The macroeconomic burden of noncommunicable diseases in the United States: Estimates and projections

RESEARCH ARTICLE The macroeconomic burden of noncommunicable diseases in the United States: Estimates and projections Simiao Chen ID1*, Michael Kuhn2, Klaus Prettner3, David E. Bloom ID4* a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS Citation: Chen S, Kuhn M, Prettner K, Bloom DE (2018) The macroeconomic burden of noncommunicable diseases in the United States: Estimates and projections. PLoS ONE 13(11): e0206702. https://doi.org/10.1371/journal. pone.0206702 Editor: Muhammad Jami Husain, Centers for Disease Control and Prevention, UNITED STATES Received: May 30, 2018 Accepted: October 10, 2018 Published: November 1, 2018 Copyright: © 2018 Chen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 1 Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany, 2 Wittgenstein Centre (IIASA, VID/ÖAW, WU), Vienna Institute of Demography, Vienna, Austria, 3 University of Hohenheim, Institute of Economics, Stuttgart, Germany, 4 Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America * (SC); (DB) Abstract We develop and calibrate a dynamic production function model to assess how noncommunicable diseases (NCDs) will affect U.S. productive capacity in 2015–2050. In this framework, aggregate output is produced according to a human capital–augmented production function that accounts for the effects of projected disease prevalence. NCDs influence the economy through the following pathways: 1) when working-age individuals die of a disease, aggregate output undergoes a direct loss because physical capital can only partially substitute for the loss of human capital in the production process. 2) If working-age individuals suffer from a disease but do not die from it, then, depending on the condition’s severity, they tend to be less productive, might work less, or might retire earlier. 3) Current NCD interventions such as medical treatments and prevention require substantial resources. Part of these resources could otherwise be used for productive investments in infrastructure, education, or research and development. This implies a loss of savings across the population and hampers economy-wide physical capital accumulation. Our results indicate a total loss of USD94.9 trillion (in constant 2010 USD) due to all NCDs. Mental health conditions and cardiovascular diseases impose the highest burdens, followed by cancer, diabetes, and chronic respiratory diseases. In per capita terms, the economic burden of all NCDs in 2015– 2050 is USD265,000. The total NCD burden roughly corresponds to an annual tax rate of 10.8% on aggregate income. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: Research reported in this paper was supported by the National Institute on Aging, National Institutes of Health, under award numbers P30AG024409 and R01AG048037. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This research was also made possible by a grant from the Carnegie Introduction Noncommunicable diseases (NCDs) have decisively replaced infectious diseases and malnutrition as the dominant cause of death globally. They are also the world’s main cause of disability, and their impact is growing over time. Table 1 shows the percentage of total deaths and disability-adjusted life years (DALYs) that NCDs have caused across countries at different stages of sociodemographic development over time according to Global Burden of Disease Study (2016) [1]. NCDs’ rapid growth affects not only developed countries, but also low- and PLOS ONE | https://doi.org/10.1371/journal.pone.0206702 November 1, 2018 1 / 14 Macroeconomic burden of NCDs Corporation of New York (https://www.carnegie. org <https://www.carnegie.org/>). The statements made and views expressed are solely the responsibility of the authors. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: This research was also made possible by a grant from the Carnegie Corporation of New York (https://www.carnegie.org). Carnegie Corporation of New York is the philanthropic foundation established by Andrew Carnegie in 1911. We declare that this does not alter our adherence to PLOS ONE policies on sharing data and materials. The statements made and views expressed are solely the responsibility of the authors. The funder had no role in study design, data collection and analysis, decision to publish, or manuscript preparation. The authors have no role relating to employment, consultancy, patents, products in development, or marketed products for Carnegie Corporation of New York. middle-income countries. These trends are reflective of changes in modifiable risk factors (such as smoking, unhealthy diet, lack of physical activity, and the harmful use of alcohol, which lead to overweight and obesity, raised blood pressure, and raised cholesterol) and nonmodifiable risk factors (such as population aging). In the United States, NCDs account for 89% of all deaths and have long surpassed infectious diseases as the main cause of death [1]. Table 2 shows U.S. prevalence and mortality rates, deaths, and DALYs by specific NCD categories. U.S. prevalence is above average for four of the leading NCDs: cardiovascular diseases, cancer, chronic respiratory diseases, and mental health conditions [1]. Currently, the United States also has a higher mortality rate than the global average for all NCDs and for the five leading NCDs. Across all NCDs, mental and substance use disorders generate substantially higher DALYs in the United States than in other countries. Mental health conditions have a DALY rate of 3,725 per 100,000, which is 1.7 times the global average (i.e., 2,198 per 100,000), or 1.3 times the high-income average (i.e., 2,867 per 100,000) [1]. NCDs are noteworthy not only for their prevalence, but also because they may impose a high economic burden that could rise substantially over the coming decades. NCDs’ global economic burden has been estimated at USD47 trillion in 2010–2030 (measured in real USD with the base year 2010)—equivalent to 75% of global gross domestic product (GDP) in 2010 [2, 3]. However, the methodology used to develop this estimate did not account for productivity losses due to morbidity and relied on poor-quality data. This paper aims to construct new estimates for the United States based on a more comprehensive model and better-quality data. In our model, NCDs can affect economic output through several pathways. First, when working-age individuals die of a disease, labor supply is (...truncated)