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

An Unhealthy AmericaMilken InstituteHEART DISEASEDeath rates from most types of heart disease have declined over the past 30 years. Heart disease prevalence rates,however, have moderated by substantially less. Despite significant treatment advances through prescription medications,angioplasty, and stent insertion, heart disease remains the leading cause of death in the United States. Coronary heartdisease is the principal form of heart disease, accounting for 71 percent of all heart disease deaths. 58Reduced smoking rates contributed to the decline in prevalence from 1980 through 1999. But other behavioral factorsappear likely to offset the decrease. More recent studies show much stronger statistical links to obesity and high BMI.Our own econometric analysis supports this finding. Combined with the aging of the population, obesity is likely tocause an increase in heart disease PRC in the absence of significant behavioral changes.Age Demographics OnlyAging demographics won’t have as strong an influence on heart disease as on cancers, but they will have adiscernable effect on prevalence and PRC during the projection period. The ratio of the prevalence rate for the65–74 cohort relative to the 25–44 cohort is 6.1. This means that an individual between 65 and 74 is 6.1 timesmore likely to develop heart disease than someone under 50. Holding age-specific prevalence rates at their2003 level and all other factors constant, we see heart disease PRC surge 40.7 percent between 2003 and 2023.Baseline ScenarioObesity is the only major behavioral risk factor expected to have a detrimental impact on future PRC. Fallingsmoking rates and modest gains in exercise will partially compensate for rising obesity. At-risk smokingdeclines by roughly 3 percentage points over the next twenty years. The net result pushes PRC above wheredemographics alone would place it by 2023. Behavioral risk factors add 800,917 (3.0 percent) to heart diseasePRC relative to aging demographics.More widespread use of existing medications and FDA approval of new ones to delay or eliminate the onset ofthe disease cut PRC by 724,347 in 2023. Still, PRC increases by 41.1 percent, slightly above where aging by itselfwould place it. Heart disease PRC reaches 27,015,705 in 2023.The inpatient hospital share of total treatment costs for heart disease is 64.2 percent. Prescription medicationaccounts for 10.8 percent of treatment costs. Based on projections on medical-care cost growth, heart diseaseexpenditures-per-PRC rise 101.9 percent between 2003 and 2023, an increase of 3.6 percent annually.Expenditures per PRC rise from $3,381 in 2003 to $6,826 in 2023.Total treatment expenditures expand from $64.7 billion in 2003 to $186.0 billion in 2023, a 187.3 percentincrease. The nation will spend $2.4 trillion cumulatively over the next twenty years. This is the highestprojected expenditure of any disease and will place enormous financial burdens on Medicare and Medicaid. Itwill force changes in both systems.58. Centers for Disease Control and Prevention. See: http://www.cdc.gov/HeartDisease/facts.htm.[ 109 ]