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

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An Unhealthy AmericaMilken InstituteHowever, no clear causal link between HRT and breast cancer has been established, and other factors, such as changesin mammography screening, may also play a role. 8Total expenditures for breast cancer rose from $4.6 billion in 1998 to $5.5 billion in 2003. This increase is almost entirelyexplained by a jump in the number of PRC during the period, from 982,000 to 1,140,000. Expenditures per PRC remainedgenerally constant, rising from $4,707 in 1998 to $4,840 in 2003.Cancer Incidence Rate - For All Age GroupsYear Breast Expenditures Colon PRC* Lung Expenditures/PRCProstateDisease 1979 102.1 (Billions) 62.3 (Millions) 58.6 (Thousands) 103.4Cancer 1980 102.1 48.1 63.7 10.660.7 105.9 4.5Breast 1981 Cancer 106.3 5.5 64.2 1.162.0 108.9 4.8Colon 1982 Cancer 106.4 3.9 62.8 0.363.3 108.2 11.5Lung1983Cancer111.16.363.60.463.4 111.517.1Prostate1984Cancer115.84.364.81.065.5 111.64.1Other1985Cancers124.128.066.37.764.6 115.43.61986 126.7 64.2 65.8 119.0Pulmonary Conditions 45.2 49.2 0.91987 134.4 62.7 67.9 133.5Diabetes 27.1 13.7 2.01988 131.3 61.4 68.0 137.5Hypertension 32.5 36.8 0.91989 127.1 61.7 67.5 145.2Heart Disease 64.7 19.2 3.41990 131.7 60.6 68.0 170.7Stroke 13.6 2.4 5.61991 133.6 59.4 69.2 214.5Mental Disorders 45.8 30.3 1.51992 131.8 58.0 69.4 237.0Total 277.0 162.2 1.71993 129.0 56.8 67.7 209.1PRC: Population1994Reporting130.8Condition55.6 67.2 179.81995 132.3 54.0 66.8 168.51996 133.3 54.7 66.4 168.41997 137.4 56.3 66.6 172.51998 140.8 56.6 67.5 169.61999 140.6 55.3 65.7 182.02000 135.7 53.9 63.9 180.92001 137.3 53.1 63.7 182.52002 133.8 52.5 63.4 179.12003 124.2 49.5 62.7 164.9Sources: Surveillance Epidemiology and End Results, National Cancer InstituteBreast Cancer Population Reporting Condition (PRC) and ExpenditureBreast Cancer Population Reporting Condition (PRC) and ExpenditurePRC Expenditures Expenditures PRC* per PRC Expenditures/PRCTotal Year Disease (Thousands) (Billions) (US$) (Millions) (Thousands) (US$ Billions)1998 982 4,707 4.6Cancer 48.1 10.6 4.51999 977 4,511 4.42000 Breast Cancer 997 5.5 4,1701.1 4.8 4.22001 Colon Cancer 1,015 3.9 4,3810.3 11.5 4.42002 Lung Cancer 1,112 6.3 4,8740.4 17.1 5.42003 Prostate Cancer 1,140 4.3 4,8401.0 4.1 5.5Sources: MEPS, Milken InstituteOther Cancers 28.0 7.7 3.6Pulmonary Conditions 45.2 49.2 0.9Diabetes 27.1 13.7 2.08. .S.L. Stewart et al. Hypertension “Decline in Breast Cancer Incidence 32.5 – United States, 36.8 1999-2003.” Morbidity 0.9 and Mortality WeeklyReport, Center for Disease Heart Disease Control and Prevention, June 64.7 8. 2007; 549-553 19.2 3.4Stroke 13.6 2.4 5.6Mental Disorders 45.8 30.3 1.5[ 41 ]Total 277.0 162.2 1.7PRC: Population Reporting Condition
An Unhealthy AmericaMilken InstituteCOLON CANCERThe incidence rate for colon cancer peaked in 1985, at 66.3 per 100,000 population. With the exception of a minorincrease from 1995 to 1998, the rate generally held steady or declined from the mid-1980s, reaching a low of 49.5 per100,000 people in 2003. Again, lower birthrates during in the 1930s and 1940s played a role. Improved screening anddetection, and a national trend toward promoting regular examinations proved to be significant factors in rate reduction.As with breast cancer, however, the demographic bulge of aging baby boomers is likely to bring the rates back up. Theincidence rate of colon cancer is directly tied to age; for people ages 60–79, the rate is more than fifty times that forpeople 40 and younger. 9Colon cancer was secondonly to lung cancer inexpenditures per PRC in2003, averaging $11,549.Smoking, alcohol consumption, and diet and exercise (and their associations withobesity) remain primary risk factors. A person whose body mass index (BMI) 10 totals35.0–39.9 has a colon cancer risk 84 percent higher than does someone in a moremoderate BMI range of 18.5–24.9. 11 (A BMI of 18.5–24.9 represents normal weight; a scoreof 25–29.9 designates an overweight condition; and a BMI of 30 or more indicates obesity.)Colon cancer was second only to lung cancer in expenditures per PRC in 2003, with the average of $10,750 in 1998 risingto $11,549. The PRC total was actually lowest among the profiled diseases, with 306,000 cases in 1998 and 339,000 in2003. Total expenditures for colon cancer amounted to $3.9 billion in 2003.Colon Cancer Colon Cancer Population Population Reporting Condition (PRC) and ExpenditurePRC Expenditures Expenditures PRC* per PRC Expenditures/PRCTotal ExpendituresYearDisease(Thousands)(Billions)(US$)(Millions) (Thousands)(US$ Billions)1998 306 10,750 3.3Cancer 48.1 10.6 4.51999 301 10,976 3.3Breast Cancer 5.5 1.1 4.82000 307 10,183 3.1Colon Cancer 3.9 0.3 11.52001 309 10,537 3.3Lung Cancer 6.3 0.4 17.12002 324 11,383 3.7Prostate Cancer 4.3 1.0 4.12003 339 11,549 3.9Other Cancers 28.0 7.7 3.6Sources: MEPS, Milken InstitutePulmonary Conditions 45.2 49.2 0.9Diabetes 27.1 13.7 2.0Hypertension 32.5 36.8 0.9LUNG CANCERHeart Disease 64.7 19.2 3.4Lung cancer has been Stroke consistently linked to smoking, but 13.6 the overall effect 2.4 of smoking on national 5.6 data trends is actuallyfairly limited. The greatest Mental Disorders impact on both smoking and 45.8 lung cancer 30.3 rates occurred in the 1.5late 1960s and early 1970s,when the surgeon general’s Total warning labels began appearing 277.0 on cigarette 162.2packaging and advertising, 1.7 and when tobaccoproducts were banned PRC: from Population television Reporting commercials.ConditionOverall incidence rates peaked in 1992, at 69.4 per 100,000 population. By 2003, the incidence rate had declined to 62.7per 100,000. The percentage of Americans smoking fell from 27.7 percent in 1985 to 22.7 percent in 2003, according9. “Colorectal Cancer Facts & Figures Special Edition 2005,” American Cancer Society, http://www.cancer.org/downloads/STT/CAFF2005CR4PWSecured.pdf. (Accessed May, 3, 2007).10. BMI is computed as weight in kilograms divided by height in meters squared.11. E.E. Calle et al. “Overweight, Obesity and Mortality from Cancer in a Prospectively Studied Cohort of U.S. Adults.”New England Journal of Medicine, April 24, 2003: 1625–38.[ 42 ]
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