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

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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 ]
An Unhealthy AmericaMilken Institutesmoking and improved air quality are the most likely sources of cost containment and reductions in disability and death.Optimistic ScenarioThe number of at-risk smokers falls to approximately 15.4 percent of the adult population by 2023, comparedto the 19.0 percent in the baseline scenario. We project lower air pollution levels. PRC grows by 12.8 percentbetween 2003 and 2023, resulting in 9.1 million fewer PRC. Notably, prevalence declines from 16.9 percent ofthe population in 2003 to 16.1 percent in 2023.Expenditures per PRC increase 79.1 percent between 2003 and 2023, reaching $1.6 trillion. Total treatmentexpenditures are projected to grow 103.3 percent between 2003 and 2023, reaching $92.0 billion.Direct Avoidable CostsBehavioral changes and improved air quality would lower future treatment expenditures on pulmonaryconditions. The difference between the baseline and optimistic expenditure projections provides an estimateof the avoidable costs. By 2023, expenditures are 22.2 percent lower ($26.2 billion less) than in the baselinescenario. The cumulative difference over the projection interval is $199.6 billion.Pulmonary ConditionsPulmonary ConditionsPRC (Thousands)Expenditures per PRC ($) Total (US$ Billions)Expenditures PRC* Expenditures/PRCDemographicsYear Disease Only Baseline Optimistic (Billions) Baseline (Millions) Optimistic (Thousands)Baseline Optimistic2003 Cancer 49,206 49,206 49,206 48.1 919 10.6 919 45.2 4.545.22023 Breast 62,602 Cancer 64,595 55,517 5.5 1,814 1.11,646 118.2 4.892.0Percent ChangeColon Cancer 3.9 0.3 11.52003-2023 27.2 31.3 12.8 97.3 79.1 161.3 103.3Source: Milken Institute Lung Cancer 6.3 0.4 17.1Prostate Cancer 4.3 1.0 4.1Other Cancers 28.0 7.7 3.6Pulmonary Conditions Pulmonary 45.2 49.2 0.9DiabetesPulmonaryConditions27.1Conditions- Avoidable Costs13.7 2.0Avoidable CostsHypertension US$ Billions32.5 36.8 0.9Heart Disease 30Expenditures64.7PRC*19.2Expenditures/PRCExpenditures PRC* Expenditures/PRC 3.4Disease Stroke (Billions) 13.6 (Millions) 2.4 (Thousands)Disease(Billions) (Millions) (Thousands)5.6Cancer Mental 25 Disorders 48.1 45.8 10.6 30.3 4.5Cancer 48.1 10.6 4.51.5Total Breast Cancer 277.0 5.5 162.2 1.1 4.8 1.7Breast Cancer 5.5 1.1 4.8PRC: Colon Population Cancer20 Reporting Condition 3.9 0.3 11.5Colon Cancer 3.9 0.3 11.5Lung Cancer 6.3 0.4 17.1Lung Cancer 6.3 0.4 17.1Prostate Cancer 4.3 1.0 4.1Prostate 15Other CancersCancer28.04.3 1.07.74.13.6Other Cancers 28.0 7.7 3.6Pulmonary Conditions 45.2 49.2 0.9Pulmonary 10DiabetesConditions 45.227.149.213.70.92.0Diabetes 27.1 13.7 2.0Hypertension 32.5 36.8 0.9Hypertension 532.5 36.8 0.9Heart Disease 64.7 19.2 3.4HeartStrokeDisease 64.713.619.22.43.45.6Stroke 013.6 2.4 5.6Mental Disorders 2005 2008 2011 45.820142017 30.3 2020 2023 1.5MentalTotalDisorders Source: Milken Institute 277.045.8162.230.3 1.51.7Total 277.0 162.2 1.7PRC: Population Reporting ConditionPRC: Population Reporting Condition[ 104 ]
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