An Unhealthy America: The Economic Burden of ... - Milken Institute

An Unhealthy AmericaMilken InstitutePULMONARY CONDITIONSAn aging population and worsening air quality will likely lead to increased incidence of pulmonary conditions. Lowersmoking prevalence, however, will have a countervailing effect.More than 31.9 million adults suffer from one or more pulmonary conditions, including asthma and chronic obstructivepulmonary disease (COPD). An additional 24.0 million show evidence of impaired lung function, indicating that thesechronic diseases are under-diagnosed. There is good news, however. Asthma death rates continue to plateau at anage-adjusted rate of approximately 1.4 per 100,000. (Hospitalizations for asthma attacks declined by 3 percent between1995 and 2003.) In many cases, pulmonary diseases are preventable. Between 80 percent and 90 percent of COPD(chronic obstructive pulmonary disease) deaths are caused by smoking. 53 Secondhand smoke increases the risk of anasthma attack.Age Demographics OnlySlightly higher prevalence rates have been associated with aging. For example, pulmonary conditions arefound in approximately 12.6 percent of people ages 25–44, compared to 20.7 percent of those 65–74. Thisrelationship is expected to continue. Maintaining age-specific prevalence rates at their 2003 levels and holdingall other factors constant, we find that the prevalence rate increases from 16.9 percent in 2003 to 18.2 percentin 2023. The aging of the population alone will increase PRC by 13.4 million by 2023, an increase of 27 percentover 49.2 million.Baseline ScenarioPulmonary conditions are more common among Hispanic-Americans than other ethnic/racial groups. Projectedgrowth of this population segment, from 11.3 percent of the population in 2003 to 16.5 percent by 2023, willlead to rising PRC.Worsening air quality will also contribute to increased disease rates. In the next two decades, the average airquality level is expected to be nearly 50 percent worse that it was in 2003. However, the baseline assumptionscall for the number of at-risk smokers to decline to 19 percent of the population, reducing prevalence andoffsetting air quality impacts.Baseline PRC increases by approximately 31.3 percent, only 4.1 percentage points greater that it would byaging alone. We project the PRC to total 64.6 million in 2023.Compared to other chronic diseases—notably the cancers profiled in this study—treatment of pulmonaryconditions is more dependent on prescription drugs. According to MEPS, prescription drugs accounted forapproximately 35 percent of health-care expenditures in 2003. In contrast, spending on drugs accounted foronly 3.5 percent for cancer treatment outlays. Consistent with the projections on medical care cost growth,expenditures per PRC grow from $919 to $1,814, or by 97.3 percent.Total treatment expenditures jump from $45.2 billion to $118.2 billion, an increase of 161.3 percent. Over thenext twenty years, the nation will spend over $1.5 trillion on pulmonary conditions treatments. Reduced53. American Lung Association. See: http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=22596 and http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=35020.[ 103 ]