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

An Unhealthy AmericaMilken InstituteDIABETESRising obesity threatens to send diabetes and associated diseases and conditions (hypertension, heart disease, stroke,adult blindness, non-traumatic amputations) soaring over the next twenty years. Treatment rates will skyrocket too.Prediabetes is a related chronic condition that increases the risk of developing type 2 diabetes—the diabetes mostclosely linked to obesity. Patients with prediabetes have blood glucose levels higher than normal, but not high enoughto be diagnosed with diabetes under current diagnostic guidelines. The CDC estimates that 41 million Americans ages40–74 suffered from prediabetes in 2000, a figure that grew to 54 million in 2002. 54 Yet the progression from prediabetesto type 2 diabetes is not inevitable. Weight loss, diet, and exercise can prevent or delay its onset. However, the size ofthe current prediabetes population gives an indication of the potential looming crisis.Age Demographics OnlyThe aging of the U.S. population alone will cause diabetes PRC to rise precipitously over the next twenty years.While the prevalence rates don’t progress as rapidly with age for diabetes as it does for cancer and stroke, thereis nonetheless a dramatic increase. For example, the ratio of 65–74 age group prevalence relative to the 25–44age group is 7.9 for diabetes versus 6.1 for heart disease. This means that an individual between 65 and 74 is 7.9times more likely to develop diabetes than someone under 50. The aging population, holding other factorsconstant, will cause PRC to increase by 40.7 percent between 2003 and 2023.Baseline ScenarioThe rate of increase will moderate and begin to plateau around 2015. By overlaying the obesity risk factor onthe aging factor, we find PRC increasing 52.9 percent from 2003 to 2023, or 12.2 percentage points more thanthat solely attributable to the aging. Rising obesity translates into an additional 1.6 million PRC in 2023, whenit hits 20,992,423. PRC would be much higher if obesity rates increase at the trend established over the pasttwo decades.Diabetes ranks second only to pulmonary conditions for share of prescription drug costs (44 percent) in totaltreatment costs. Most diabetes cases don’t require hospitalization. Consistent with the projections on medicalcarecost growth, expenditures per PRC rise 91.2 percent, an increase of 3.3 percent per year. Expenditures perPRC grow from $1,977 in 2003 to $3,780 in 2023.Total expenditures swell from $27.1 billion in 2003 to $79.7 billion in 2023, an increase of 193.7 percent. Withoutchanges in diet, physical activity, and therapeutic compounds to obviate weight gains, the health-care systemmay not be able to absorb these costs. Cumulatively between 2003 and 2023, baseline projections call for $1.0trillion in treatment costs.54. Centers for Disease Control and Prevention. National Diabetes Fact Sheet. 2005. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2005.pdf[ 105 ]