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

An Unhealthy AmericaMilken InstituteImproved diagnosis and understanding of symptoms have strengthened the obesity link. In 1960, the prevalence ofdiagnosed diabetes among those classified as overweight was 1.6 percent, and among the obese, 2.9 percent. By 2000,these rates had more than doubled for both groups, with a prevalence of 4.2 percent among the overweight and 10.0percent among the obese. 21 Overweight and obese individuals have also been more effectively diagnosed with heartdisease and related diabetes comorbidities.Diabetes has a clear genetic component that can increase risk even more. African Americans are particularly at risk, witha 60 percent greater incidence than that of Caucasians. Twenty-five percent of all African-American women over age 55have diabetes, and 25 percent of all African Americans between 65 and 75 have the disease. 22The PRC totals rose more than 37 percent from 1998 to 2003, from 9,981,000 to 13,729,000. Total expenditures rosenearly 60 percent for the period, from $17.0 billion to $27.1 billion. Expenditures per PRC accounted for only a smallportion of the increase, rising from $1,701 per patient to $1,977.Diabetes Population Reporting Condition (PRC) and ExpenditureDiabetes Population Reporting Condition (PRC) and ExpenditurePRC Expenditures Expenditures PRC* per PRC Expenditures/PRCTotal Year Disease(Thousands)(Billions)(US$)(Millions) (Thousands)(US$ Billions)1998 9,981 1,701 17.0Cancer 48.1 10.6 4.51999 10,784 1,697 18.32000 Breast Cancer 11,423 5.5 1,5621.1 4.8 17.82001 Colon Cancer 12,104 3.9 1,7120.3 11.5 20.72002 Lung Cancer 12,902 6.3 1,8450.4 17.1 23.82003 Prostate Cancer 13,729 4.3 1,9771.0 4.1 27.1Sources: 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 0.9HYPERTENSIONHeart Disease 64.7 19.2 3.4Like diabetes, hypertensionStroke(high blood pressure) presents13.6a number2.4of debilitating symptoms5.6on its own. But it alsoserves as an enabler Mental for comorbidities Disorders that are often more 45.8 destructive 30.3 than the disease itself. 1.5 Chronic hypertension isthe primary risk factor Total for stroke and a principal contributor 277.0 to heart 162.2 attacks. 231.7PRC: Population Reporting ConditionSignificant risk factors include age, high alcohol consumption, obesity, and race. Among women, low alcoholconsumption—less than one drink per day—appears to reduce rates of hypertension below the national average.However, 1.51 to 2.00 drinks per day show a 20 percent risk increase, and two drinks or more per day raise risk by 31percent. 24 Key factors also include being male, African American, and overweight. 2521. E. Gregg et al. “Secular Trends In Cardiovascular Disease Risk Factors According to Body Mass Index in U.S. Adults.”Journal of the American Medical Association. 2005;293(15):1868–1874.22. Statistics from www.blackhealthcare.com. (Accessed January 31, 2007).23. Centers for Disease Control and Prevention. See: www.cdc.gov/bloodpressure. (Accessed January 30, 2007).24. R. Thadhani et al. “Prospective Study of Moderate Alcohol Consumption and Risk of Hypertension in Young Women.”Archives of Internal Medicine, 2002;162(5): 569–574.25. I. Hajjar et al. “Trends in Prevalence, Awareness, Treatment and Control of Hypertension in the United States, 1988-2000.” Journal of the American Medical Association. 1999;281(14):1291–1297.[ 47 ]