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

Many causes of health burden in the United States are preventable or manageable through effective health promotion and prevention. The aim of this study is to better understand the relationships between risk factors, medical conditions, and health expenditure. We examine a set of lifestyle risks which can be targeted by private and public health promotion and prevention programs for children, working-aged adults, and adults older than 65 years, and their associated illnesses and health expenditure in 2012.

Disease burden and population attributable fractions (PAFs) relating 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 U.S. Disease Expenditure project. The fraction of disease burden attributed to each risk factor is applied to its expenditure to obtain the amount of savings that could have been achieved had the risk factor been at the ideal scenarios – those which are regularly targeted by health promotion programs. We also apply pragmatic risk factor thresholds to consider the burden and costs averted if the US were able to reduce risk factor prevalence to the best observed level across all countries.

Preliminary results show that decreasing lifestyle risk factors to clinical minimums could prevent a substantial amount of health expenditure. For example, we estimate that from 2006 to 2010 diet-related risk factors contributed to $130 billion in health care expenditure across cardiovascular diseases, circulatory diseases, diabetes, cancer, and musculoskeletal disorders.