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

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An Unhealthy AmericaMilken InstitutePULMONARY CONDITIONSOf the profiled diseases, asthma displays the highest geographic relationship to prevalence rates. Smoking plays a clearrole in asthma risk, but the overall linkage between the two is relatively minor compared to the impacts of urbanpollution, particularly on children. Smoking and lung cancer incidence rates have declined, but the rates of pulmonaryconditions like asthma continue to rise. As noted in the following chart, rates of pulmonary disease have increased from14.65 per 100,000 population in 1984 to 18.19 in 2003.One significant factor in the increase appears to be motor vehiclepollution. As vehicle ownership rates rise, so does the rate ofchildhood asthma. According to a study at the Keck School ofMedicine at the University of Southern California, a child’s risk of asthmarises 82 percent for every 1.2 kilometers he lives nearer a freeway. 17According to a USC study, a child’s risk ofasthma rises 82 percent for every 1.2kilometers he lives nearer a freeway.Geography is also tied into a strong racial variation in asthma rates, according to the American Lung Association. The muchhigher concentration of African Americans in urban settings contributes to a prevalence rate more than 37 percent higher thanthat for Caucasians. The age-adjusted death rate for asthma among African Americans is three times that of Caucasians. 18Expenditures per PRC in 2003 were the lowest among the profiled diseases. Total expenditures, however, amounted to$45.2 billion, placing it among the most expensive diseases profiled. Pulmonary conditions also saw a clear spike interms of PRC numbers, rising from 40,853,000 in 1998 to 49,206,000 in 2003. At the same time, expenditures per PRCrose from $728 to $919.Pulmonary Conditions Population Reporting Condition (PRC) and ExpenditurePulmonary Conditions Population Reporting Condition (PRC) and ExpenditurePRC Expenditures Expenditures PRC* per PRC Expenditures/PRCTotal Year Disease (Thousands) (Billions) (US$) (Millions) (Thousands) (US$ Billions)1998 40,853 728 29.8Cancer 48.1 10.6 4.51999 41,652 755 31.42000 Breast Cancer 42,278 5.5 8031.1 4.8 33.92001 Colon Cancer 45,030 3.9 8480.3 11.5 38.22002 Lung Cancer 47,562 6.3 8840.4 17.1 42.12003 Prostate Cancer49,206 4.3 9191.0 4.1 45.2Other 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 3.4Stroke 13.6 2.4 5.6Mental Disorders 45.8 30.3 1.5Total 277.0 162.2 1.7Sources: MEPS, Milken InstitutePRC: Population Reporting Condition17. Rob McConnell et al. “Traffic, Susceptibility, and Childhood Asthma.” Environmental Health Perspectives, 2006 May;114(5): 766–772.18. http://www.lungusa/org/site/pp.asp?c=dvLUK9O0E&b=312474.[ 45 ]
An Unhealthy AmericaMilken InstitutePrevalence RatesExpenditures PRC* Expenditures/PRCPulmonaryYear DiseaseDiabetes Hypertension (Billions) Stroke (Millions) Heart (Thousands)Disease Conditions1984 Cancer 4.2 19.9 48.1 2.0 10.6 15.1 4.5 14.71985 Breast Cancer 4.2 19.9 5.5 1.91.1 14.6 4.8 14.61986 Colon Cancer 4.3 19.2 3.9 1.90.3 14.211.514.01987 Lung Cancer 4.3 18.5 6.3 1.80.4 14.417.115.21988 Prostate Cancer 4.0 18.8 4.3 1.61.0 14.8 4.1 15.01989 Other Cancers 4.1 17.7 28.0 1.77.7 13.4 3.6 15.71990 Pulmonary Conditions 3.9 17.0 45.2 1.849.2 13.8 0.9 15.31991 Diabetes 4.5 17.2 27.1 1.813.7 14.5 2.0 15.31992 Hypertension 4.5 17.0 32.5 2.036.8 14.5 0.9 16.61993 Heart Disease 4.6 16.6 64.7 2.019.2 14.5 3.4 16.01994Stroke4.7 17.013.61.82.414.95.617.71995Mental Disorders5.1 17.945.82.030.314.21.517.5Total 277.0 162.2 1.71996 5.5 19.7 2.2 13.4 17.31997PRC: Population Reporting Condition5.9 21.6 2.5 12.9 16.71998 6.1 21.7 2.5 12.4 16.11999 6.4 22.0 2.5 12.1 16.32000 6.9 22.9 2.6 12.5 18.32001 7.3 23.8 2.8 12.6 19.02002 7.4 24.2 2.8 12.4 18.02003 7.7 24.8 2.9 12.6 18.2Source: Trends In Health and Aging, National Center for Health Statistics (CDC)DIABETESU.S. dietary health and physical fitness levels have declined over the past fifteen years. In the same period, diabetesprevalence has nearly doubled, from a low of 3.91 per 100,000 in 1990 to 7.72 in 2003. This rate suggests a strongrelationship with obesity. During the period, the percentage of the population classified as obese—rather than simplyoverweight—rose from 12.81 percent to 22.81 percent. 19A key source for tracking links between diabetes and obesity is the data examining type 2 diabetes in men and womenby body mass index. The prevalence in both men and women with a BMI of 18.5–24.9 is only slightly above 2 percent(2.03 percent and 2.38 percent, respectively), but the prevalence rises rapidly with higher BMIs. For men with a BMI of25–29.9, the prevalence more than doubles, to 4.93 percent, and then doubles again, to 10.10 percent, in men of a BMIof 30–34.9. For women with a BMI of 25–29.9, the ratio is even higher, at 7.12 percent. Although a negligible rise occursin women with BMI of 30–34.9, at 7.24 percent, the ratio for women with a BMI greater than 40 rises to 19.89 percent. 20According to these statistics, nearly one in five women with BMI greater than 40 has type 2 diabetes, compared to onlyone in forty women in the nominal BMI range.19. Based on Behavioral Risk Factor Surveillance System (BRFSS) self-reported rates, which under-report actual rates.20. National Diabetes Information Clearinghouse. See http://diabetes.niddk.nih.gov/dm/pubs/statistics. (Accessed January19, 2007).[ 46 ]
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