Special Report

$1.1 Trillion: What the 10 Leading Causes of Death Cost the U.S. Economy

Last week, the Centers for Disease Control and Prevention (CDC) released its estimated causes of death for 2010. The 10 leading causes of death in the U.S. accounted for 75% of the nearly 2.5 million deaths in 2010. Overall costs for the top 10 causes of death topped $1.1 trillion in 2007, the last fully reported year for all causes. 24/7 Wall St. reviewed the causes to determine how much they cost and to reflect how efficiently they are being treated.

The overall cost for the top 10 causes of death, which includes direct medical care and the indirect loss of productivity, is far greater when the lost wages of family members are taken into account. Since 2000, the overall cost of the top 10 causes of death has increased by an estimated 35%. During this same time, the death rate from these diseases and injuries has decreased by 13.5%.

In some of the areas, spending to treat the disease has been very efficient. For example, the costs attributable to heart disease and stroke (two closely related diseases) have declined both due to decreasing deaths and improvements in the efficiency of care.

In other areas, however, costs have gone up disproportionately compared to the decreases in death rate. For example, while the cost to treat diabetes has risen by 30%, the death rate dropped by only 11%. Of course, when taking lives saved into account, it is tough to decide how much is too much to spend.

Finally, some areas continue to increase in both cost and rate of death. Alzheimer’s disease deaths have increased by more than 50% over the past decade, and total costs have more than doubled. This is likely a function of an aging population and very limited success in treatment.

24/7 Wall St. reviewed the 10 leading causes of death to determine how much they cost and how effectively they’re being treated. We used yearly estimates from the CDC to examine changes in death rates between 2000 and 2010. We also examined data from the National Institutes of Health (NIH), CDC and several national health organizations focused on individual diseases to determine the direct costs for medical care and procedures and the indirect cost of death and lost productivity, as well as to reflect how the leading causes of death individually affect the U.S. economy. The costs for each cause of death are based on the last fully reported year for all causes, 2007. More recent estimates on costs were also referenced when available.

These are the 10 leading causes of death and what they cost the American economy.

10. Suicide
> No. of deaths: 37,793
> Change since 2000: 15% increase in death rate
> Total cost: $36 billion

The age-adjusted suicide rate in America has been steadily increasing over the past decade, and the costs associated with successful and unsuccessful suicide attempts continue to rise. In successful suicide attempts, more than 99.6% of the costs are due to lost wages and work productivity. In 2010, the most recent available estimate, successful suicides cost the economy approximately $34 billion. The overall cost is even higher when all intentionally inflicted self-harm is included. In 2010, there were more than 450,000 injuries in this category, which cost the economy an additional $3 billion in direct medical care costs and $5.1 billion in indirect costs due to lost wages and productivity. The rate of self-inflicted injuries increased by 36% since 2000, a greater increase than suicide itself.

9. Pneumonia and the Flu
> No. of deaths: 50,003
> Change since 2000: 32% decrease in death rate
> Total cost: $40 billion

Despite widespread use of vaccinations, influenza continues to be a major cause of death in the United States. While the death rate due to both pneumonia and flu has fallen by 32% over the past decade, the impact of the flu itself varies widely from year to year. In 2000, flu directly accounted for 1,765 of the 65,313 deaths in the category, compared to 494 of 50,003 in 2010. Much of this variation is due to the differing severity of the flu strains each year, as well as the success of the yearly flu vaccine. Until a better flu vaccine is invented, this wide variation is likely to continue. Pneumonia and the flu cost $6 billion in direct medical care and another $34.2 billion in projected lost earnings in 2007, according to the American Lung Association. This represented an increase of nearly 50% from 2003, the previously reported year.

8. Renal Disease
> No. of deaths: 50,472
> Change since 2000: 21% increase in death rate
> Total cost: $61 billion

Not only do kidney diseases cause an increasing number of deaths every year, their total cost has also been rising at an even faster pace. Dialysis, the process of filtering the blood of a patient with failing kidneys, is an enormously expensive medical procedure. In 2007, direct medical treatments cost the U.S. economy $54 billion. Between 2000 and 2009, the direct costs of kidney diseases doubled in the Medicare budget, from $12 billion to $24 billion, according to the U.S. Renal Data System. As diabetes and obesity rates continue to rise, the costs of damaged kidneys will continue to skyrocket.

7. Diabetes Mellitus
> No. of deaths: 68,905
> Change since 2000: 11% decrease in death rate
> Total cost: $112 billion

Deaths attributable to diabetes have been falling because of increased awareness and treatment of the disease complications. But even as deaths from the disease decline, more and more Americans are diagnosed and the costs of the disease continue to rise. In 2002, the American Diabetes Association (ADA) estimated that the 12.1 million Americans diagnosed with the disease cost twice as much per person in direct medical expenses compared to otherwise similar people without diabetes. That same year, they estimated $92 billion in direct costs and an additional $40 billion in losses to the U.S. economy. By 2007, there were 17.5 million Americans diagnosed with diabetes. That year, according to the ADA, costs jumped to $116 billion in direct costs and $58 billion in lost wages and productivity, for an inflation-adjusted increase of $21 billion over five years. According to the World Diabetes Foundation, 80% of type 2 diabetes, which represents roughly 90% of all cases, is preventable by changing eating habits, increasing physical activity, and improving living situations. Unless people start living a healthier lifestyle, this disease will continue to be a major drain on the U.S. economy.

6. Alzheimer’s Disease
> No. of deaths: 83,308
> Change since 2000: 50% increase in death rate
> Total cost: $70 billion

As of 2011, an estimated 5.4 million Americans are living with Alzheimer’s disease. This number is projected to hit 13.2 million by 2050, according to the Alzheimer’s Association. Alzheimer’s is a very expensive disease with high direct medical costs, as well as lost productivity from patients and unpaid care given by the family and friends. This last category is not counted in government reports as part of the disease’s cost, but was estimated at more than $200 billion in 2010 for over 17 billion hours of unpaid care. As of 2004, total medical costs for Medicare beneficiaries with Alzheimer’s disease were three times the cost of similarly aged people without the disease. From 2005 to 2011, the total direct costs of Alzheimer’s disease increased from $91 billion to $183 billion, according to the Alzheimer’s Association. By 2050, this is projected to increase to $1.1 trillion (in 2011 dollars).

5. Accidents
> No. of deaths: 118,043
> Change since 2000: 7.6% increase in death rate
> Total cost: $308 billion

The rate of accidental injury and death has remained fairly constant over the past decade. It has also remained incredibly expensive. Accidental deaths alone accounted for $91 billion in lost earnings and productivity in 2010. The direct medical costs of all accidental injuries, fatal and nonfatal, accounted for $78 billion. Additional costs due to death, disability and lost productivity accounted for another $233 billion. Despite rather stable costs, accidental death, injury and poisoning account for a greater share of medical spending and indirect losses than all other diseases on the list.

4. Strokes
> No. of deaths: 129,180
> Change since 2000: 31% decrease in death rate
> Total cost: $34 billion

While the total costs of all cardiovascular disease have declined slightly over the past decade, costs attributable to stroke have decreased an impressive inflation-adjusted 46%, according to data from the American Heart Association. Direct and indirect costs have both dropped significantly. These declines have been linked to increased awareness and treatment of major risk factors, including high blood pressure, diabetes and smoking, as well as to improvements in acute stroke care, which appears to decrease both death and long-term disability from stroke. Despite these improvements, stroke remains the leading cause of serious long-term disability in the United States.

3. Chronic Lung Disease (Chronic Lower Respiratory Diseases)
> No. of deaths: 137,789
> Change since 2000: <1% increase in death rate
> Total cost: $65 billion

Chronic lung disease is the third leading cause of death in the U.S., but unlike the top two causes of death, heart disease and cancer, it is not seeing any significant improvement in the death rate. The main contributors to this category of disease are asthma and chronic obstructive pulmonary disease (COPD). As of 2008, there were 23.3 million Americans with asthma, which cost approximately $14.7 billion in direct health care and $5 billion in lost productivity, according to the American Lung Association. Prescription drugs constituted $6.2 billion alone. Another 12.1 million adults have COPD. COPD cost the U.S. economy $42.6 billion in 2007, including $26.7 billion in direct health care expenditures, $8 billion in decreased productivity and $7.9 billion in costs related to death. Smoking remains the number one cause of COPD.

2. Cancer
> No. of deaths: 573,855
> Change since 2000: 7.5% decrease in death rate
> Total cost: $227 billion

In the next five years, cancer is likely to become the number one killer of Americans, if current trends continue. Despite major advances in treatments and increases in the number of people who survive for five years or more, few true “cures” have been found. Real progress is being made, but there is still a long way to go. Direct costs of medical treatments will continue to rise, more than offsetting any gains due to decreased mortality rates. In 2004, direct medical costs to the U.S. economy were $69.4 billion. By 2007, costs were $104 billion, and by 2020, they are projected to range between $160 billion to $200 billion, according to the American Cancer Society. The vast majority of these increases in cost are driven by new medical treatments, usually highly tailored and difficult-to-manufacture drugs that cost $5,000/month on average. One such drug, Gleevec, increased five-year survival rates to 95% (from 70%) for one blood cancer and has been used to varying degrees of success in a different cancers since.

1. Heart Disease
> No. of deaths: 595,444
> Change since 2000: 25% decrease in death rate
> Total cost: $190 billion

Heart disease remains the number one killer of Americans. But deaths due to the disease have been declining at a rapid rate over the past several decades, despite the ever-increasing issues of obesity and diabetes in America. The indirect costs of heart disease due to death have declined from an inflation-adjusted $114 billion in 2000 to $94.8 billion in 2008. Over the same time period, direct costs of medical interventions and care have decreased from an inflation adjusted $129 billion to $96 billion. These declining costs are likely due to major improvements in care. For example, in 2001, only 43% of heart disease patients were counseled on smoking cessation compared to 99% in 2010, according to the American Heart Association. Similarly, only 60% to 85% of patients were discharged from the hospital on all recommended medications in 2001, compared to 92% to 99% in 2010. Additionally, there was a decrease in the number of bypass surgeries, stent placements, angioplasties and diagnostic cardiac catheterizations between 2002 and 2009, likely contributing to the decrease in direct medical costs. Despite the recent trends, total costs are likely to rise over the next couple decades due to an aging population and increased rates of obesity and diabetes.

Baxter B. Allen, MD

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