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

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An Unhealthy AmericaMilken InstitutePrevalence ProjectionsPrevalence Projections Based on Aging, - Based Thousands on Aging, ThousandsPulmonary ConditionsExpenditures PRC* Expenditures/PRCAge Age Age Age AgeAge Prevalence**Disease(Billions) (Millions) (Thousands)Year* 25-44 45-49 50-64 65-74 75 and over 25 and over (%)Cancer 48.1 10.6 4.52003 10.6 3.1 8.4 3.8 3.1 29.1 16.1Breast Cancer 5.5 1.1 4.82013 10.6 3.1 11.0 5.0 3.5 33.2 16.4Colon Cancer 3.9 0.3 11.52023 11.2 2.9 11.2 7.1 4.6 37.0 16.5DiabetesLung Cancer 6.3 0.4 17.1Prostate Cancer 4.3 1.0 4.1 Prevalence**Year* Other 25-44 Cancers 45-49 50-64 28.0 65-74 75 and 7.7over 25 and over 3.6 (%)2003 Pulmonary 1.9 Conditions 1.3 5.2 45.23.3 49.2 2.8 0.9 14.6 8.12013 Diabetes 1.9 1.2 6.9 27.14.4 13.7 3.1 2.0 17.6 8.72023 Hypertension 2.1 1.2 7.0 32.56.2 36.8 4.1 0.9 20.5 9.1HypertensionHeart Disease 64.7 19.2 3.4Stroke 13.6 2.4 5.6 Prevalence**Year* Mental 25-44 Disorders 45-49 50-64 45.8 65-74 75 and 30.3over 25 and over 1.5 (%)2003 Total 7.5 4.2 16.5 277.09.0 162.2 9.7 1.7 46.8 26.02013 PRC: 7.5 Population Reporting 4.1 Condition 21.5 12.0 10.7 55.9 27.72023 7.9 3.8 22.0 16.9 14.1 64.7 28.9Heart DiseaseYear* 25-44 45-49 50-64 65-74 75 and over 25 and overPrevalence**(%)2003 3.8 1.7 6.8 5.0 6.5 23.8 13.22013 3.8 1.7 9.0 6.7 7.2 28.3 14.02023 4.0 1.6 9.1 9.3 9.5 33.5 14.9StrokeYear* 25-44 45-49 50-64 65-74 75 and over 25 and overPrevalence**(%)2003 0.4 0.2 1.4 1.3 2.0 5.4 3.02013 0.4 0.2 1.8 1.7 2.3 6.5 3.22023 0.4 0.2 1.9 2.4 3.0 7.9 3.5Mental DisordersYear* 0-24 25-44 45-54 55-64 65 and over All agesPRC rate ***(%)2003 202 1,924 1,823 1,303 25,086 30,338 10.42013 211 1,918 1,961 1,817 30,690 36,597 11.52023 223 2,039 1,814 1,963 41,812 47,850 13.9*Selected years for twenty-year projection** Percent of U.S. population age 25 and over*** Population Reporting Condition (PRC) divided by U.S. populationSource: Milken Institute[ 73 ]
An Unhealthy AmericaMilken InstituteModel 2: Pooled, Cross-Sectional ModelModel 2 builds on Model 1 by taking the census-based aging demographic projections and quantifying the impacts ofselected demographic and behavioral risk factors on them. Thus, we build assumptions into the demographics—assumptions about age, race, air quality, weight, activity levels, smoking, and alcohol consumption.To quantify the impacts of risk factors on aging demographics, it is necessary to construct state cross sections, pooledover time, to allow for more significant variation across risk factors. There will be eleven such pooled models, one foreach profiled disease category. (These will be addressed below.) We develop baseline and optimistic assumptions foreach risk factor, and optimistic and baseline projections of incidence/prevalence for each pooled model.The assumptions include:Demographic Risk Factor AssumptionsAfrican-American share of the populationThe African-American share of the population is projected to increase from 12.8 percent in 2000 to approximately14.0 percent in 2023. The prevalence of asthma is greater among African Americans, and the changingcomposition of the general population will drive this component of the baseline forecast for incidence andprevalence. African Americans are more likely than the general population to develop heart disease, andAfrican-American males are more prone to prostate cancer.Hispanic share of the populationBetween 1990 and 2000, the Hispanic share rose from 9.0 percent to 11.3 percent. In 2023, it is projected toincrease to 16.5 percent, pushing up prevalence rates in diabetes and heart disease, holding all other factorsconstant. In fact, the biggest racial/ethnic factor affecting diabetes prevalence over the next twenty years willbe the rising share of the Hispanic population.White share of the populationThe white, non-Hispanic share of the populationis projected to decline, from 80 percent in 2000 to75.3 percent in 2023. But its share of the 65-andoverpopulation will not decline as rapidly.Changing patterns of age and race/ethnicity will likelyhave a significant impact on the nation’s future health, butreducing or eliminating behavioral risks can delay theonset or diminish the severity of these diseases. In ourmodels, the following risk factors generated the largestand most significant impacts.Population Population Projections Projections - By RaceBy RacePercentPercent20Expenditures86PRC*African American - (L)Disease Hispanic - (L) (Billions) (Millions)18White - (R)84Cancer 48.1 10.616Breast Cancer 5.5 1.182Colon Cancer 3.9 0.314Lung Cancer 80 6.3 0.412Prostate Cancer 4.3 1.0Other Cancers 7828.0 7.710Pulmonary Conditions 45.2 49.2876Diabetes 27.1 13.7Hypertension History Forecast32.5 36.86741983 1988 1993 Heart 1998 Disease 2003 2008 2013 2018 2023 64.7 19.2Source: U.S. Census BureauStroke 13.6 2.4Mental Disorders 45.8 30.3Total 277.0 162.2PRC: Population Reporting Condition[ 74 ]
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