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

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An Unhealthy AmericaMilken InstituteII: Projecting Avoidable Direct CostsA. Assumptions and SimulationsIf one quits smoking or begins an exercise regimen, the benefits are quickly felt. But long-term projections are necessary inorder to appreciate the broad impacts of behavioral change and improved therapies on chronic disease and treatment costs.In this section, we begin by discussing three models—an aging-only demographic scenario; a pooled cross-sectionalmodel measuring the relationships between behavioral risk factors and selected disease; and a model depicting thepath of screening and treatment innovation.Utilizing these models—two of which include their own baseline and optimistic assumptions—we run simulations tobuild twenty-year projections for overall baseline and optimistic incidence and prevalence rates, PRC totals, andtreatment costs. These projections appear in Section B.Model 1: Aging-Only DemographicModel 1, the aging-only demographic, relies on U.S. Census population projections, which call for a rise in the 65-and-overshare over the twenty-year period: from 12.4 percent in 2003 to 17.4 percent by 2023. We assume no changes in the 2003values for behavioral or demographic risk factors over the projection period, and use the following population cohorts:50-and-over shareThis share slipped from 25.9 percent in 1983 to 25.5 percent in 1992. As baby boomers began to enter the50-and-over age group, their share of overall population increased, reaching 28.5 percent in 2003. The share isprojected to reach 35.6 percent in 2023.The female 50-and-over share of the population slipped from 28.2 percent in 1983 to 27.8 percent in 1992.The first of the baby boomers reached 50 in 1996, and by 2003, the 50-and-over female share rose to30.6 percent. By 2023, the share is projected to hit 37.6 percent.Meanwhile, the male 50-and-over share of the population is projected to rise from 26.3 percent in 2003 to33.6 percent in 2023. By age 50, this segment is likely to see increased rates of diabetes and hypertension.65-and-over shareThe 65-and-over population share is projected to increase from 12.4 percent in 2003 to 17.4 percent in 2023.Over the next twenty years, these aging baby boomers will have a significant impact on incidence rates formost chronic conditions, and particularly for heart disease, hypertension, and stroke (more than 75 percent ofstrokes occur in people over age 65).In 1983, the share of the male population over age 65 totaled 9.7 percent. This figure edged up to 10.5 percentin 2003. The first baby boomer males will reach 65 in 2011, and the population share will increase substantiallyin 2023, to 15.5 percent.While the 65-and-over male population share increases by 47.6 percent in the next twenty years, the femalepopulation share will also increase, but by just 35.9 percent, from 14.2 percent in 2003 to 19.3 percent by 2023.[ 69 ]
An Unhealthy AmericaMilken InstitutePopulation Projections - By Age GroupPopulation ProjectionsBy Age GroupPopulation Projections - 65 and overPopulation Projections65 and overPercentPercentExpenditures PRC* Expenditures/PRC Expenditures PRC*402050 and over Disease(Billions) (Millions)Male 65 and overDisease (Thousands)(Billions) (Millions)65 and overFemale 65 and over65 to 74 Cancer 48.1 18 10.6 Cancer 4.548.1 10.630 75 and overBreast Cancer 5.5 1.1 Breast Cancer 4.85.5 1.1Colon Cancer 3.9 16 0.3 Colon Cancer 11.53.9 0.3Lung Cancer 6.3 0.4 Lung Cancer 17.16.3 0.42014Prostate Cancer 4.3 1.0 Prostate 4.1 Cancer 4.3 1.0Other Cancers 28.0 12 7.7 Other Cancers 3.628.0 7.710Pulmonary Conditions 45.2 49.2 Pulmonary 0.9Conditions 45.2 49.2Diabetes 27.1 10 13.7 Diabetes 2.027.1 13.7Hypertension History Forecast32.5 36.8 Hypertension History 0.9 Forecast32.5 36.8081983 1988 1993 Heart 1998 Disease 2003 2008 2013 2018 2023 64.7 1983 19.219881993 Heart 1998 Disease 3.4 2003 2008 2013 2018 2023 64.7 19.2Source: U.S. Census Bureau Stroke 13.6 Source: U.S. 2.4Census Bureau Stroke 5.613.6 2.4Mental Disorders 45.8 30.3 Mental Disorders 1.545.8 30.3Total 277.0 162.2 Total 1.7277.0 162.265–74 sharePRC: Population Reporting ConditionPRC: Population Reporting ConditionThis age group dipped from 7.0 percent of the population in 1983 to 6.3 percent in 2003. As the first boomersenter the bracket in 2011, they are expected to represent nearly 10 percent of the total population, an increaseof 57 percent from 2003.75-and-over shareThe 75-and-over share climbed from 4.7 percent in 1983 to 6.1 percent in 2003. This share is expected to reach7.5 percent in 2023, increasing at a slower rate over the next twenty years than it did in the previous two decades.To derive projections of incidence/prevalence rates for Model 1, we apply the 2003 age-specific incidence andprevalence rates, shown in the next two tables, to the census projections from 2004 to 2023. The results arestraightforward forecasts of how disease rates change as the population ages.AgeExpendituresAge AgePRC* Expenditures/PRCAge AgeCancerDisease0-49(Billions)50-54*(Millions)55-64 65-74(Thousands)75 and overCancer 48.1 10.6 4.5Cancer 94.4 645.0 1035.4 1917.3 2319.0Breast Cancer 5.5 1.1 4.8Breast CancerColon Cancer42.4 258.23.9319.40.3397.911.5416.5Colon Cancer Lung Cancer 5.7 60.0 6.3 93.10.4 205.5 17.1 339.0Lung Cancer Prostate Cancer 4.6 57.1 4.3 134.41.0 325.8 4.1 380.7Prostate Other Cancer Cancers 5.6 184.7 28.0 453.97.7 936.1 3.6 834.0Other Cancers* Pulmonary Conditions 60.3 305.6 45.2 423.8 49.2 743.0 0.9 1026.2* Incidence Diabetes specific to the age cohort 50-54 was constructed 27.1 using the given 13.7 age cohort 50-and-over, 2.0 55-64, and65 and over. Hypertension 32.5 36.8 0.9Source: National Heart Disease Cancer Institute64.7 19.2 3.4Stroke 13.6 2.4 5.6Mental Disorders 45.8 30.3 1.5Total 277.0 162.2 1.7PRC: Population Reporting ConditionAge-Specific Incidence RatesAge-Specific Incidence Rates - Per 100,000 Population, 2003Per 100,000 Population, 2003[ 70 ]
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