The Cost of Chronic Diseases: millions of lives & Trillions of Dollars

Chronic Diseases: The Leading Causes of Death and Disability in the United States

Chronic diseases are  the most common, costly, and preventable of all health problems. As of 2012, about half of all adults—117 million people—had one or more chronic health conditions. One in four adults had two or more chronic health conditions. (1) Seven of the top 10 causes of death in 2014 were chronic diseases. Two of these chronic diseases—heart disease and cancer—together accounted for nearly 46% of all deaths. (2) Obesity is a serious health concern. During 2011–2014, more than one-third of adults (36%), or about 84 million people, were obese (defined as body mass index [BMI] ≥30 kg/m2). About one in six youths (17%) aged 2 to 19 years was obese (BMI ≥95th percentile). (3) Arthritis is the most common cause of disability (4)  Of the 54 million adults with doctor-diagnosed arthritis, more than 23 million say they have trouble with their usual activities because of arthritis. (5) Diabetes is the leading cause of kidney failure, lower-limb amputations other than those caused by injury, and new cases of blindness among adults. (6)

Health Risk Behaviors that Cause Chronic Diseases

Health risk behaviors are unhealthy behaviors you can change. Four of these health risk behaviors—lack of exercise or physical activity, poor nutrition, tobacco use, and drinking too much alcohol—cause much of the illness, suffering, and early death related to chronic diseases and conditions. In 2015, 50% of adults aged 18 years or older did not meet recommendations for aerobic physical activity. In addition, 79% did not meet recommendations for both aerobic and muscle-strengthening physical activity. (7) More than 1 in 3 adults (about 92.1 million) have at least one type of cardiovascular disease.(8) About 90% of Americans aged 2 years or older consume too much sodium, which can increase their risk of high blood pressure. (9) In 2015, more than 37% of adolescents and 40% of adults said they ate fruit less than once a day, while 39% of adolescents and 22% of adults said they ate vegetables less than once a day. (10) An estimated 36.5 million adults in the United States (15.1%) said they currently smoked cigarettes in 2015. (11) Cigarette smoking accounts for more than 480,000 deaths each year. (12) Each day, more than 3,200 youth younger than 18 years smoke their first cigarette, and another 2,100 youth and young adults who smoke every now and then become daily smokers. (13)

Drinking too much alcohol is responsible for 88,000 deaths each year, more than half of which are due to binge drinking. (13-14) US adults report binge drinking an average of 4 times a month, and have an average of 8 drinks per binge, yet most binge drinkers are not alcohol dependent. (15-16)

I am not talking about oenophiles (sophiticated winos) who drink light to moderately quality wine, especially red. While most non-quality alcoholic beverages are deleterious for the health, quality wine is different. In truth, the World Health Organization’s experts deemed the absence of regular and moderate wine intake as a greater risk than not drinking any wine, while these experts naturally did confirm that too much alcoholic beverages damages health.  See wine workshop.

The Cost of Chronic Diseases and Health Risk Behaviors

In the United States, chronic diseases and conditions and the health risk behaviors that cause them account for most health care costs. Eighty-six percent of the nation’s $2.7 trillion annual health care expenditures are for people with chronic and mental health conditions. These costs can be reduced.(17)  Total annual cardiovascular disease costs to the nation averaged $316.1 billion in 2012–2013. Of this amount, $189.7 billion was for direct medical expenses and $126.4 billion was for lost productivity costs (from premature death). (18) Cancer care cost $157 billion in 2010 dollars. (19) The total estimated cost of diagnosed diabetes in 2012 was $245 billion, including $176 billion in direct medical costs and $69 billion in decreased productivity. Decreased productivity includes costs associated with people being absent from work, being less productive while at work, or not being able to work at all because of diabetes. (20) The total cost of arthritis and related conditions was about $128 billion in 2003. Of this amount, nearly $81 billion was for direct medical costs and $47 billion was for indirect costs associated with lost earnings. (21) Medical costs linked to obesity were estimated to be $147 billion in 2008. Annual medical costs for people who were obese were $1,429 higher than those for people of normal weight in 2006. (22) For the years 2009–2012, economic cost due to smoking is estimated to be at least $300 billion a year. This cost includes nearly $170 billion in direct medical care for adults and more than $156 billion for lost productivity from premature death estimated from 2005 through 2009. (Cf 12) The economic costs of drinking too much alcohol were estimated to be $249 billion, or $2.05 a drink, in 2010. Most of these costs were due to binge unhealthy drinking and resulted from losses in workplace productivity, health care expenses, and crimes related to excessive drinking. (23) Chronic diseases are also associated associated with the rate of mortality. (24).

Reference Notes

  1. Ward BW, Schiller JS, Goodman RA. Multiple chronic conditions among US adults: a 2012 update. Prev Chronic Dis. 2014;11:E62.
  2. Centers for Disease Control and Prevention. Leading causes of death and numbers of deaths, by sex, race, and Hispanic origin: United States, 1980 and 2014 (Table 19). Health, United States, 2015.[PDF – 13.4 MB]. Accessed June 21, 2017.
  3. Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011–2014. NCHS Data Brief. 2015 Nov;(219):1-8.
  4. Brault MW, Hootman J, Helmick CG, Theis KA, Armour BS. Prevalence and most common causes of disability among adults, United States, 2005. MMWR. 2009;58(16):421–426.
  5. Barbour KE, Helmick CG, Boring M, Brady TJ. Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation—United States, 2013-2015. MMWR. 2017;66(9):246–253.
  6. Centers for Disease Control and Prevention. National Diabetes Fact Sheet, 2011.[PDF – 2.66 MB] Accessed December 20, 2013.
  7. US Department of Health and Human Services. Healthy People 2020: Physical Activity. Accessed June 9, 2017.
  8. Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart disease and stroke statistics—2017 update: a report from the American Heart Association. Circulation. 2017;135:e1–e458.
  9. Jackson SL, Coleman King SM, Zhao L, Cogswell ME. Prevalence of sodium intake in the United States. 2016;64(52):1394–1397.
  10. Centers for Disease Control and Prevention. Nutrition, Physical Activity, and Obesity: Data, Trends and Maps. Accessed June 7, 2017.
  11. Jamal A, King BA, Neff LJ, Whitmill J, Babb SD, Graffunder CM. Current cigarette smoking among adults — United States, 2005–2015. 2016;65(44):1205–1211.
  12. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: US Dept. of Health and Human Services, Centers for Disease Control and Prevention; 2014. Accessed February 7, 2014.
  13. Centers for Disease Control and Prevention. Alcohol and Public Health: Alcohol Related Disease Impact (ARDI). Accessed June 1, 2017.
  14. Centers for Disease Control and Prevention. Binge Drinking. Accessed June 1, 2017.
  15. Kanny D, Liu Y, Brewer RD, Lu H. Binge Drinking — United States, 2011. 2013;62 (Suppl):77-80.
  16. Esser MB, Hedden SL, Kanny D, Brewer RD, Gfroerer JC, Naimi TS. Prevalence of alcohol dependence among us adult drinkers, 2009–2011. Prev Chronic Dis. 2014;11:E206.
  17. Gerteis J, Izrael D, Deitz D, LeRoy L, Ricciardi R, Miller T, Basu J. Multiple Chronic Conditions Chartbook.[PDF – 10.62 MB] AHRQ Publications No, Q14-0038. Rockville, MD: Agency for Healthcare Research and Quality; 2014. Accessed November 18, 2014.
  18. Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart disease and stroke statistics—2017 update: a report from the American Heart Association. Circulation. 2017;135:e1–e458.
  19. National Cancer Institute. Cancer Prevalence and Cost of Care Projections. Accessed December 23, 2013.
  20. American Diabetes Association. The Cost of Diabetes. Accessed December 23, 2013.
  21. Centers for Disease Control and Prevention. Arthritis Cost Statistics. Accessed December 23, 2013.
  22. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer- and service-specific estimates. Health Aff.2009;28(5):w822-31.
  23. Sacks JJ, Gonzales KR, Bouchery EE, Tomedi LE, Brewer RD. 2010 National and State Costs of Excessive Alcohol Consumption. Am J Prev Med. 2015; 49(5):e73–e79.

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