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

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An Unhealthy AmericaMilken InstituteHeart disease is affected by drugs (“no surgery,” in the table); part-surgery (BCS without radiation); and full-surgery(mastectomy). Thus, using the uncertainty weight (0.3), we assume that the change in the ratio of presenteeism to lostworkdays for each year is proportional to the change for cancer. The absolute difference in the cancer ratio between2003 and 2004 was (-0.31). (Following this logic, heart disease should amount to 70 percent of the absolute differenceof the cancer ratio. However, we use 60 percent to allow for any additional side effects specific to heart disease.) Finallywe adjust for differences in 2003 cancer and heart disease impact ratio. 86 We follow this methodology in the following table.Heart DiseaseHeart Disease - Presenteeism to Lost WorkdaysPresenteeism to Lost WorkdaysPresenteeism Expenditures/PRC* Absolute Expenditures/PRCDisease Year Lost (Billions) Workdays (Millions) Change (Thousands)Cancer 2003 3.63 48.1 10.6-4.5Breast Cancer 2004 3.59 5.5 -0.046 1.1 4.8Colon Cancer 2005 3.54 3.9 -0.051 0.3 11.5Lung Cancer 2006 3.49 6.3 -0.052 0.4 17.1Prostate Cancer2007 3.434.3-0.0511.0 4.1Other Cancers2008 3.3928.0-0.0437.7 3.6Pulmonary Conditions2009 3.3545.2 49.2-0.0440.92010 3.32 -0.027Diabetes 27.1 13.7 2.02011 3.29 -0.034Hypertension 32.5 36.8 0.92012 3.26 -0.025Heart Disease 64.7 19.2 3.42013 3.24 -0.025Stroke 13.6 2.4 5.62014 3.19 -0.050Mental Disorders 45.8 30.3 1.52015 3.16 -0.031Total 277.0 162.2 1.72016 3.13 -0.029PRC: Population Reporting Condition2017 3.10 -0.0272018 3.07 -0.0272019 3.05 -0.0272020 3.02 -0.0272021 2.99 -0.0272022 2.97 -0.0262023 2.94 -0.026Source: Milken InstituteFollowing a similar logic for diabetes, we use 35 percent of the absolute difference of the cancer ratio to allow for anyadditional side effects.We assume that impact ratios for other diseases are only affected by drugs (no surgery). But in order to bring in somevariation, we assume stroke will display 25 percent of the impact relative to cancer, followed by asthma (20 percent),emotional disturbances (15 percent), and hypertension (10 percent). A complete methodology is available online atwww.chronicdiseaseimpact.com.86. Hence, the final change in the impact ratio of presenteeism to lost workdays for heart disease from 2003 to 2004 willbe (-0.31X 0.60) x (3.63/16.95).[ 143 ]
An Unhealthy AmericaMilken InstituteB. Projections of Avoidable Indirect ImpactsThe avoidable indirect economic impact is defined as the difference between the baseline and optimistic projections.National-Level Avoidable Indirect ImpactsOn the national level, the projected difference between the baseline and optimistic GDP-based scenarios for totalavoidable indirect impacts in 2023 is $905 billion, reflecting a difference of 26.9 percent. The next table provides thecomparisons by disease. The difference in the two GDP-based cancer scenarios, for example, is $373 billion in 2023. Forheart disease, the difference is $137 billion.For wage-based scenario projections, the total difference in 2023 comes to $390 billion. For cancer, the projecteddifference is $161 billion, a difference of 38.9 percent. For heart disease, the difference is $59 billion, or 43.0 percent.2023 Projections of Wage-Based Indirect Impacts2023 Projections of Wage-Based Indirect Impacts - US$ BillionsUS$ BillionsDifferenceExpenditures PRC* Expenditures/PRCChronic Disease Baseline Optimistic Absolute PercentDisease Cancer (Billions) 414 253 (Millions) -161 (Thousands)-38.9Cancer Breast Cancer 44 48.1 28 10.6 -16 -36.1 4.5Breast Colon Cancer 30 5.5 19 1.1 -11 -38.1 4.8Colon Lung Cancer 45 3.9 27 0.3 -18 -39.9 11.5Lung Prostate Cancer Cancer 40 6.3 23 0.4 -17 -42.1 17.1Prostate Other Cancers 254 4.3 156 1.0-98 -38.64.1Asthma 114 94 -20 -17.7Other Cancers 28.0 7.7 3.6Diabetes 151 119 -31 -20.8Pulmonary Conditions 45.2 49.2 0.9Hypertension 360 286 -74 -20.6DiabetesHeart Disease 13727.17813.7-59 -43.02.0Hypertension Stroke 26 32.5 20 36.8 -6 -23.4 0.9Heart Emotional Disease Disturbances 245 64.7 207 19.2 -38 -15.5 3.4Stroke Total 1,448 13.6 1,058 2.4 -390 -26.9 5.6Mental Source: Disorders Milken Institute45.8 30.3 1.5Total 277.0 162.2 1.7PRC: Population Reporting Condition2023 Projections of GDP-Based Indirect Impacts US$ Billions2023 Projections of GDP-Based Indirect Impacts - US$ BillionsDifferenceChronic DiseaseDisease Cancer(Billions) 960 587 (Millions) -373 (Thousands)-38.9ExpendituresBaseline OptimisticPRC*AbsoluteExpenditures/PRCPercentCancer Breast Cancer 10148.1 66 10.6 -36 -35.1 4.5Breast Colon Cancer 69 5.5 42 1.1 -27 -38.8 4.8Colon Lung Cancer 105 3.9 63 0.3 -42 -39.811.5Lung Prostate Cancer Cancer 93 6.3 54 0.4 -39 -42.117.1Other Cancers 592 362 -230 -38.9Prostate Cancer 4.3 1.0 4.1Asthma265 218 -47 -17.7Other Cancers 28.0 7.7 3.6Diabetes350 277 -73 -20.8PulmonaryHypertensionConditions83945.266649.2-172 -20.60.9Diabetes Heart Disease 31927.1 182 13.7-137 -43.0 2.0Hypertension Stroke6132.5 47 36.8 -14 -23.4 0.9Heart Emotional Disease Disturbances 56864.7 480 19.2 -88 -15.5 3.4Stroke Total3,36313.6 2,458 2.4-905 -26.9 5.6Mental Source: Disorders Milken Institute45.8 30.3 1.5Total 277.0 162.2 1.7PRC: Population Reporting Condition[ 144 ]
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