Exploring the Economic Toll of Chronic, Infectious Diseases in the US

October 03, 2023 - The United States is grappling with the relentless challenge of disease burden in the web of healthcare complexities. Chronic and infectious diseases' economic toll reverberates across the nation's healthcare system, affecting patients, providers, and the broader economy. This article explores the multifaceted economic impacts of disease burden in the US, revealing the hidden costs that often remain unseen but profoundly shape our healthcare landscape. 

Disease burden encompasses a spectrum of health challenges, from chronic conditions like diabetes and heart disease to infectious outbreaks like the flu or a global pandemic.  

Healthcare Expenditure 

The strain on the healthcare system is the most immediate and tangible economic impact of disease burden. Chronic diseases, such as diabetes, hypertension, and obesity, require ongoing medical attention, leading to significant healthcare expenditures. According to the Centers for Disease Control and Prevention (CDC), chronic diseases and mental health conditions account for 90% of the nation's healthcare spending, translating to nearly $4.1 trillion annually. 

Lost Workforce Productivity 

While direct healthcare costs like hospital care and prescription drugs are commonly considered, they may only represent a portion of the economic burden of illness, leading to underestimation. One often-overlooked cost is lost labor productivity. 

Beyond direct healthcare costs, diseases greatly affect the nation's workforce productivity. Chronic illnesses can lead to absenteeism and presenteeism (being present at work but not fully productive), reducing employees' overall efficiency. A study by the Integrated Benefits Institute found that health-related productivity losses cost US employers a staggering $530 billion annually. 

Luo et al. conducted a study using 2019 data from the Panels Study of Income Dynamics in the US, focusing on individuals aged between 18 and 64. They found that people with heart disease earned $13,463 less, and those with stroke earned $18,716 less annually than those without these conditions after adjusting for various factors. Extrapolating this data, it is estimated that, in 2018, the US lost $203.3 billion in income due to heart disease and $63.6 billion due to stroke, surpassing the loss from early mortality. 

However, this study has limitations, such as the lack of detailed income loss estimates for specific heart disease and stroke types or severity. Both conditions were self-reported, potentially leading to misclassification. The study's observational nature prevents proving causation and accounting for confounders like socioeconomic status. 

The economic cost of illness comprises direct and indirect costs, with direct healthcare costs estimated at $4.3 trillion annually in the US. The indirect expenses, including lost labor income, lost costs due to early mortality, and the impact on employers, can be substantial. While efforts are made to control direct healthcare costs, indirect costs are often overlooked. 

Preventing chronic diseases like cardiovascular diseases can reduce direct and indirect costs. Atherosclerosis, a common cause of cardiovascular diseases, is preventable through lifestyle changes and medications. Cardiovascular prevention is generally cost-effective, although estimating indirect expenses can be challenging. 

Chronic Diseases’ Impact on Small Businesses 

Although small businesses often bear the brunt of the disease's economic consequences, chronic diseases are a significant cost burden for nearly all individuals and businesses. It is estimated that 99.9% of American companies are small businesses, and almost half (46.8%) of US employees work for small businesses. When employees grapple with chronic diseases or face prolonged illness, these businesses face direct healthcare cost pressures and the ripple effects of a less productive workforce. 

A staggering 75% of healthcare costs are attributed to preventable conditions, placing a heavy financial strain on employers. Here are some key statistics highlighting the impact: 

• Approximately 45% of Americans suffer from at least one chronic disease. 
• Over two-thirds of all deaths result from 5 chronic diseases: heart disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes. 
• Treatment for chronic diseases accounts for roughly $0.96 per dollar for Medicare and $0.83 per dollar for Medicaid. 
• More than one in four Americans have multiple chronic conditions (MCC), which continues to rise. 

Chronic diseases, which last for extended periods and cannot typically be cured, affect 1.7 million lives annually, making them the leading cause of death and disability in the US. Furthermore, chronic diseases are not limited to the elderly, as diagnoses among working-age adults have risen by 25% in the past decade. This epidemic significantly impacts healthcare costs. 

A study conducted at the Milken Institute examined the relationship between chronic disease and absenteeism among full-time workers. The study revealed that the indirect costs of chronic conditions, such as missed workdays, exceed the direct treatment costs. 

To combat this issue, businesses can take steps to improve employee health. While some offer amenities like healthier food options and fitness centers, preventing chronic diseases requires a more proactive approach. Educating employees about behavior modification before conditions become chronic is crucial, and the workplace is an ideal setting for such education.  

Implementing a Workplace Wellness Program, such as the GMS Wellness Program, can provide employees with education and tools to take control of their health and prevent chronic conditions. This proactive approach can ultimately reduce healthcare costs and improve employee well-being. 

Health Disparities and Socioeconomic Impact 

Disease burden does not discriminate, but its impact is disproportionate. Marginalized communities often face higher disease prevalence and limited access to quality healthcare.  

A person's health significantly affects their financial well-being, especially as they age. A 2022 analysis by the National Council on Aging (NCOA) and the LeadingAge LTSS Center at UMass Boston reveals that women and people of color are disproportionately affected by the financial burdens of chronic diseases. These individuals are more likely to face higher treatment costs and lost wages due to chronic illnesses despite having fewer financial resources to rely on. 

Older adults with more chronic conditions often experience greater physical limitations and financial challenges related to healthcare costs. The costliest chronic diseases for older adults, when considering both treatment and lost wages, include Alzheimer's disease, dementia, cancer, and diabetes. Moreover, older women, particularly those with lower household incomes, and people of color bear the highest financial burdens associated with chronic diseases, exacerbating disparities in health and wealth. 

The COVID-19 pandemic laid bare these disparities, with minority communities experiencing higher infection and mortality rates. The economic consequences of these disparities are profound, affecting not only individuals and families but also entire communities and local economies. 

Real-World Examples 

Let's examine a few key examples to shed light on the real-world consequences of disease burden. 

Diabetes Epidemic 

Diabetes, a chronic disease affecting over 37 million Americans — 11.3% of the nation’s population — provides a poignant illustration of the economic impact of the disease. Beyond the staggering healthcare costs, consider the indirect costs like reduced workforce productivity, disability, and premature mortality. 

According to research by the American Diabetes Association, the total costs associated with diagnosed diabetes in the US rose significantly from $245 billion in 2012 to $327 billion in 2017, marking a 26% increase over five years. These costs encompass direct medical expenses of $237 billion and $90 billion in reduced productivity. Major contributors to medical expenditures include hospital inpatient care, prescription medications for diabetes-related complications, anti-diabetic agents, and physician office visits.  

Individuals with diagnosed diabetes incur an average of $16,752 in medical expenses annually, with around $9,601 attributed directly to diabetes. The study also highlights the disproportionate impact on different populations, with government insurance covering most diabetes care costs and variations among states. This research underscores the substantial societal and economic burden posed by diabetes. 

COVID-19 Pandemic 

The COVID-19 pandemic brought the world to its knees, with the US being one of the hardest-hit nations. Beyond the immediate healthcare costs, the pandemic led to widespread job losses, small business closures, and industry disruptions. 

A 2022 Systematic Review published in ClinicoEconomics and Outcomes Research assessed the economic burden of COVID-19, including healthcare resource utilization and costs. Researchers systematically reviewed studies published between January 2020 and February 2021. They found 27 relevant studies that highlighted several key findings. Patients with severe COVID-19 incurred higher costs, primarily driven by factors like ICU admission and mechanical ventilation, resulting in increased medical expenses. Indirect costs, such as productivity losses, were also significant. Older patients tended to have higher costs. A simulation estimated a total direct medical cost of $163.4 billion in the US due to COVID-19. The study underscores the substantial economic impact of the pandemic and emphasizes the importance of preventative measures, including vaccination, to mitigate these costs. 

Opioid Crisis 

The opioid crisis offers another grim example. As highlighted in a congressional report, the economic impact of opioid addiction and overdose crisis in the US surged to nearly $1.5 trillion in 2020 due to the influence of the COVID-19 pandemic, which is expected to continue rising. 

The pandemic led to a significant rise in opioid-related fatalities, particularly from the potent synthetic painkiller fentanyl, further worsening an already tragic and costly national crisis. In 2021, this crisis was responsible for 75% of the total drug overdose deaths, which amounted to 107,000 fatalities, according to CDC data. Notably, between 2020 and 2021, there was a staggering increase of more than 15% in opioid-related death rates. 

“It has become abundantly clear that the opioid epidemic is not only a health crisis but also an economic and national security one,” said Congressman David Trone (D-MD), Co-Founder and Co-Chair of the Bipartisan Addiction and Mental Health Task Force in a 2022 press release. “With the epidemic taking a $1.5 trillion annual toll on our economy, our nation is more vulnerable due to our inaction. Over the last two years, the nation has rallied behind a common cause, investing trillions into research and treatment to cure the Coronavirus. Now, it's time to do the same for the opioid epidemic. With incalculable human cost and a staggering economic impact, this epidemic deserves urgent, collective action on a national scale." 

Disease burden in the US is not solely a medical concern; it's a critical economic issue that permeates every facet of society. Its impact ripples through healthcare expenditure, workforce productivity, and small businesses and exacerbates health disparities. Real-world examples provide sobering insight into the profound economic costs of diseases like diabetes, the opioid crisis, and the COVID-19 pandemic. 

Addressing disease burden requires a multifaceted approach that spans prevention, access to care, and innovation in healthcare technologies. 

The economic impact of disease burden may be invisible at times, but its consequences are felt by all. It's a challenge that requires collective effort, innovative solutions, and a commitment to improving the nation's health and economic well-being. Understanding the economic burden of illness requires looking beyond healthcare costs and considering the societal impact, including lost labor income. Reducing indirect expenses is essential to save money, improve health, and reduce suffering.