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