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

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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 ]
An Unhealthy AmericaMilken InstituteOptimistic ScenarioThis scenario assumes lower obesity rates due to aggressive “healthy body weight” initiatives. The obesity ratepeaks in 2011, then falls by 2023 to the rate last experienced in 1998. PRC rises by 32.6 percent, resulting in 13.3percent fewer (2.8 million fewer) PRC relative to the baseline.Expenditures per PRC for diabetes are 9.3 percent lower ($350 less) than the baseline by 2023. Total expendituresincrease 130.6 percent between 2003 and 2023, reaching $62.6 billion.Direct Avoidable CostsThe difference between the baseline and optimistic diabetes expenditure projections gives us an estimate ofthe avoidable costs. By 2023, expenditures are 21.5 percent lower ($17.1 billion less) in the optimistic scenario. Thecumulative difference between the optimistic and baseline scenarios over the projection period is $118.5 billion.DiabetesDiabetesPRC (Thousands)Expenditures per PRC ($) Total Expenditures (US$ Billions)Expenditures PRC* Expenditures/PRCDemographicsYear Disease Only Baseline Optimistic (Billions) Baseline (Millions) Optimistic (Thousands)Baseline Optimistic2003 Cancer 13,729 13,729 13,729 48.1 1,977 10.61,977 27.1 4.527.12023 Breast 19,314 Cancer 20,992 18,201 5.5 3,780 1.13,431 79.7 4.862.6Percent ChangeColon Cancer 3.9 0.3 11.52003-2023 40.7 52.9 32.6 91.2 73.5 193.7 130.6Source: 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 45.2 49.2 0.9Diabetes 27.1 13.7 2.0Hypertension Diabetes 32.5 36.8 0.9Diabetes - Avoidable CostsHeart Disease Avoidable 64.7 Costs 19.2 3.4Stroke US$ Billions13.6 2.4 5.6Mental 20 DisordersExpenditures45.8PRC*30.3Expenditures/PRCExpenditures PRC* Expenditures/PRC 1.5Disease Total (Billions) 277.0 (Millions) 162.2 (Thousands)Disease(Billions) (Millions) (Thousands) 1.7Cancer 48.1 10.6 4.5PRC: Cancer Population Reporting Condition 48.1 10.6 4.5Breast 15Cancer 5.5 1.1 4.8BreastColon CancerCancer 5.53.91.10.3 11.54.8Colon Cancer 3.9 0.3 11.5Lung Cancer 6.3 0.4 17.1Lung Cancer 106.3 0.4 17.1Prostate Cancer 4.3 1.0 4.1ProstateOther CancersCancer28.04.3 1.07.74.13.6Other Cancers 28.0 7.7 3.6Pulmonary Conditions 45.2 49.2 0.9PulmonaryDiabetes5Conditions 45.227.149.213.70.92.0Diabetes 27.1 13.7 2.0Hypertension 32.5 36.8 0.9Hypertension 32.5 36.8 0.9Heart Disease 64.7 19.2 3.4HeartStrokeDisease 064.7 19.2 3.4Stroke 2005 2008 201113.613.6 2014 20172.42.4 2020 20235.65.6Mental Disorders Source: Milken Institute 45.8 30.3 1.5MentalTotalDisorders277.045.8162.230.3 1.51.7Total 277.0 162.2 1.7PRC: Population Reporting ConditionPRC: Population Reporting Condition[ 106 ]
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