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

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An Unhealthy AmericaMilken InstituteCaregiversCaregiversin theinU.S.the- MillionsU.S.MillionsExpenditures PRC* Gender Expenditures/PRCDisease Caregivers(Billions) Male (Millions) Female (Thousands)CancerTotal48.117.310.6 4.527.1Breast Cancer 5.5 1.1 4.8Full-Time Employed 10.4 11.1Colon Cancer 3.9 0.3 11.5Source: NAC and AARP, 2004Lung Cancer 6.3 0.4 17.1Prostate Cancer 4.3 1.0 4.1Other Cancers 28.0 7.7 3.6Caregivers’ lost workdaysPulmonaryfor eachConditionsdisease are calculated45.2by applying49.2the disease-specific0.9percentage of the individualDiabetes 27.1 13.7 2.0lost workdays against all lost workdays due to illness or injury. To estimate caregiver presenteeism, we calculate theHypertension 32.5 36.8 0.9number of EmployedHeartCaregiversDiseaseby Condition (ECC). 69 The64.7following table19.2depicts ECC by3.4disease.Stroke 13.6 2.4 5.6ECC for the U.S.*Mental Disorders 45.8 30.3 1.5ECC for theTotal Millions, U.S.* - Millions,277.0 2003 2003162.2 1.7PRC: Population Reporting ConditionChronic Disease Expenditures PRC* ECC Expenditures/PRCDisease Cancer (Billions) (Millions) 0.77 (Thousands)Cancer Asthma 48.1 10.61.784.5Breast CancerDiabetes 5.5 1.10.764.8Colon Cancer Hypertension 3.9 0.33.5211.5Lung Cancer Heart Disease 6.3 0.41.2317.1Prostate Cancer Stroke 4.3 1.00.144.1Other CancersEmotional Disturbances 28.0 7.71.003.6Pulmonary Conditions * Employed Caregivers 45.2 by Condition 49.2 0.9Diabetes Sources: NAC, Milken Institute 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 1.7Next we calculate ECC-adjusted individual presenteeism. 70 Following a study by Levy, 71 we allocate 75 percent ofECC-adjusted individual presenteeism as caregiver presenteeism. 72 We follow the same methodology to estimatecaregiver presenteeism for other diseases, then allocate these across states and regions. Again, all state estimates arePRC: Population Reporting Conditionobtained using state-specific PRC. Those PRC totals are calculated from prevalence and incidence rates using differentsources, 73 and the rates will influence these state-level impacts as well.69. For example, we find that EPRC for cancer in 2003 (from individual lost workdays) totaled 5.92 million, whichaccounted for 3.5 percent of the total employed population in that year for the National Health Interview Survey. Followingthat, we allocate 3.5 percent of all full-time employed caregivers (21.5 million) to cancer (0.77 million).70. For cancer, wage-based EPRC presenteeism totaled $103.7 billion. After adjusting for ECC, the total drops to $13.4 billion.71. Levy D. “Presenteeism: A Method for Assessing the Extent of Family Caregivers in the Workplace and their FinancialImpact” American Association for Caregiver Education Inc. (2003, 2007).72. For cancer, 75 percent of $13.42 billion is $10.1 billion.73. Sources include, for example, the Behavioral Risk Factor Surveillance System (BRFSS), CDC, State Cancer profile.[ 129 ]
An Unhealthy AmericaMilken InstituteSummary of FindingsThe historical indirect impacts here are based on (a) average wages and (b) nominal GDP. The following table summarizesnational-level, wage-based indirect impacts for 2003.Wage-Based Wage-Based Indirect Indirect Impacts for Impacts the U.S. for - US$ the Billions, U.S. 2003IndividualCaregiverChronic Disease Lost Workdays ExpendituresPresenteeism Lost PRC* Workdays Expenditures/PRCPresenteeism TotalCancer Disease 6.1 (Billions) 103.7 (Millions) 0.45 (Thousands) 10.1 120.4Breast Cancer Cancer 0.7 48.1 11.8 10.6 0.05 4.51.1 13.7Colon Cancer Breast Cancer 0.5 8.4 5.5 1.1 0.04 4.80.8 9.7Lung Cancer Colon Cancer 0.8 13.5 3.9 0.3 0.06 11.51.3 15.7Prostate Cancer 0.5 9.1 0.04 0.9 10.6Lung Cancer 6.3 0.4 17.1Other Cancers 3.6 61.0 0.26 5.9 70.7Prostate Cancer 4.3 1.0 4.1Asthma 8.3 29.7 0.61 2.9 41.6DiabetesOther Cancers4.6 37.828.0 7.70.343.63.7 46.4Hypertension Pulmonary Conditions 18.2 94.5 45.2 49.2 1.79 0.99.2 123.6Heart Disease Diabetes 9.1 33.1 27.1 13.7 0.90 2.03.2 46.3Stroke Hypertension 1.7 32.5 7.3 36.8 0.12 0.90.7 9.8Emotional Disturbances Heart Disease 8.4 61.1 64.7 19.2 0.61 3.45.8 75.9Total Stroke 56.4 367.2 13.6 2.4 4.81 5.6 35.5 464.0Source: Milken InstituteMental Disorders 45.8 30.3 1.5Total 277.0 162.2 1.7PRC: Population Reporting ConditionUS$ Billions, 2003As depicted, total wage-based historical indirect impacts (lost workdays and lower employee productivity) amountedto $464.0 billion in 2003. 74 They were highest for hypertension, at $123.6 billion, followed by cancer at $120.4 billion.Stroke ranks lowest, at $9.8 billion.Lost EPRC workdays are most associated with hypertension and least with stroke ($1.7 billion). EPRC presenteeism ismost associated with cancer, at $103.7 billion. For caregivers, lost workdays are also most associated with hypertension,and presenteeism with cancer. It is not surprising that presenteeism is highest for cancer, but the high impacts forhypertension are puzzling. The low impact of stroke may be attributable to a significant number of affected employeeswho leave the work force altogether and enter managed care.74. It is to be noted that comorbidities are involved in this estimate. So the total indirect impact estimate should be usedwith caution.[ 130 ]
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