The Costs of The Costs of Chronic DiseaseChronic Disease

Jack ZwanzigerJack Zwanziger

School of Public HealthSchool of Public Health

UICUIC

Overview of Chronic Disease in Overview of Chronic Disease in the United Statesthe United States

CancerCancer Cardiovascular Cardiovascular DiseaseDisease

DiabetesDiabetes TobaccoTobacco Overweight Overweight and Obeseand Obese

Deaths/yrDeaths/yr 570,280570,280 927,000927,000 200,000200,000 440,000440,000 112,000112,000

Current # Current # affectedaffected

1.4 1.4 millionmillion

71.3 million71.3 million 18.2 18.2 millionmillion

45.8 45.8 million million

smokerssmokers

60 million 60 million adults, 9 adults, 9

million kidsmillion kids

Direct Direct medical medical costscosts

$69 $69 billionbillion

$273 billion$273 billion $92 $92 billionbillion

$75 $75 billionbillion

$61 billion$61 billion

Indirect Indirect medical medical costscosts

$120 $120 billionbillion

$130 billion$130 billion $40 $40 billionbillion

$80 $80 billionbillion

$56 billion$56 billion

Total Total costscosts

$189 $189 billionbillion

$403 billion$403 billion $132 $132 billionbillion

$150 $150 billionbillion

$117 billion$117 billion

Sources: Centers for Disease Control, American Cancer Society, American Heart AssociationSources: Centers for Disease Control, American Cancer Society, American Heart Association

SummarySummary Chronic diseases account for 70% of all Chronic diseases account for 70% of all

deaths in the United States.  deaths in the United States.  The medical care costs of people with The medical care costs of people with

chronic diseases account for more than 75% chronic diseases account for more than 75% of the nation’s $1.4 trillion medical care of the nation’s $1.4 trillion medical care costs.  costs. 

Chronic diseases account for one-third of the Chronic diseases account for one-third of the years of potential life lost before age 65. years of potential life lost before age 65. 

Chronic diseases increase with ageChronic diseases increase with age    

Diabetes by AgeDiabetes by AgeEstimated total prevalence of diabetes in people aged 20 years or older, by age group— United States, 2005

Source: CDC, 1999–2002 National Health and Nutrition Examination Survey estimates of total prevalence (both diagnosed and undiagnosed) were projected to year 2005.

Diabetes PrevalenceDiabetes PrevalencePrevalence of Diagnosed Diabetes by Age, United States, 1980–2004

Source: CDC, National Center for Chronic Disease Prevention and Health Promotion

Prevalence of Cardiovascular Diseases in Americans Age 20 and Older by Age

and Sex

Source: NHANES: 1999-2002. CDC/NCHS and NHLBI. Includes coronary heart disease, heart failure, stroke and hypertension.

11.2

22.9

86.4

36.2

52.9

68.5

77.8

6.2

17.6

36.6

56.5

75.0

0102030405060708090

100

20-34 35-44 45-54 55-64 65-74 75+

Ages

Per

cen

t o

f P

op

ula

tio

n

Males

Females

Health ExpendituresHealth ExpendituresEstimated Per Capita Health Expenditures, by Age and Sex, 1995

Source: CDC National Center for Chronic Disease Prevention and Health Promotion, citing: From Baby Boom to Elder Boom: Providing Health Care for an Aging Population. Copyright 1996, Watson Wyatt Worldwide.

U.S. Population Projections U.S. Population Projections 2000- 20302000- 2030

(in thousands)(in thousands)

Source: Population Projections Program, Population Division, U.S. Census Bureau, Internet Release Date January 13, 2000

AgeGroup

2000 2010 2020 2030 Numericalchange

2000-2030

PercentChange

2000-2030

Total 275,306 299,862 324,927 351,070 75,764 27.5%

0-9 38,646 39,537 43,354 46,028 7,382 19.1%

10-19 39,805 41,576 42,370 46,615 6,810 17.1%

20-29 36,379 41,000 42,404 43,738 7,359 20.2%

30-39 41,856 38,041 42,438 44,343 2,487 5.9%

40-49 42,519 42,631 38,807 43,405 886 2.1%

50-59 30,589 41,111 41,216 37,770 7,181 23.5%

60-69 20,113 28,411 38,294 38,697 18,584 92.4%

70-79 16,175 16,170 23,348 31,907 15,732 97.3%

80-84 4,913 5,600 6,024 9,638 4,725 96.2%

85+ 4,313 5,786 6,764 8,930 4,617 107.0%

Illinois Population ProjectionsIllinois Population Projections2000-20302000-2030

Source: U.S Census Bureau, Population Division, Interim State Population Projections, 2005. Internet Release Date: April 21, 2005

AgeAgeGroupGroup

20002000 20102010 20202020 20302030 NumericNumericChangeChange

2000-20302000-2030

PercentPercentChange Change

2000-20302000-2030

TotalTotal 12,419,29312,419,293 12,916,89412,916,894 13,236,72013,236,720 13,432,89213,432,892 1,013,5991,013,599 8.2%8.2%

0-90-9 1,806,4071,806,407 1,821,4341,821,434 1,858,0711,858,071 1,841,1841,841,184 34,77734,777 1.9%1.9%

10-1910-19 1,799,0991,799,099 1,736,4111,736,411 1,738,7281,738,728 1,765,7301,765,730 -33,369-33,369 -1.8%-1.8%

20-2920-29 1,742,6021,742,602 1,845,7781,845,778 1,763,8711,763,871 1,768,6791,768,679 26,07726,077 1.5%1.5%

30-3930-39 1,916,8011,916,801 1,747,3741,747,374 1,811,4231,811,423 1,739,2161,739,216 -177,585-177,585 -9.3%-9.3%

40-4940-49 1,860,7961,860,796 1,829,6351,829,635 1,662,8001,662,800 1,718,3611,718,361 -142,435-142,435 -7.6%-7.6%

50-5950-59 1,330,6771,330,677 1,693,7461,693,746 1,649,5651,649,565 1,504,1441,504,144 173,467173,467 13.0%13.0%

60-6960-69 860,329860,329 1,108,3771,108,377 1,387,0921,387,092 1,346,3501,346,350 486,021486,021 56.5%56.5%

70-7970-79 691,752691,752 643,938643,938 843,230843,230 1,061,0761,061,076 369,324369,324 53.4%53.4%

80-8480-84 218,799218,799 230,824230,824 233,527233,527 336,211336,211 117,412117,412 53.7%53.7%

85+85+ 192,301192,301 259,377259,377 288,413288,413 351,941351,941 159,640159,640 83.0%83.0%

Projecting costsProjecting costs Basic assumptionsBasic assumptions

8% underlying growth in healthcare costs 8% underlying growth in healthcare costs (based on 25 years experience)(based on 25 years experience)

Relative expenditures by age groups Relative expenditures by age groups remain the sameremain the same

National and Illinois census projectionsNational and Illinois census projections Nationally, average costs would increase by Nationally, average costs would increase by

~7.7 X (2005 vs 2030); even without aging it ~7.7 X (2005 vs 2030); even without aging it would increase by 6.5Xwould increase by 6.5X

Illinois average costs would increase by Illinois average costs would increase by ~7.6X~7.6X

During the same period the overall economy During the same period the overall economy would be expected to increase by 300-400%would be expected to increase by 300-400%

ImplicationsImplications The rates of increases are unsustainable The rates of increases are unsustainable Aging will accelerate health care cost Aging will accelerate health care cost

increasesincreases Illinois with relatively low population Illinois with relatively low population

growth and rapidly aging population growth and rapidly aging population will face an even greater challenge over will face an even greater challenge over the long termthe long term

Cost savings must be generated from Cost savings must be generated from reductions in chronic disease costs (the reductions in chronic disease costs (the Willie Sutton principle)Willie Sutton principle)