June 22, 2024

In a recent study published in the journal Circulation, researchers projected the economic burden of cardiovascular disease and stroke (CVDS) in the United States (U.S.) through 2050, using comprehensive health, economic, and demographic data to inform effective policy and health system interventions.

Study: Forecasting the Economic Burden of Cardiovascular Disease and Stroke in the United States Through 2050: A Presidential Advisory From the American Heart Association. Image Credit: Mr Dasenna / ShutterstockStudy: Forecasting the Economic Burden of Cardiovascular Disease and Stroke in the United States Through 2050: A Presidential Advisory From the American Heart Association. Image Credit: Mr Dasenna / Shutterstock

Background 

In 2022, U.S. healthcare spending reached $4.2 trillion, a 62% increase from a decade earlier, accounting for 17% of Gross Domestic Product (GDP). Per-capita spending was $12,555, 2.5 times higher than in other developed countries. CVDS contributed $251 billion in 2019, with an additional $156 billion in lost productivity. Rising obesity, diabetes, uncontrolled blood pressure, aging, and higher-risk demographic groups are expected to increase CVDS-related costs further. Effective projections and further research are crucial for developing strategies to reduce healthcare costs and improve the prevention and treatment of CVDS.

About the study 

The study projected future cardiovascular costs by estimating baseline healthcare costs for individuals with cardiovascular risk factors or CVDS conditions by age and sex, using nationally representative survey data. Productivity losses from morbidity and premature mortality were also calculated. These costs were projected through 2050, assuming annual increases of 1.91% for health care and 0.8% for productivity costs based on Congressional Budget Office assumptions. Projections accounted for demographic changes, aging, racial or ethnic composition shifts, and recent prevalence trends. Baseline prevalence data from 2015 to 2019 informed projections for 2020 to 2050, with costs aggregated in 2022 U.S. dollars. Uncertainty intervals were estimated using bootstrapping.

U.S. Census data estimated the number of adults aged 20 and older by demographics through 2050. Major cardiovascular risk factors and CVDS conditions, including hypertension, diabetes, and hypercholesterolemia, were quantified. The primary outcome was the inflation-adjusted cost attributable to each risk factor or CVDS condition, including healthcare costs and productivity losses. Healthcare costs were derived from the Medical Expenditure Panel Survey, capturing total annual spending. Future projections assume that actual indirect costs will grow at the estimated average annual earnings growth rate. Costs were examined by sex, age group, race and ethnicity, education, income, and insurance coverage. Analyses were conducted by Research Triangle Institute (RTI) International and funded by the American Heart Association (AHA) without Institutional Review Board review.

Study results 

In 2020, approximately 35% of U.S. adults aged 20 and older received care for cardiovascular risk factors or CVDS conditions, incurring significant economic burdens. Adults receiving care for hypertension incurred an average additional annual health care cost of $2,500 per person, diabetes $7,300, and hypercholesterolemia $1,200. By 2050, healthcare costs attributable to hypertension are projected to rise from $160 billion to $513 billion, diabetes from $186 billion to $765 billion, and hypercholesterolemia from $54 billion to $66 billion. Collectively, these costs are expected to nearly triple, reaching $1.344 trillion by 2050, driven by increasing per-person costs and demographic changes.

The economic burden of cardiovascular conditions is even more pronounced. In 2020, adults receiving care for coronary heart disease had additional annual healthcare costs of $13,000 per person, stroke $35,000, and heart failure $18,000. Total costs for all cardiovascular conditions are projected to rise from $627 billion in 2020 to $1.851 trillion in 2050, increasing from 2.7% to 4.6% of the U.S. GDP. Healthcare costs alone are expected to grow from $393 billion to $1.490 trillion, with 27% of this increase due to rising per-person costs and the remainder from demographic changes. Productivity losses from morbidity and premature mortality are projected to rise from $234 billion to $361 billion, with morbidity losses increasing by 197% and premature mortality losses by 43%.

The projected increases in total costs vary by condition. Costs for coronary heart disease are expected to rise by 124%, from $260 billion to $584 billion, while stroke costs are projected to increase by 535%, from $67 billion to $423 billion. Stroke is expected to see the largest absolute increase in total costs, followed by coronary heart disease and heart failure.

Subgroup analyses reveal differing patterns. The youngest (20-44 years) and oldest (80+ years) age groups will see the most significant increases in cardiovascular disease-related costs, with increases of 261% and 371%, respectively. Women are projected to have lower total costs than men but will experience a higher percentage increase (224% vs. 173%). Costs will also rise significantly across all racial and ethnic groups, with the largest increases in the Asian non-Hispanic and Hispanic populations. By insurance category, Medicare recipients will incur the highest spending increase, from $384 billion to $1.205 trillion. Education and income also influence spending, with the highest costs and growth seen in the most educated and highest-income groups.

Conclusions 

To summarize, based on U.S. Census projections and forecasted prevalence of cardiovascular risk factors and conditions, inflation-adjusted total costs for these factors are expected to nearly triple, and CVDS-related costs will almost quadruple from 2020 to 2050. This increase is driven by significant rises in healthcare spending for coronary heart disease, stroke, atrial fibrillation, and heart failure due to an aging population. These findings highlight the need for timely investments in primary and secondary prevention and cost-control strategies to reduce future healthcare costs. Tailored prevention approaches for specific populations and enhancing healthcare access and affordability are crucial for mitigating these projected increases.

Journal reference:

  • Dhruv S. Kazi,  Mitchell S.V. Elkind,  Anne Deutsch, et al. Forecasting the Economic Burden of Cardiovascular Disease and Stroke in the United States Through 2050: A Presidential Advisory From the American Heart Association, Circulation (2024), DOI –  10.1161/CIR.0000000000001258, 

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