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

An Unhealthy AmericaMilken InstituteSTROKEA stroke is a cardiovascular injury that causes damage directly to the brain by reducing or blocking blood flow. Symptomsand potential costs differ from those associated with other cardiovascular conditions, such as heart disease, but the riskfactors overlap considerably. Men are more likely than women to suffer from stroke, and African Americans have twicethe risk of Caucasians. The greatest risk factor is hypertension, which increases the chance of stroke by four to six times.Other risk factors include age, gender, race, and family history. Of these, age is by far the most significant, with nearly 75percent of strokes occurring in people 65 and older, after which the risk of stroke doubles every ten years. 27The strong causal linkage between hypertension and stroke is reflected in the previous prevalence table. Stroke ratesdeclined from 1984 to 1988, with a spike in 1992 and 1993. Similarly, hypertension rates declined from 1984 to 1990, witha spike in 1991 and 1992. Each then dropped for two years before rising again. The stroke rate declined from 1.97 per100,000 population in 1984 to a low of 1.62 per 100,000 in 1988. Stroke rates have since risen to 2.85 per 100,000 in 2003,despite reductions in smoking.Unlike the other diseases profiled, total stroke expenditures remained stagnant in the 1998–2003 period, at around$13.6 billion. This decrease occurred despite an additional 247,000 PRC in 2003. Expenditures per PRC also decreased,from $6,269 to $5,596, which may be explained by limitations of the MEPS data, which exclude individuals ininstitutionalized care.Stroke Population Reporting Condition (PRC) and ExpenditureStroke Population Reporting Condition (PRC) and ExpenditurePRC Expenditures Expenditures PRC* per PRC Expenditures/PRCTotal Year Disease(Thousands)(Billions)(US$)(Millions) (Thousands)(US$ Billions)1998 2,178 6,269 13.7Cancer 48.1 10.6 4.51999 2,094 6,545 13.72000 Breast Cancer 2,136 5.5 6,1991.1 4.8 13.22001 Colon Cancer 2,190 3.9 6,0190.3 11.5 13.22002 Lung Cancer 2,360 6.3 5,5500.4 17.1 13.12003 Prostate Cancer 2,426 4.3 5,5961.0 4.1 13.6Sources: MEPS, Milken InstituteOther Cancers 28.0 7.7 3.6Pulmonary Conditions 45.2 49.2 0.9Diabetes 27.1 13.7 2.0MENTAL DISORDERS Hypertension 32.5 36.8 0.9The causes of mental Heart illness Disease are complex. Heredity and 64.7 environment 19.2 both play a large role, 3.4and behavioral risk factors,Stroke 13.6 2.4 5.6such as drug and alcohol abuse and diet, can also be contributors. More than half the people with bipolar disorder haveMental Disorders 45.8 30.3 1.5a relative who also suffers a form of depression.Total 277.0 162.2 1.7PRC: Population Reporting ConditionSocioeconomic factors play a significant role in both the likelihood of a depressive disorder onset and its severity. Otherkey factors include marital status and suffering from another chronic condition that includes depression as a comorbidity.In a survey of individuals approaching retirement age (54–65), those who lived alone were 62 percent more likely tosuffer a major depressive episode. Divorced or widowed individuals were 117 percent more likely to experience such anepisode. Individuals who suffered from potentially life-threatening cancer saw their risk increase by 49 percent; fromhypertension, 71 percent; diabetes, 72 percent; stroke, 144 percent; heart disease, 166 percent; and lung disease, 192 percent. 2927. National Stroke Association. See: http://www.stroke.org/site/PageServer?pagename=CONT. (Accessed January 29, 2007).28. National Institute of Mental Health. See: www.nimh.gov.29. D. Dunlop et al. “Racial/Ethnic Differences in Rates of Depression Among Preretirement Adults.” American Journal ofPublic Health. 2003;93(11):1945–1952.[ 49 ]