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

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An Unhealthy AmericaMilken InstituteA. Disease Trends and Direct Costs: National LevelNumerous factors have shaped health trends over the past two decades. On the positive side, improvements in diagnosisand treatments have helped flatten and, in some cases, roll back disease rates. The benefits of lifestyle changes, such assmoking cessation and improved diet, are also showing up in disease trends. Countering these factors, the aging babyboom population is pushing up health-care costs and straining the health-care system. Meanwhile, as more Americansmove to cities, health problems associated with urbanization are on the rise.Many of the trends in the data have actually been discernable even beyond the scope observed in the MEPS data.According to the National Center for Health Statistics, for example, the prevalence 2 rate of cardiovascular disease rosefrom 64.7 per 1,000 people in 1970 to 99.3 per 1,000 people in 1990, a 53.4 percent increase. During the same period,overall cancer incidence rates rose from 11.1 per 1,000 people to 18.7 per 1,000, an increase of 68.5 percent. 3Key Differences in Direct Costs from Other StudiesDirect Costs (US$ (US$ Billions) Billions)Chronic Disease Disease Milken Study Study Other Studies Studies Source of of Other Other Studies StudiesCancer 48.1 74.0 American Cancer Society SocietyCOPD, Asthma 45.2 45.3 31.5 31.5American Lung Lung Association AssociationDiabetes 27.1 27.2 92.0 American Diabetes Diabetes Association AssociationHeart Disease, Stroke Stroke 78.3 78.5 242.0 Centers for for Disease Disease Control Control and and Prevention PreventionHypertension 32.5 32.6 – Centers for Disease Control Control and and Prevention PreventionMental Disorders 45.8 45.9 92.0 National Mental Health Health Association/CDCAssociation/CDCBecause this study is addressing a larger economic context, the summary of historical direct costs (treatment costs)excludes the costs of comorbidities and secondary effects. Nowhere is this more apparent than with diabetes. TheAmerican Diabetes Association included the cost of all comorbidities when it determined that $91.8 billion in directcosts for 2002 were attributable to the disease. 4If comorbidity costs are removed, the costs are the same as the MEPS total for the year.With the exception of blindness and amputation, most significant diabetes comorbidities are examined as part of theoverall cost of our study. However, since the secondary effects of diabetes are often diseases unto themselves or arerelated to other factors (cancers, hypertension, and obesity), these treatment costs are excluded from diabetes-specific costs.It is important to note when comparing estimates of direct costs that this study uses the direct costs to establishbenchmarks for projecting future increases in both direct and indirect impacts. In order to establish benchmarks, wemust create a uniform methodology that eliminates the possibility of cost overlap or replication. This approach is notintended to underestimate or understate the impacts of the individual diseases. But it is necessary in order to examinethe economic costs of each disease in terms of historic context and projections.2. Prevalence is used to define the number of individuals with a disease, while incidence refers to the numbers of newcases reported in a given year.3. David M. Cutler et al. “Measuring the Health of the U.S. Population.” Brookings Papers on Economic Activity, 1997: 218.4. American Diabetes Association. “Economic Costs of Diabetes in the U.S. in 2002.” Diabetes Care, March, 2003;26(3):917-932[ 39 ]
An Unhealthy AmericaMilken InstituteDiseaseExpenditures(Billions)PRC* PRC* Expenditures/PRC(Millions) (Millions) (Thousands) (Thousands)CancerCancer 48.148.110.610.64.54.5Breast Cancer 5.5 1.1 4.8Breast Cancer 5.5 1.1 4.8Colon Cancer 3.9 0.3 11.5Colon Lung Cancer Cancer 6.33.9 0.4 0.3 17.1 11.5Lung Prostate Cancer Cancer 4.36.3 1.0 0.4 4.1 17.1Prostate Other Cancers 28.04.3 7.7 1.0 3.6 4.1Other Pulmonary Cancers Conditions 45.2 28.0 49.2 7.7 0.9 3.6Diabetes 27.1 13.7 2.0Pulmonary Conditions 45.2 49.2 0.9Hypertension 32.5 36.8 0.9DiabetesHeart Disease 64.727.119.213.73.42.0Hypertension Stroke 13.6 32.5 2.436.8 5.6 0.9Heart Mental Disease Disorders 45.8 64.7 30.319.2 1.5 3.4Stroke Total 277.0 13.6 162.2 2.4 1.7 5.6*PRC: Population Reporting ConditionMental Sources: Disorders MEPS, Milken Institute 45.8 30.3 1.5Total 277.0 162.2 1.7PRC: Population Reporting ConditionDirect Direct Costs Costs by Chronic by Disease, Disease 20032003BREAST CANCERBreast cancer has been on the decline in the United States over the past decade due to changing demographics,improved screening, and advances in treatment. The clearest definable cause for the decrease is demographic: duringmuch of the 1990s, the share of the population over age 65 actually shrank (due chiefly to lower birth dates during theDepression years). As shown in the following table, the breast cancer rate increased by nearly 40 percent from 1979 to1998. From 1998 to 2002, the rate declined from 140.8 per 100,000 to 133.8. As the baby boomer generation moves intoretirement age, this trend should reverse itself amid a surge of breast cancer cases based entirely on demographics inthe absence of countervailing behavioral factors.Behavioral factors, such as exercise, can explain the regional variations in breast cancer rates. Increased physical activityclearly reduces risk of the disease. Other factors, such as occupation, also affect rates of the disease. In fact, women whowork in jobs requiring high levels of physical labor are 18 percent less likely to develop the disease 5 . Poor diet andinadequate levels of exercise lead to increased risk of obesity and a higher probability of breast cancer. Some researchsuggests that alcohol consumption also has an effect on incidence rates, although a definitive link has not beenestablished. Women who consumed between two and five drinks a day in a long-term study in North America andEurope were found to have a 41 percent greater risk of developing breast cancer than were non-drinkers. 6Perhaps the most controversial factor is a suggested link to hormone replacement therapy (HRT). While there isdisagreement about the complex set of risks and benefits associated with HRT, much attention has been paid to thefact that breast cancer rates dropped in 2003, after the federal government issued warnings about the dangers of HRT.A recent press release by the M.D. Anderson Cancer Center at the University of Texas reinforces this perception, notingspecifically that the drop occurred after a nearly 50 percent reduction in the use of HRT in the 2002–2003 period. 75. P.F. Coogan et al. “Physical Activity in Usual Occupation and Risk of Breast Cancer,” 1997: 626–31.6. S.A. Smith-Warner et al. “Alcohol and Breast Cancer in Women: A Pooled Analysis of Cohort Studies.” Journal of theAmerican Medical Association.7. P. Ravdin and D. Berry. Press Release. “Decline in Breast Cancer Cases Likely Linked to Reduced Use of HormoneReplacement.” M.D. Anderson Cancer Center at the University of Texas, December 14, 2006.[ 40 ]
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