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

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An Unhealthy AmericaMilken InstituteState-Level Risk FactorsDemographic and behavioral shifts will affect the overall health of state populations, and states showing vulnerabilityto significant risk factors—high rates of smoking, obesity, cholesterol, and particulate pollution—maintain these factorsover the course of the projection period. In most cases, states retain their PRC rankings as well. However, specific datatrends, especially those driven by an aging population demographic, play a clear role in the projections.Percentage of Population Age 65 and Over - By State, 2023DiseaseExpenditures(Billions)PRC*(Millions)Expenditures/PRC(Thousands)Cancer 48.1 10.6 4.5Breast Cancer 5.5 1.1 4.8Colon Cancer 3.9 0.3 11.5Lung 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 32.5 36.8 0.9Heart Disease 64.7 19.2 3.4Stroke 13.6 2.4 5.6Mental Disorders 45.8 30.3 1.5LowestTotal 277.0 162.2 Third Tier1.7PRC: Population Reporting ConditionSecond TierHighestStates with a greater share of aging populations will see increased prevalence of diseases to which the older individualsare vulnerable. Wyoming, Maine, and New Mexico show the clear effects of a concentrated aging demographic in theirhigher rankings for almost every disease.Regional Cost VariationsRegional variations in treatment costs, insurance, and other trends present in the historical data through 2003 are preservedand extended in the cost projections through 2023. Alaska and Delaware place in the top five states for expendituresper capita for most diseases, even though particular disease prevalence rates may rank near the national average.State Health ExpendituresState Health Expenditures Percentage of - National Percentage Average, of National 2003 Average, 2003Top Five States Percent Bottom Five States PercentExpenditures PRC* Expenditures/PRCAlaska 135.8 New Hampshire 84.9Disease(Billions) (Millions) (Thousands)Delaware 122.4 Utah 86.2Cancer 48.1 10.6 4.5North Dakota 114.8 Idaho 87.0MinnesotaBreast Cancer 112.7 5.5 New Mexico1.1 4.8 87.8Massachusetts Colon Cancer 110.8 3.9 Arizona 0.3 11.5 89.3Sources: Centers Lung for Cancer Medicare & Medicaid Services (CMS), 6.3 Milken Institute 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 2.0[ 115 ]Hypertension 32.5 36.8 0.9Heart Disease 64.7 19.2 3.4Stroke 13.6 2.4 5.6
An Unhealthy AmericaMilken InstituteState Trends, by DiseaseIn this section we compare 2023 projections of PRC and direct costs with historical 2003 totals.BREAST CANCERTrends in the data continue to show the highest concentrations of breast cancer in New England, while the lowestincidence rates remain in Western states. Aging demographics play a key role in shifts among state rankings, and theoverall aging of the population shows an increase in PRC for every state, in both the optimistic and baseline scenarios.Among states with the highest incidence rates (PRC share of female population), Vermont moves from 4 th in historictrends to 1 st in projected trends. Maine moves from 7 th to 3 rd among the top five, and Rhode Island, which ranked 5 th in2003, falls to 9 th place. In the bottom five, aging demographics cause huge shifts in Wyoming and New Mexico rankings,which move out of the bottom five: Wyoming moves from 50 th to 28 th , and New Mexico from 49 th to 37 th . The secondtable shows that Vermont, Alaska, and Maine are projected to have the highest treatment expenditures per capita.Projected Breast Cancer PRCProjected Breast Cancer PRC - Percentage of Female Population, 2023Percentage of Female Population, 2023Top Five States Baseline Optimistic Expenditures Bottom Five PRC* States Expenditures/PRCBaseline OptimisticVermont Disease 1.474 1.293 (Billions) Arizona(Millions)(Thousands) 0.747 0.656New HampshireCancer 1.416 1.242 48.1 Utah 10.6 0.755 4.50.662Maine 1.328 1.165 Nevada 0.816 0.716Breast Cancer 5.5 1.1 4.8Connecticut 1.250 1.096 Idaho 0.864 0.758Colon Cancer 3.9 0.3 11.5Massachusetts 1.214 1.064 Oregon 0.866 0.759Lung Cancer 6.3 0.4 17.1Source: Milken InstituteProstate Cancer 4.3 1.0 4.1Other Cancers 28.0 7.7 3.6Pulmonary Conditions 45.2 49.2 0.9DiabetesProjected Expenditure27.1for Breast13.7Cancer2.0Projected Expenditure forHypertension Per Breast Female Cancer32.5Population, - Per 2023 Female Population, 202336.8 0.9Heart Disease 64.7 19.2 3.4Top Five States Stroke Baseline Optimistic Expenditures 13.6 Bottom Five PRC* 2.4 States Expenditures/PRCBaseline 5.6 OptimisticVermont Disease Mental Disorders 174.9 135.3 (Billions) 45.8Utah (Millions) 30.3 (Thousands) 57.9 1.545.1Alaska Cancer Total 165.0 127.5 277.0 48.1New Mexico 162.2 10.6 58.5 4.5 1.746.4Maine 154.0 119.9 Arizona 64.0 50.2PRC: Breast Population Cancer Reporting Condition 5.5 1.1 4.8New Hampshire 139.4 109.8 California 67.7 54.8Colon Cancer 3.9 0.3 11.5Massachusetts 137.8 110.1 Hawaii 67.9 55.0Lung Cancer 6.3 0.4 17.1Source: Milken InstituteProstate 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 32.5 36.8 0.9Heart Disease 64.7 19.2 3.4Stroke 13.6 2.4 5.6Mental Disorders 45.8 30.3 1.5Total 277.0 162.2 1.7PRC: Population Reporting Condition[ 116 ]
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