Costly diseases, many of them related to obesity and smoking, are more prevalent among aging Americans than their European peers and add as much as $100 billion to $150 billion a year in treatment costs to the U.S. healthcare tab, a new study says.
The study by researchers at Emory University's Rollins School of Public Health found higher rates of several serious diseases -- including cancer, diabetes and heart disease -- among Americans 50 and older as compared with aging Europeans.
For example, heart disease was diagnosed in nearly twice as many Americans as Europeans 50 and older. More than 16% of American seniors had diagnosed diabetes, compared with about 11% of their European peers. And arthritis and cancer were more than twice as common among Americans as Europeans.
The study published on the Web today by the journal Health Affairs found that Americans were nearly twice as likely as Europeans to be obese (33.1% versus 17.1%), and they also were more likely to be current or former smokers (53% versus 43%).
"We expected to see differences between disease prevalence in the United States and Europe, but the extent of the differences is surprising," said lead author Kenneth Thorpe, a public health professor at Emory and former deputy assistant secretary of the U.S. Department of Health and Human Services.
Thorpe said the findings suggested that "we spend more on healthcare because we are, indeed, less healthy."
The study has implications for the continuing debate over healthcare reform and attempts to illustrate the economic consequences of lifestyle choices often viewed as intensely personal.
Does the Emory study mean that Americans are actually sicker than Europeans, or that their illnesses are more likely to be diagnosed and treated? Both, the authors said.
When it comes to cancer, the higher diagnosis rate appears to be due to more intensive screening in the U.S., they said. But higher rates of obesity-related diseases and conditions, such as high blood pressure, suggest Americans also are, indeed, sicker.
"I think the big difference is the doubling of obesity rates," Thorpe said.
"If you look at the doctor-diagnosed rates of diabetes and other chronic diseases related to obesity, it's just startling," he said. "It just jumped out at us when we looked at it."
It is the latest look at why the U.S. spends more on healthcare than any of its European counterparts. In 2004, the year of the data the Emory study examined, the U.S. spent $6,102 per capita on healthcare -- about twice that of the Netherlands and Germany and nearly twice that of France.
If older Americans were diagnosed and treated at the lower European rate for 10 common chronic conditions, the authors estimate, this would reduce spending by $100 billion to $150 billion a year, which is 13% to 19% of total U.S. spending on this age group.
The study concludes that the best way to trim U.S. healthcare spending -- or at least curb its rate of increase -- is to put Americans on a diet and encourage other measures aimed at preventing the diseases.
Physicians such as Rob Blackman, a Los Angeles internist, already counsel their patients to take a cue from Europeans in the way they eat -- less fast food -- and the way they pace their lives. Six-week vacations and afternoon siestas help reduce stress that makes people vulnerable to disease, he said.
Such conventions are commonplace in Europe but unheard of in the U.S., so the advice is often easier given than taken.
"Last year I took a 15-day vacation -- first time I took more than 10 days in 30 years," Blackman said. "I couldn't believe how much better I felt. It's like the old saying, 'You don't know how sick you are until you get better.' "
Other studies have sought to explain the spending gap between the U.S. and Europe by comparing factors such as capacity, access to technology and prices.
Thorpe said he hoped the study helped shift the debate over healthcare reform away from arguing about who pays for what to a focus on preventing diseases that affect the quality of life and run up costs.
He said he would like to see the nation embrace obesity and disease prevention the way it targeted cigarette smoking. That campaign slashed smoking rates by more than half.
The U.S. healthcare system -- driven by when and how providers get paid -- does not promote prevention or effective and efficient disease management, Thorpe said.
Instead, he said, "We wait for people to get sick. They show up. We treat them. And doctors and hospitals get paid. That's not a very good way for managing disease."
The Emory study compared 2004 data on disease rates among adults 50 and older in the U.S. and in a group of European countries: Austria, Denmark, France, Germany, Greece, Italy, the Netherlands, Spain, Sweden and Switzerland.
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Percentage of people 50 and older diagnosed with diseases in the U.S. and Europe
High blood pressure
Chronic lung disease
Source: Emory University Rollins School of Public Health
Los Angeles Times