards pathological indicators. Generally speaking, if irreversible organic damage occurs for more than 3 consecutive months, or physiological indicators continue to be abnormal, a chronic disease will be diagnosed. Two months ago, a 29-year-old programmer came for a physical examination. His fasting blood sugar was above 7.2mmol/L for three consecutive months. He did not feel thirsty or urinate at all. He was still diagnosed with type 2 diabetes and was included in our chronic disease management ledger.

However, the definition of public health should be broader and pay more attention to the value of long-term intervention. Now many places have included hyperuricemia, simple obesity, and childhood myopia, which have not yet caused organic damage, into the list of chronic disease pre-management. A clinical friend of mine often complains about this, saying, "Nowadays, everything is considered a chronic disease. It makes all young people think that they are sick, which is purely to create anxiety." But my colleagues in public health also have a point: wait until the indicators are abnormal and the organs are damaged before taking care of it. It's too late. How much treatment costs and sins can be saved by early intervention?

I have been working as a chronic disease manager in the community for 8 years. To be honest, for ordinary people, there is really no need to dwell on the unreasonable definitions. Just remember one thing: Any doctor who tells you, "You can't expect this disease to be cured by just taking medicine for a few days, and it requires long-term care and regular check-ups" basically falls into the category of chronic disease. To use an inappropriate metaphor, a chronic disease is like your old air conditioner that has been in use for more than ten years. It does not turn on completely, but it occasionally trips and cools slowly. You have to clean the filter regularly and add fluoride. Don’t leave it running 24 hours a day. It will serve you well for another ten or eight years. If you ignore it, it may go out on the hottest day and it will be difficult to repair.

There used to be a 71-year-old Zhou in our jurisdiction who had suffered from COPD for 12 years. At first, he thought, “It’s just a cough, what’s the disease?” He continued to smoke and didn’t pay attention to keeping warm in the winter. He was admitted to the ICU due to acute attacks in the winter for two consecutive years. He spent more than 100,000 yuan and almost couldn’t be saved. Now he is good. He does breathing exercises for 20 minutes every morning. He has quit smoking for almost 5 years. He still goes to the park to do Tai Chi twice a week. During the last follow-up, he joked with me: "I have finally figured it out. This disease will be my old companion for the rest of my life. If I treat it well, it will not bother me." ”

Oh, yes, there is now a fairly new discussion direction in the academic community: Should “impact on quality of life” be included in the definition of chronic diseases? For example, if someone has high blood pressure and takes medicine on time, exercises regularly, and controls blood pressure exactly like a normal person, without affecting work and life at all, can it be considered a "chronic disease remission state" and does not need to be labeled as a "patient" all the time? This view is currently quite controversial. Some people think that this can reduce the psychological burden of patients with chronic diseases, while others think that it will relax everyone's awareness of management, which is not good.

In fact, to put it bluntly, all definitions are tools in the final analysis. They are meant to help us better manage our health and reduce the pain caused by diseases. They are not meant to label or limit people. Are you right?