Quantifying the burden of disease and the expenditure associated with behavioral, physiological, and occupational risk factors

Chronic non-communicable diseases (NCDs) are the leading causes of morbidity and premature mortality, and lead to tremendous health spending. However, many NCDs are largely preventable or manageable through health promotion and prevention activities. The aim of this study is to better understand the relationships between risk factors, medical conditions, and health expenditure in the US. We examine a set of modifiable risks which can be targeted by private and public health promotion and prevention programs.

Disease burden and population attributable fractions (PAFs) which relate risk factors to causes of illness are drawn from the Global Burden of Disease 2013 study. Data on disease expenditure by age, sex, and disease are drawn from the Institute for Health Metrics and Evaluation’s US Disease Expenditure project. The fraction of burden attributed to each risk factor is applied to that burden’s expenditure.  With this, we obtain the amount of savings attributable to the risk factor, had the ideal risk exposure existed. Joint PAFs were developed across a series of risk factors conditional on each other, and consider risk factors such as alcohol use, diet, drug dependence, smoking, physiological risks, and occupational risks. We construct counterfactuals, and assess time trends to compare burden and health expenditure across these different risk factor scenarios. We also assess the cost of each risk factor independently.

Preliminary results show that 41% of health expenditure in 2012 was attributable to modifiable risks. 21% of health expenditure is attributable to the risks that exist in excess to the best peer-country performers. There is a large potential to lower attributable burden of disease and health expenditure by targeting lifestyle risks with effective public and private health promotion and prevention programs. Understanding which risk factors would yield the greatest improvements in health and expenditure savings will help direct targeting and coordination of public and private efforts.