Health care utilization and costs of adult cardiovascular conditions United States, 1980.

Cardiovascular conditions have a major economic as well as health impact on adults in the United States. In the National Medical Care Utilization and Expenditure Survey, conducted during 1980, health service data were obtained from a national sample of 17,123 civilian noninstitutionalized individuals. These data have been analyzed to define the impact and demographic patterns of health care utilization and costs attributable to adult cardiovascular conditions. Approximately 28 million persons in the United States, or 17.3 percent of the total civilian noninstitutionalized population 17 years of age and over, had a cardiovascular condition during 1980. Cardiovascular conditions were reported with increasing frequency in successively older age groups and were reported most frequently by black persons. The prevalence and economic impact differed by specific type of cardiovascular condition and whether the condition was complicated by another disease. To examine these differences, persons reporting cardiovascular conditions were categorized into four mutually exclusive groups: persons with hypertension alone, persons with arteriosclerotic cardiovascular and cerebrovascular disease associated with hypertension, persons with arteriosclerotic cardiovascular disease alone, and persons with cardiovascular disease associated with other conditions that might alter medical care utilization and disability. The disability, service utilization, and health care charges were compared among these groups, and data for each group were compared with those for the overall U.S. population. Survey participants were asked to rate their health relative to that of other people their age. The self-rating of persons reporting hypertension alone was lower than the national average. Only 17 percent of the general population rated their health as "fair" or "poor," but 27 percent of persons with hypertension alone used these descriptions. Overall, persons with hypertension alone were much less likely to be employed than the general population (52.2 percent versus 71.6 percent). However, when controlling for age, it was found that persons with hypertension alone were about as likely to be employed as the general population. On the average, persons with hypertension reported only slightly more work-loss days than did the general population (6.5 versus 4.9 days). A modest restriction of activity was reported by those with hypertension alone (20.1 days per year on the average compared with 15.6 for the general population). The mean number of ambulatory visits per year for those with hypertension alone was 7.9, only slightly greater than the 5.7 average for the overall population.(ABSTRACT TRUNCATED AT 400 WORDS)

Incidence, utilization, and costs associated with acute respiratory conditions, United States, 1980.

Acute respiratory conditions are common causes of health disturbance in the general population. They are generally self-limiting, although occasionally recurrent, and seldom result in large health care costs for each episode of illness. The National Medical Care Utilization and Expenditure Survey (NMCUES), conducted during 1980, provided an opportunity to assess the effect of acute respiratory conditions on utilization of medical services and on functional capability as well as the cost of related medical care. Acute respiratory conditions were reported by survey respondents and separated into five subgroups: colds, influenza, nasopharyngitis, otitis media, and lower respiratory infections. Allergic conditions and chronic respiratory disorders (tuberculosis, chronic obstructive pulmonary disease, and pneumoconioses) were excluded. The subgroupings of acute respiratory conditions appear to separate the disorders in a manner consistent with the epidemiologic characteristics of each condition. About one-half (50.4 percent) of the U.S. civilian noninstitutionalized population had one or more acute respiratory conditions during 1980. The highest rates for upper respiratory conditions (colds, influenza, nasopharyngitis, and otitis media) were reported for those under 18 years of age, and rates were lower in successively older groups. Lower respiratory infection rates were higher in the youngest and oldest groups. Despite a high incidence in the general population, most symptomatic episodes of colds, influenza, and nasopharyngitis did not result in ambulatory care visits or hospital admissions. Otitis media and lower respiratory infections were more often associated with medical visits. Acute respiratory conditions were associated with lower disability levels than the average for the U.S. civilian noninstitutionalized population during 1980 (5.9 restricted-activity days for acute respiratory conditions, compared with an overall average of 13.8 restricted-activity days). Persons with upper respiratory conditions (colds, influenza, otitis media, and nasopharyngitis) averaged 2.3 to 5.4 restricted-activity days, but persons with lower respiratory infections experienced an average of 8.2 restricted-activity days. Indirect costs attributed to acute respiratory conditions in 1980 were $7.7 billion for employed persons and $698 million for homemakers, for a total of $8.4 billion, about the same as total direct costs ($8.3 billion). These indirect costs were several times larger than the annual indirect costs estimated for either cardiovascular diseases or musculoskeletal diseases, two common chronic or recurrent condition groups. The high indirect costs reflect the high frequency of episodes in the general population during 1980 and the greater likelihood of associated bed-disability and work-loss days than for other conditions.(ABSTRACT TRUNCATED AT 400 WORDS)

Costs of illness: United States, 1980.

The total costs of illness and injury in the U.S. civilian noninstitutionalized population in 1980 amounted to $381.7 billion. The direct costs of illness and injury--resource expenditures for the diagnosis, treatment, and management of medical and dental conditions--were $153.9 billion, or 40.3 percent of total costs. Indirect costs--economic losses from morbidity and mortality--were $227.9 billion, or 59.7 percent of total costs. Of indirect costs, $104.9 billion resulted from productivity losses because of morbidity, and $123.0 billion represent the present value of lost productivity from premature mortality based on a net effective discount rate of 4 percent. These estimates, based on data from the 1980. National Medical Care Utilization and Expenditure Survey (NMCUES), differ from other estimates of the costs of illness and injury in 1980 (Gibson and Waldo, 1982; Rice, Hodgson, and Kopstein, 1985). The differences, which can be resolved, are attributable to two major factors: (1) NMCUES includes only the civilian noninstitutionalized population, but the other estimates include the institutionalized population and the military; and (2) NMCUES indirect cost estimates for the population unable to work include persons who were retired for health reasons in 1979 and 1980, disabled homemakers, and other persons who were disabled for the entire year 1980 but were not retired for health reasons in 1979, but the Rice et al. estimates do not include the last two categories in the population unable to work. The principal NMCUES findings on the total costs of illness in the civilian noninstitutionalized population reinforce the importance of considering distributional effects. Persons 65 years of age and over represent one-tenth of this population yet account for more than one-fourth of direct costs and more than their share of total costs, even though the institutionalized elderly are excluded. More than two-thirds of total costs for this age category are accounted for by direct costs. Direct costs also account for more than two-thirds of total costs for people under 17 years of age. However, this youngest age category, which constitutes over one-fourth of the civilian noninstitutionalized population, generates only 12.3 percent of direct costs. In contrast, indirect costs account for well more than 60 percent of total costs for the working-age population (17-64 years of age). Within the working-age population, per capita direct costs are highest among persons who are not full participants in the work force, many of whom are not working full time or at all because of injury or ill health.(ABSTRACT TRUNCATED AT 400 WORDS)

High-volume and low-volume users of health services: United States, 1980.

Data from the National Medical Care Utilization and Expenditure Survey of 1980 are used to examine the characteristics of high-volume users of health care services, contrasting them with low-volume users and those who used no services at all. The three major types of medical care services examined are hospital inpatient care, ambulatory visits, and prescribed medications. Low users were defined, respectively, as those who during the year had either one or two hospital days, one nondental visit to a physician or nonphysician, and one prescribed medicine acquisition. High users were those with, respectively, 17 or more hospital days, 20 or more visits, and 25 or more prescribed medicine acquisitions. A very small percent of the U.S. civilian noninstitutionalized population and of those who used services at all during the year consume a large percent of services in each of the three service types. High users of inpatient hospital care constitute 1.7 percent of the civilian noninstitutionalized population and 15 percent of persons hospitalized during the year, yet they used 54.4 percent of all hospital days used by the reference population. High users of ambulatory services constitute 4.5 percent of the reference population and only 5.7 percent of all users of ambulatory services, yet they accounted for 32.3 percent of all ambulatory visits. For prescribed medications, only 3.7 percent of the civilian noninstitutionalized population are high users, comprising 5.9 percent of all users, but they account for 32.9 percent of all prescription acquisitions. At the other extreme, low users of ambulatory care visits represent 17 percent of the reference population, and 21 percent of all users of such care, but only 3.3 percent of all visits. High users share certain characteristics. They are more likely than low users to be older and poorer, to have poorer health status and more medical conditions, and are more likely to have functional limitations. Both univariate and multivariable analyses show that the most important distinguishing characteristics of high users of any of the three medical services are poor health status, severe functional limitations, and the presence of multiple medical conditions--most importantly cancer, cardiac disorders, musculoskeletal diseases, respiratory diseases, and injuries and poisonings. Almost all high-volume users of every category of service (88 percent for hospital days, 89 percent for ambulatory visits, and 94 percent for prescribed medications) had at least three different diagnostic conditions reported during the year.(ABSTRACT TRUNCATED AT 400 WORDS)

Premature deaths avoided by the antismoking campaign.

The antismoking campaign has encouraged millions of people to quit smoking cigarettes and millions of others not to initiate the habit. Because quitting smoking, or deciding not to start, reduces one's mortality risks relative to the continuing smoker, we estimate that these consumption impacts resulted in the avoidance of more than 200,000 premature smoking-related deaths during 1964-1978. On average, each of these premature deaths averted translates into 23 additional years of life. Furthermore, campaign-related smoking cessation and non-initiation during the 1964-1978 period will result in the avoidance of many more premature deaths in the coming decades. Although these figures suggest that the antismoking campaign has been successful, tens of millions of Americans continue to smoke and the premature deaths avoided constitute only a small fraction of the 4 million deaths attributable to smoking that occurred during the same years.