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4. Disease Statistics


Cardiovascular, lung, and blood diseases constitute a large morbidity, mortality, and economic burden on individuals, families, and the Nation. Common forms are atherosclerosis, hypertension, COPD, and blood-clotting disorders—embolisms and thromboses. The most serious atherosclerotic diseases are CHD, as manifested by heart attack and angina pectoris, and cerebrovascular disease, as manifested by stroke.

In 2003, cardiovascular, lung, and blood diseases accounted for 1,150,000 deaths and 47 percent of all deaths in the United States (p. 39). The projected economic cost in 2006 for these diseases is expected to be $560 billion, 22 percent of the total economic costs of illness, injuries, and death (p. 55). Of all diseases, heart disease is the leading cause of death, cerebrovascular disease is third (behind cancer), and COPD (including asthma) ranks fourth (p. 42). Cardiovascular and lung diseases account for 3 of the 4 leading causes of death (p. 42) and 5 of the 10 leading causes of infant death (p. 48). Hypertension, heart disease, asthma, and chronic bronchitis are especially prevalent and account for substantial morbidity in Americans (p. 51). Increases in prevalence have been greatest for asthma and heart failure.

The purpose of the biomedical research conducted by the NHLBI is to contribute to the prevention and treatment of cardiovascular, lung, and blood diseases. National disease statistics show that by mid-century, morbidity and mortality from these diseases had reached record high levels. Since then, however, substantial improvements have been achieved, especially over the past 40 years, as shown by the significant decline in mortality rates. Because many of these diseases begin early in life, their early detection and control can reduce the risk of disability and can delay death. Although important advances have been made in the treatment and control of cardiovascular, lung, and blood diseases, these diseases continue to be a major burden on the Nation.

Cardiovascular Diseases

  • In 2003, CVD caused 911,000 deaths—37 percent of all deaths (p. 39).
  • Heart disease is the leading cause of death; the main form, CHD, caused 479,000 deaths in 2003 (pp. 40, 42).
  • The annual number of deaths from CVD increased substantially between 1900 and 1970 and remains high (p. 41).
  • The death rate (not age-adjusted) for CVD increased from 1920 until it peaked in 1968. Since then, the trend has been downward. In 2003, the rate was similar to the rate in 1930 (p. 41).
  • Cerebrovascular disease, the third leading cause of death, accounted for 158,000 deaths in 2003 (pp. 40, 42).
  • Heart disease is second only to all cancers combined in years of potential life lost (p. 42).
  • Among minority groups, heart disease ranks first, and stroke ranks fifth or higher as the leading causes of death (p. 42).
  • The rapid increase in deaths due to heart failure between 1970 and 2003 is a major exception to the mortality decline in CVD (p. 43).
  • Between 1985 and 2002, death rates for heart disease and stroke declined in men and women of all racial/ethnic groups. Declines in death rates for heart disease were greatest in whites and for stroke, were greatest in blacks (p. 44).
  • Because of the rapid decline in mortality from CHD since the peak in 1968, there were 941,000 fewer deaths from CHD in 2003 than would have occurred if there had been no decline (p. 45).
  • Substantial improvements have been made in the treatment of CVD. Since 1975 or 1985, case-fatality rates from hospitalized AMI, stroke, heart failure, and cardiac dysrhythmia declined appreciably (p. 45).
  • The decline in CHD mortality began earlier in the United States than in most countries and outpaced that in most countries (only selected countries are shown) (p. 46).
  • Between 1993 and 2003, the percent decline in death rates for CHD was greatest among white males and least among black females (p. 47).
  • In 2003, an estimated 71.3 million persons in the United States had some form of CVD, 65 million had hypertension, and 13 million had CHD (p. 51).
  • Since the 1960s, there has been a substantial reduction in the prevalence of CVD risk factors: hypertension, smoking, and high cholesterol, but not overweight. The decline in prevalence of hyperten-sion ceased in 1990; since then the prevalence has increased (p. 52).
  • Between 1976–80 and 1999–2002, the percent of persons with hypertension who were aware of their condition, on treatment for it, and having their blood pressure under control increased substantially (p. 53).
  • A 1999–2002 national survey showed only about one-third of hypertensive patients (systolic BP ≥ 140 mm Hg or diastolic BP ≥ 90 mm Hg or on antihypertensive medication) had their condition under control (p. 53).
  • Hospitalization rates for heart failure increased between 1971 and 2003 (p. 54).
  • The estimated economic cost of CVD for 2006 is approximately $403 billion:
    • $258 billion in direct health expenditures
    • $36 billion in indirect cost of morbidity
    • $110 billion in indirect cost of mortality (p. 55).

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Lung Diseases

  • Lung diseases, excluding lung cancer, caused an estimated 243,000 deaths in 2003 (p. 39).
  • COPD caused 122,000 deaths in 2003 and is the fourth leading cause of death (pp. 40, 42).
  • Between 1993 and 2003, death rates for COPD increased substantially in women and decreased in men; mortality for asthma decreased appreciably (p. 47).
  • Between 1980 and 2003, infant death rates for various lung diseases declined markedly (p. 45).
  • Of the eight leading causes of infant mortality, four are lung diseases or have a lung disease component (p. 48). Between 1993 and 2003, changes in mortality for the causes were:
    • Congenital anomalies (-14 percent)
    • Disorders of short gestation (-<1 percent)
    • Sudden infant death syndrome (-60 percent)
    • Respiratory distress syndrome (-57 percent).
  • Lung diseases accounted for 18 percent of all deaths of children under 1 year of age in 2003 (p. 48).
  • The COPD death rate for women in the United States is increasing significantly compared with the rates in several other countries (p. 49).
  • Between 1985 and 2002, death rates for COPD increased for women in all racial/ethnic groups except Asian. For men, they increased in American Indians, decreased in whites and Asians, and were essentially flat in blacks and Hispanics (p. 50).
  • Sleep disorders are increasingly being recognized as an important health problem. The number of physician office visits for sleep apnea, restless legs syndrome, and narcolepsy increased from 1,046,927 in 1990 to 5,798,762 in 2003 (p. 50).
  • Asthma is a common chronic condition, particularly in children (pp. 51, 52, 54).
  • The economic cost of lung diseases is expected to be $144 billion in 2006—$87 billion in direct health expenditures and $57 billion in indirect cost of morbidity and mortality (p. 55).

Blood Diseases

  • An estimated 242,000 deaths, 10 percent of all deaths, were attributed to blood diseases in 2003 (p. 39). These include the following:
    • 232,000 due to blood-clotting disorders
    • 10,000 to diseases of the red blood cell and bleeding disorders (p. 40).
  • A large proportion of deaths from AMI and cerebrovascular disease involve blood-clotting problems (p. 40).
  • In 2006, blood-clotting disorders are expected to cost the Nation’s economy $94 billion, and other blood diseases will cost $13 billion (p. 55).
  • The mean age at death for persons with sickle cell anemia increased from about 28 years in 1979 to 37.3 years in 2002 (not shown).

Deaths From All Causes and Deaths From Cardiovascular, Lung, and Blood Diseases, U.S., 1983 and 2003

  1983 2003
Cause of Death Number of Deaths Percent of Total Number of Deaths Percent of Total
All Causes 2,019,000 100 2,444,000 100
All Cardiovascular, Lung, and Blood Diseases 1,149,000 57 1,150,000 47
Cardiovascular Diseases
992,000 49 911,000 37
Blood
321,000* 16 242,000** 10
Lung
162,000† 8 243,000‡ 10
All Other Causes 870,000 43 1,294,000 53

*Includes 314,000 CVD deaths involving blood-clotting diseases.
**Includes 232,000 CVD deaths involving blood-clotting diseases.
†Includes 12,000 CVD deaths due to pulmonary heart disease.
‡Includes 14,000 CVD deaths due to pulmonary heart disease.
Source: Vital Statistics of the United States, National Center for Health Statistics (NCHS).

Deaths by Major Causes, U.S., 2003
Deaths From Cardiovascular, Lung, and Blood Diseases, U.S., 2003
Deaths by Major Causes, U.S., 2003
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Deaths From Cardiovascular, Lung, and Blood
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*Excludes deaths from pulmonary heart disease (14,000).
†Excludes deaths from blood-clotting disorders and pulmonary embolism (232,000).

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Deaths From Specific Cardiovascular, Lung, and Blood Diseases, U.S., 2003
 
Deaths (Thousands)
Cause of Death Cardiovascular Lung Blood
Acute Myocardial Infarction 171 - 116*
Other Coronary Heart Disease 308 - -
Heart Failure 57 - -
Cerebrovascular Diseases (Stroke) 158 - 103*
Other Atherosclerosis 38 - 4*
Pulmonary Embolism 9 9* 9*
Other Cardiovascular Diseases 170 5* -
Bleeding and Red Blood Cell Diseases - - 10
Chronic Obstructive Pulmonary Disease - 122 -
Asthma - 4 -
Other Airway Diseases - 1 -
Pneumonia - 63 -
Neonatal Pulmonary Disorders - 5 -
Interstitial Lung Diseases - 6 -
Lung Diseases Due to External Agents - 19 -
Other Lung Diseases - 9 -
Total 911 243 242
*Deaths from clotting or pulmonary disorders also are included as cardiovascular deaths.
Note: Total, excluding overlap, is 1,150,000.
Source: Estimated by the NHLBI from Vital Statistics of the United States, NCHS.

 

Deaths From Cardiovascular Diseases, U.S., 2003
Deaths From Lung Diseases, U.S., 2003
Deaths From Blood Diseases, U.S., 2003
Deaths From Cardiovascular Diseases, U.S., 2003
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Deaths From Lung Diseases, U.S., 2003
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Deaths From Blood Diseases, U.S., 2003
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*Includes cardiac dysrhythmias, hypertensive disease, and other heart and blood vessel diseases.   Source: Estimated by the NHLBI from Vital Statistics of the United States, NCHS.

 

Deaths From Cardiovascular Diseases, U.S., 1900–2003
Deaths From Cardiovascular Diseases, U.S., 19002003
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Source: Vital Statistics of the United States, NCHS.

 

Death Rates* for Cardiovascular Diseases, U.S., 1900–2003
Death Rates* for Cardiovascular Diseases, U.S., 1900-2003
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*Not age-adjusted.
Source: Vital Statistics of the United States, NCHS.

 

Ten Leading Causes of Death: Death Rates, U.S., 2003
Ten Leading Causes of Death: Death Rates, U.S., 2003
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Years of potential life lost (millions)‡ 3.6 4.9 0.6 0.6 3.0 0.6 0.3 <0.1 0.2 0.2  
* Includes 164.8 deaths per 100,000 population from CHD.
† COPD and allied conditions (including asthma); the term in the ICD/10 is “chronic lower respiratory diseases.”
‡ Based on the average remaining years of life up to age 77 years.
Note: Bolded diseases are those addressed in Institute programs.
Source: Vital Statistics of the United States, NCHS.

 

Ten Leading Causes of Death Among Minority Groups, U.S., 2002
Ten Leading Causes of Death Among Minority Groups, U.S., 2002
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* Includes deaths among individuals of Asian extraction and Asian-Pacific Islanders.
† Includes deaths among Aleuts and Eskimos.
Note: Bolded causes of death are those addressed in Institute programs.
Source: Vital Statistics of the United States, NCHS.

Death Rates* for Cardiovascular and Noncardiovascular Diseases, U.S., 1963, 1983, and 2003
  Rate* Percent Change Percent Change
Cause of Death 1963 1983 2003 1963–2003 1983-2003
All Causes 1,346 990 831 -38 -16
Cardiovascular Diseases 805 504 307 -62 -39
Coronary Heart Disease
476 316 163 -66 -48
Stroke
174 86† 54 -69 -37
Other
153 102 90 -41 -12
Noncardiovascular Diseases 541 486 524 -3 +8
COPD and Asthma
16 33‡ 42 +164 +28
Other
525 453 482 -8 +6
*Age-adjusted; rate per 100,000 population.
†Comparability ratio (1.0588) applied.
‡Comparability ratio (1.0478) applied.
Source: Vital Statistics of the United States, NCHS.
 
Deaths From Heart Failure, U.S., 1970–2003
Deaths From Heart Failure, U.S., 1970-2003
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Note: The sharp drop occurring in 1989 is attributed to the revision of the death certificate.
Source: Vital Statistics of the United States, NCHS.

 

Death Rates* for Heart Disease by Gender, Race, and Ethnicity, U.S., 1985–2002
Death Rates* for Heart Disease by Gender, Race, and Ethnicity, U.S., 1985-2002
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*Age-adjusted.
†Non-Hispanic.
Note: Each line is a log linear regression derived from the actual rates.
Source: Vital Statistics of the United States, NCHS.

 

Death Rates* for Stroke by Gender, Race, and Ethnicity, U.S., 1985–2002
Death Rates* for Stroke by Gender, Race, and Ethnicity, U.S., 1985-2002
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*Age-adjusted.
†Non-Hispanic.
Note: Each line is a log linear regression derived from the actual rates.
Source: Vital Statistics of the United States, NCHS.

 

Death Rates* for Coronary Heart Disease, U.S., 1950–2003
Actual Rate and Expected Rates if Rise Had Continued or Reached a Plateau
Death Rates* for Coronary Heart Disease, U.S., 1950-2003
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*Age-adjusted.
Source: Vital Statistics of the United States, NCHS.

 

Common Cardiovascular and Lung Diseases With High Percentage Discharged Dead From Hospitals, U.S., 1975, 1985, and 2003
Common Cardiovascular and Lung Diseases With High Percentage Discharged Dead From Hospitals, U.S., 1975, 1985, and 2003
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Source: National Hospital Discharge Survey, NCHS.

 

Death Rates* for Coronary Heart Disease in Men Ages 35–74 Years, Selected Countries, 1970–2003
Death Rates* for Coronary Heart Disease in Men Ages 35-74 Years, Selected Countries, 1970-2003
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* Age-adjusted to the European Standard Population.
Source: World Health Organization.

 

Death Rates* for Coronary Heart Disease in Women Ages 35–74 Years, Selected Countries, 1970–2003
Death Rates* for Coronary Heart Disease in Women Ages 35-74 Years, Selected Countries, 1970-2003
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* Age-adjusted to the European Standard Population.
Source: World Health Organization.

 

Change in Death Rates* for Selected Causes by Race and Gender, U.S., 1993–2003
Change in Death Rates* for Selected Causes by Race and Gender, U.S., 1993-2003
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* Age-adjusted.
Source: Vital Statistics of the United States, NCHS.

 

Death Rates for Lung Diseases in Infants, U.S., 1980–2003
Death Rates for Lung Diseases in Infants, U.S., 1980-2003
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Source: Vital Statistics of the United States, NCHS.

 

Ten Leading Causes of Infant Mortality, U.S., 2003
Ten Leading Causes of Infant Mortality, U.S., 2003
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*Congenital CVD and congenital anomalies of the respiratory system (black bar) represented 42 percent of all infant deaths due to congenital anomalies.
†Between 1993 and 2003, congenital CVD declined 28 percent; congenital anomalies of the respiratory system increased 1 percent; other congenital anomalies declined 6 percent.
NA: Not available.
Note: Bolded diseases are those addressed in Institute programs.
Source: Vital Statistics of the United States, NCHS.

 

Deaths Under Age 1 Year Due to Cardiovascular and Lung Diseases, U.S., 2003
Cause of Death Deaths Under Age 1 Deaths Under Age 1 Year Due to Cardiovascular and Lung Diseases, U.S., 2003
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All Causes 28,422
Cardiovascular Diseases 2,580

Congenital Anomalies

1,746
Other
834
Lung Diseases 5,169
Sudden Infant Death Syndrome
1,994
Respiratory Distress Syndrome
819
Pneumonia
314
Bronchopulmonary Dysplasia (BPD)
238
Atelectasis of Newborn
450
Congenital Anomalies
641

Other Lung Diseases

713
Other Diseases 20,673
Note: Bolded diseases are those addressed in Institute programs.
Source: Vital Statistics of the United States, NCHS.

 

Death Rates* for Chronic Obstructive Pulmonary Disease in Men Ages 35+ Years, Selected Countries, 1980–2003
Death Rates* for Chronic Obstructive Pulmonary Disease in Men Ages 35+ Years, Selected Countries, 1980-2003
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* Age-adjusted to the European Standard Population.
Source: World Health Statistics Annual, WHO.

 

Death Rates* for Chronic Obstructive Pulmonary Disease in Women Ages 35+ Years, Selected Countries, 1980–2003
Death Rates* for Chronic Obstructive Pulmonary Disease in Women Ages 35+ Years, Selected Countries, 1980-2003
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* Age-adjusted to the European Standard Population.
Source: World Health Statistics Annual, WHO.

 

Death Rates* for Chronic Obstructive Pulmonary Disease by Gender, Race, and Ethnicity, U.S., 1985–2002
Death Rates* for Chronic Obstructive Pulmonary Disease by Gender, Race, and Ethnicity, U.S., 1985-2002
Text-only with data points
* Age-adjusted.
† Non-Hispanic.
Note: Each line is a log linear regression derived from the actual rates. Rates from 1999–2002 are modified by the ICD revision comparability ratio.
Source: Vital Statistics of the United States, NCHS.

 

Physician Office Visits for Sleep Disorders, U.S., 1990–2003
Physician Office Visits for Sleep Disorders, U.S., 1990-2003
Text-only with data points
Source: National Ambulatory Medical Care Survey, NCHS.

 

Prevalence of Common Cardiovascular, Lung, and Blood Diseases, U.S., 2003
  Disease
Number
 
  Total Cardiovascular Diseases
71,300,000
 
  Hypertension*
65,000,000
 
  Coronary Heart Disease
13,200,000
 
  Heart Failure
5,000,000
 
  Stroke
5,500,000
 
  Congenital Heart Disease
1,000,000
 
  Asthma
20,600,000
 
  COPD
10,800,000
 
 
Chronic Bronchitis only (age 18+)
8,200,000
 
 
Emphysema only (age 18+)
1,700,000
 
 
Chronic Bronchitis and Emphysema (age 18+)
900,000
 
  Anemias (all forms) (1996)
3,500,000
 
*Systolic blood pressure > 140 mm Hg, diastolic blood pressure > 90 mm Hg, on antihypertensive medication, or told twice of having hypertension.
Note: Some persons are included in more than one diagnostic group, and persons with more than one form of anemia are counted more than once.
Sources:Extrapolated to United States from National Health and Nutrition Examination Survey (NHANES), 1999–2002, and National Health Interview Survey (NHIS), 2002, 2003.

 

Prevalence of Cardiovascular Diseases* in Adults by Age, U.S., 1999–2002
Prevalence of Cardiovascular Diseases* in Adults by Age, U.S., 1999-2002
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*Hypertension, CHD, cerebrovascular disease, or heart failure.
Hypertension = systolic blood pressure > 140 mm Hg, diastolic bloo d pressure > 90 mm Hg, on antihypertensive medication, or told twice of having hypertension.
Source: NHANES, 1999–2002.

 

Prevalence of Common Cardiovascular, Lung, and Blood Diseases by Age, U.S., 2002
Prevalence of Common Cardiovascular, Lung, and Blood Diseases by Age, U.S., 2002
Text-only with data points
Note: Numbers depicted in bars are not additive by disease because some persons have more than one disease.
Source: NHIS 1996 for anemias, 2004 for lung diseases, and NHANES 1999–2002 for CVD.

 

Prevalence of Cardiovascular Disease Risk Factors* in Adults, U.S., 1961–2001
Prevalence of Cardiovascular Disease Risk Factors* in Adults, U.S., 1961-2001
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*Age-adjusted.
Note: Hypertension is systolic blood pressure > 140 mm Hg, diastolic blood pressure is > 90 mm Hg, or on antihypertensive medication. High cholesterol is 240+ mg/dl. Overweight is BMI 25+ kg/m2.
Source: NHIS for smoking (age 18+) and NHANES for the other risk factors (ages 20–74).

 

Hypertensive Population Aware, Treated, and Controlled, Age 18+, U.S., 1976–80 to 1999–2002
Hypertensive Population Aware, Treated, and Controlled, Age 18+, U.S., 1976-80 to 1999-2002
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Hypertensive Population Aware, Treated, and Controlled, Age 18+, U.S., 1976-80 to 1999-2002
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* Systolic blood pressure > 140 mm Hg, diastolic blood pressure > 90 mm Hg, or on antihypertensive medication.
† Systolic blood pressure > 140 mm Hg, diastolic blood pressure > 90 mm Hg, on antihypertensive medication, or told twice of having hypertension. Here, “treated” includes medication use and other means.
Source: NHANES, NCHS.

 

Adult Population With Hypertension* by Age, Gender, and Race, U.S., 1999–2002
Adult Population With Hypertension* by Age, Gender, and Race, U.S., 1999-2002
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* Systolic blood pressure > 140 mm Hg, diastolic blood pressure > 90 mm Hg, on antihypertensive medication, or told twice of having hypertension.
Source: NHANES, NCHS.

 

Hospitalization Rates for Heart Failure, Ages 45–64 Years and 65+ Years, U.S., 1971–2003
Hospitalization Rates for Heart Failure, Ages 45-64 Years and 65+ Years, U.S., 1971-2003
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Source: National Hospital Discharge Survey, NCHS.

 

Persons Experiencing Asthma Episodes in Previous 12 Months by Age, U.S., 1997–2004
Persons Experiencing Asthma Episodes in Previous 12 Months by Age, U.S., 1997-2004
Text-only with data points
Source: National Health Interview Survey, NCHS.

 

Direct and Indirect Economic Costs of Illness by Major Diagnosis, U.S., 2006
 
Amount (Dollars in Billions)
Percent Distribution
 
Indirect Costs
Indirect Costs
  Direct Costs* Morbidity Mortality Total Direct Costs Morbidity Mortality Total
Cardiovascular Disease $257.6 $35.6 $109.8 $403.0 14.6% 17.0% 20.7% 16.1%

    (including Blood Clotting)§

(60.5) (7.9) (25.6) (94.0) (3.4) (3.8) (4.8) (3.8)
Lung Diseases** 87.0 27.4 29.8 144.2 4.9 13.0 5.6 5.8
Blood Diseases 9.0 0.7 2.9 12.6 0.5 0.3 0.5 0.5
Subtotal 353.6 63.7 142.5 559.8 20.1 30.3 26.9 22.4
Diseases of the Digestive System 179.2 10.8 24.0 214.0 10.2 5.1 4.5 8.6
Neoplasms 78.2 17.9 110.2 206.3 4.4 8.5 20.8 8.3
Mental Disorders 141.62 27.6 8.4 177.6 8.0 13.1 1.6 7.1
Diseases of the Nervous System 147.6 8.2 11.9 167.7 8.4 3.9 2.2 6.7
Diseases of the Musculoskeletal System 100.5 21.4 2.7 124.6 5.7 10.2 0.5 5.0
Diseases of the Genitourinary System 74.4 5.5 6.0 85.9 4.2 2.6 1.1 3.4
Endocrine, Nutritional, and Metabolic Diseases 70.8 6.9 19.1 96.8 4.0 3.3 3.6 3.9
Infectious and Parasitic Diseases 36.1 12.7 26.5 75.3 2.0 6.1 5.0 3.0
Diseases of the Skin 39.7 1.6 0.6 41.9 2.3 0.8 0.1 1.7
Other and Unallocated to Diseases 537.8 33.6 177.9 749.3 30.6 16.0 33.6 30.0
Total $1,759.5 $209.9 $529.8 $2,499.2 100% 100% 100% 100%
*Direct costs are personal health care expenditures for hospital and nursing home care, drugs, home care, and physician and other professional services. The estimation method is based on Centers for Medicare & Medicaid Services (CMS) projections for total 2006 health expenditures by type of direct costs and NCHS estimates of direct costs in 1995 for each of the major diagnostic groups. The proportion of costs for 1995 for each diagnostic group is applied to the equivalent 2006 total by type of direct cost.
†Morbidity costs were estimated for 2006 by multiplying NCHS estimates for 1980 by a 1980–2006 percent inflation factor derived from the increase in mean earnings estimated by the Bureau of the Census.
‡The mortality cost for each disease group was estimated for 2006 by first multiplying the number of deaths in 2002 in each age- and sex-specific group by the 2002 present value of lifetime earnings (latest available) discounted at 3 percent; second, summing these estimates for each diagnostic group; and third, multiplying the estimates by a 2002–2006 inflation factor (1.07) based on change in mean earnings.
§Costs of blood-clotting disease are estimated from predetermined proportions of CVD morbidity and mortality statistics for MI, cerebrovascular diseases, and diseases of arteries.
**Does not include lung cancer or leukemia.
Note: Numbers may not add to totals due to rounding.
Source:Estimates by NHLBI; data from the NCHS, the CMS, the Bureau of the Census, and the Institute for Health and Aging, University of California, San Francisco.
Total Economic Costs, U.S., 2006 Economic Costs: Cardiovascular, Lung, and Blood Diseases, U.S., 2006
Total Economic Costs, U.S., 2006
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Economic Costs: Cardiovascular, Lung, and Blood Diseases, U.S., 2006
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