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

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An Unhealthy AmericaMilken Instituteto survey data from the Behavioral Risk Factors Surveillance System. The effects of higher cigarette taxes and efforts tolimit secondhand smoke in public places are only just beginning to show up in the data.According to data from the National Center for Health Statistics, a male chain smoker (twenty-five or more cigarettes aday) age 35 and older has a three times greater chance of dying before age 65 than a former smoker of the same age (6.3percent versus 1.9 percent). Even among younger men, ages 35–44, the estimated death rate is 3.2 per 100,000 forformer smokers, compared to 9.3 for moderate smokers (twenty-five cigarettes or less) and 24.8 per 100,000 who smoketwenty-five or more cigarettes a day. By ages 65–74, the death rate of male former smokers rises to 383.3 per 100,000,and the death rate of current chain smokers rises to 1,365.2 per 100,000. 12Environmental factors, such as pollution levels and exposure to toxins, also play a clear role in incidence rates. For urbanresidents, the presence of radon in the home poses a risk of lung cancer. According to the Environmental ProtectionAgency, a non-smoker exposed to only 0.4 picoCurie of radon per liter of air (pCi/L) has a 73 in 10,000 risk of lung cancerdeath. If the rate rises to a significant 10 pCi/L, the lifetime risk of lung cancer death rises to 180 out of 10,000. 13Although the 2003 lung cancer PRC total was relatively low, at 370,000, its economic impact was significant. Expendituresper PRC totaled $17,088 in 2003, leading to a total expenditure of $6.3 billion. This high figure is attributable to treatmentcomplications. It is the largest cost among the profiled cancers.Lung Cancer Population Reporting Condition (PRC) and ExpenditureLung Cancer Population Reporting Condition (PRC) and ExpenditurePRC Expenditures Expenditures PRC* per PRC Expenditures/PRCTotal Year Disease(Thousands)(Billions)(US$)(Millions) (Thousands)(US$ Billions)1998 298 16,928 5.1Cancer 48.1 10.6 4.51999 311 15,497 4.82000 Breast Cancer 325 5.5 14,525 1.1 4.7 4.82001 Colon Cancer 346 3.9 15,180 0.3 11.5 5.22002 Lung Cancer 351 6.3 16,918 0.4 17.1 5.92003 Prostate Cancer 370 4.3 17,088 1.0 6.3 4.1Sources: MEPS, Milken InstituteOther Cancers 28.0 7.7 3.6Pulmonary Conditions 45.2 49.2 0.9Diabetes 27.1 13.7 2.0Hypertension 32.5 36.8 0.9PROSTATE CANCERHeart Disease 64.7 19.2 3.4Prostate cancer incidenceStrokerates exhibit a direct correlation13.6to age. Although2.4clear advances have5.6been made in treatment,the rate trends are mainly Mental attributable Disorders to wider screening. 45.8Prostate cancer 30.3 rates began to 1.5 rise dramatically in the 1980swith the introduction Total of the prostate-specific antigen 277.0 (PSA) exam. From 162.2 1986 to 1992, the incidence 1.7 rate nearly doubled,from 119 per 100,000 PRC: population Population Reporting to 237 per Condition 100,000 people. The rates declined sharply through 1998. As preventativescreenings continued and cases were treated, the numbers normalized.Diet doesn’t appear to be as closely linked to prostate cancer as it is to colon cancer. Still, men with a BMI of 35.0–39.9show a 34 percent higher incidence rate than do men with a BMI of 18.5–24.9. 14 Geography also plays a role in prostate12. Mattson et al. “What Are the Odds that Smoking Will Kill You?” American Journal of Public Health, 1987, Vol. 77, Issue 4: 425–431.13. http://www.epa.gov/radon/risk_assessment.html. (Accessed January 19, 2007).14. D. Albanes et al. “Physical Activity and the Risk of Cancer in the National Health and Nutrition Examination Survey andFollowup.” American Journal of Public Health, 1989;79: 744–750.[ 43 ]
An Unhealthy AmericaMilken Institutecancer incidence. Regional diets and standards of medical care have clear impacts on disease rates that will be examinedin a later discussion of state levels. With greater access to regular exams, urban areas show higher incidence rates andlower overall mortality rates. In fact, disparities in medical care appear to be responsible for between 10 percent and 30percent of the regional variations in prostate cancer rates. 15Prostate cancer shows the lowest expenditures per PRC of the four isolated cancers in this study, rising from $3,793 in1998 to $4,100 in 2003. Total expenditures during this period actually surpassed those of colon cancer, reaching $4.3billion in 2003. This is largely due to a steep increase in the numbers of PRC, up from 771,000 in 1998 to 1,043,000 in 2003.Prostate Cancer Population Reporting Condition (PRC) and ExpenditureProstate Cancer Population Reporting Condition (PRC) and ExpenditurePRCExpenditures per PRC Total ExpendituresYear(Thousands)Expenditures(US$)PRC* Expenditures/PRC(US$ Billions)1998 Disease 771 (Billions) (Millions) 3,793 (Thousands) 2.91999 Cancer 764 48.1 3,642 10.6 4.5 2.82000 Breast Cancer 779 5.5 3,3701.1 4.8 2.62001 Colon Cancer 849 3.9 3,4860.3 11.5 3.02002 Lung Cancer 947 6.3 3,7870.4 17.1 3.62003 Prostate Cancer 1,043 4.3 4,1001.0 4.1 4.3Sources: MEPS, Other Milken Institute Cancers 28.0 7.7 3.6Pulmonary Conditions 45.2 49.2 0.9Diabetes 27.1 13.7 2.0OTHER CANCERS Hypertension 32.5 36.8 0.9Skin cancer is by far the Heart most Disease common cancer, with more 64.7 than one million 19.2 cases diagnosed each 3.4 year. 16 Improved warningshave led to the overall Stroke decline in incidence rates, although 13.6 deaths from melanomas, 2.4 the deadliest 5.6 form of skin cancer, areon the rise. (Skin cancer Mental is not Disorders profiled because of the relatively 45.8 low cost of 30.3 treatment, and low 1.5 mortality and morbidity rates.)Total 277.0 162.2 1.7PRC: Population Reporting ConditionCancers of the liver, kidney, brain, bladder, and uterus, as well as leukemia, are also significant. Most of these, particularlyliver and kidney cancers, are directly affected by such risk factors as alcohol abuse and poor diet. In this category, livercancer and brain cancer have the highest mortality rates. However, because of low incidence rates, they do not constitutea significant share of other cancers.Other Cancers Population Reporting Condition (PRC) and ExpenditureOther Cancers Population Reporting Condition (PRC) and ExpenditurePRCExpenditures per PRC Total ExpendituresYear(Thousands)Expenditures(US$)PRC* Expenditures/PRC(US$ Billions)1998 Disease 6,383 (Billions) (Millions) 3,678 (Thousands) 23.51999 Cancer 6,193 48.1 3,617 10.6 4.5 22.42000 Breast Cancer 6,536 5.5 3,3051.1 4.8 21.62001 Colon Cancer 6,819 3.9 3,6640.3 11.5 25.02002 Lung Cancer 7,243 6.3 3,7430.4 17.1 27.12003 Prostate Cancer 7,689 4.3 3,6441.0 4.1 28.0Sources: MEPS, Other Milken Institute 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 3.415. A. Jemal et al. “Geographic Stroke Patterns of Prostate Cancer 13.6 Mortality and Variations 2.4 in Access 5.6 to Medical Care in the UnitedStates.” Cancer Epidemiology, Mental Disorders Biomarkers and Prevention. 45.8 American Association 30.3 for Cancer Research, 1.5 2005;14(3): 582–5.16. National Cancer Total Institute. See: http://www.cancer.gov/cancertopics/types/skin. 277.0 162.2 (Accessed 1.7 February 2, 2007).PRC: Population Reporting Condition[ 44 ]
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