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

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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 ]
An Unhealthy AmericaMilken InstituteHypertension PRC totals rose by about a third, from 27,264,000 in 1998 to 36,761,000 in 2003. Expenditures per PRC,while the lowest among the diseases profiled, still saw a rise from $670 per PRC to $885 for the period. The lowexpenditures per PRC could be attributable to low levels of hospitalizations and intensive medical care. However, thetendency of hypertension to increase the risks of other, more expensive conditions (such as stroke) results in significantlyhigher potential treatment costs than can be measured just for the disease itself.Hypertension Population Reporting Condition (PRC) and ExpenditureHypertension Population Reporting Condition (PRC) and ExpenditurePRCExpenditures per PRC*Expenditures/PRCTotal YearDisease(Thousands)(Billions)(US$)(Millions) (Thousands)(US$ Billions)1998 27,264 670 18.3Cancer 48.1 10.6 4.51999 28,615 728 20.82000 Breast Cancer 30,039 5.5 750 1.1 4.822.52001 Colon Cancer 31,881 3.9 802 0.3 11.525.62002 Lung Cancer 34,253 6.3 821 0.4 17.128.12003 Prostate Cancer 36,761 4.3 885 1.0 4.132.5Sources: MEPS, Milken InstituteOther Cancers 28.0 7.7 3.6Pulmonary Conditions 45.2 49.2 0.9HEART DISEASEDiabetes 27.1 13.7 2.0Hypertension 32.5 36.8 0.9Heart disease is the Heart leading Disease cause of death in the United 64.7States. The 19.2 term itself refers to 3.4 a wide range of diseases andconditions, including Stroke angina, arrhythmia, heart failure, and 13.6heart attack. 2.4 In 2002, 696,947 people 5.6 died from heart disease,and in 2004, 24.7 million Mental adults Disorders suffered from the disease. 45.8 30.3 1.5Total 277.0 162.2 1.7PRC: Population Reporting ConditionFrom 1984 to 1999, prevalence fell from 15.05 per 100,000 population to 12.10 per 100,000. This decline was largely dueto increased prevention awareness and treatment, as well as new drug classes, including anti-clotting medications,beta-blockers, and angiotension-converting enzyme inhibitors. Since 1999, however, heart disease has been on the rise:up to 12.59 per 100,000 population. The increase is not yet significant, but the links to increased obesity and reducedexercise suggest that rates will climb further. The aging population will also add prevalence numbers. And secondaryeffects of other diseases (cancer, hypertension, and diabetes, for example) can weaken or damage the heart, andcontribute to the upward trend.Total expenditures here were higher than for any other profiled disease—in fact, more than for all forms of cancercombined. The increase over the period was almost entirely due to an upsurge in the number of cases. Expenditures perPRC increased very slightly, from $3,260 in 1998 to $3,381 in 2003. Total costs rose from $55.1 billion in 1998 to $64.7billion in 2003, while PRC totals rose from 16,903,000 to 19,145,000.Heart Disease Population Reporting Condition (PRC) and ExpenditureHeart Disease Population Reporting Condition (PRC) and ExpenditurePRC Expenditures Expenditures per PRC* PRC Expenditures/PRCTotal YearDisease(Thousands)(Billions)(US$)(Millions) (Thousands)(US$ Billions)1998 16,903 3,260 55.1Cancer 48.1 10.6 4.51999 17,082 3,233 55.22000Breast Cancer 17,175 5.5 3,200 1.1 4.8 55.02001Colon Cancer 17,400 3.9 3,331 0.3 11.5 58.02002Lung Cancer 18,236 6.3 3,346 0.4 17.1 61.02003Prostate Cancer 19,145 4.3 3,381 1.0 4.1 64.7Sources: MEPS, Milken InstituteOther Cancers 28.0 7.7 3.6Pulmonary Conditions 45.2 49.2 0.9Diabetes 27.1 13.7 2.026. http://www.cdc.gov/heartdisease/facts.htm. Hypertension (Accessed 32.5January 29, 36.8 2007).0.9Heart Disease 64.7 19.2 3.4[ 48 ]Stroke 13.6 2.4 5.6Mental Disorders 45.8 30.3 1.5Total 277.0 162.2 1.7
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