Cardiovascular disease claims more lives each year than the next five prevalent causes of death combined. In 2002, cardiovascular disease was a primary or contributing factor in nearly 60 percent of all deaths in the United States.OVERALL COST
An estimated $68 billion annually (not including many of the expenses for drugs to lower cholesterol or blood pressure). Most of these costs (about $41 billion) result from hospital stays.(1)  

COSTS TO EMPLOYERS

In a study of 375,000 employees, two of the five costliest health conditions among employees were heart-related ailments: chest pain, which ranked first, and heart attack, which ranked fifth. (2)  

CONTROLLABLE RISK FACTORS

The greatest risk factors for cardiovascular disease are: tobacco use, high blood cholesterol and other lipids, physical inactivity and overweight/obesity, and diabetes mellitus.(3)  

PREVENTION WORKS

Most risk factors responsible for the development and progression of coronary heart disease are associated with behavior.(4)A study involving 120,000 patients estimated that 80 to 90 percent of heart attacks could be traced to lifestyle factors, including smoking, eating too much, and exercising too little.(5)

SOURCES
(1) American Heart Association. Heart disease and stroke statistics – 2005 (data for year 2002), Dallas, TX.
(2) Agency for Healthcare Research & Quality, 2002. “The Most Expensive Diseases,” Forbes.com April 14, 2005.
(3) Conti & Burton. “The economic impact of depression in a workplace.” Journal of Occupational Medicine, Volume 36, No. 9, Sept. 1994.
(4) Sebregts, Falger & Bar. “Risk factor modification through nonpharmacological interventions in patients with coronary heart disease,” Journal of Psychosomatic Research, Volume 28, No. 5, April 2000.
(5) JAMA, May 2, 2004. 

Diabetes is one of the fastest-growing health problems in the Western world. It was the sixth leading cause of death listed on U.S. death certificates in 2000, contributing to 213,062 deaths.(22)

OVERALL COST
An estimated $28 billion annually. There were 14 million diagnoses for the condition in the U.S. in 2002. Most of the cost came from prescription drugs (id="mce_marker"1 billion) and doctor visits or outpatient care ($6.8 billion).(2)

COSTS TO EMPLOYERS
In a study of employees of one large employer, the incremental cost (medical and reduced productivity) of diabetes among employees ranged from $4,369 to $4,671 annually.(23)

CONTROLLABLE RISK FACTORS
Among the controllable risk factors for type 2 diabetes are obesity, high blood pressure, abnormal cholesterol levels and physical inactivity.(24)

PREVENTION WORKS
In the Diabetes Prevention Program, a federally funded study of 3,234 people at high risk for diabetes, moderate diet and exercise resulting in a 5- to 7-percent weight loss was shown to delay and possibly prevent type 2 diabetes.(24)

A 15-year study involving 2,200 diabetic men found that the death rate for the least fit men was seven times higher than the death rate for the most fit.(25)

SOURCES
(2) Agency for Healthcare Research & Quality, 2002. “The Most Expensive Diseases,” Forbes.com April 14, 2005.
(22) Centers for Disease Control and Prevention. “National diabetes fact sheet: general
information and national estimates on diabetes in the United States, 2002,” U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2003.
(23) Ramsey, Summers et al. “Productivity and Medical Costs of Diabetes
in a Large Employer Population,” Diabetes Care, Vol. 25, No. 1, January 2002.
(24) National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Heath. “Am I at Risk for Type 2 Diabetes?” National Diabetes Information Clearinghouse, 2003.
(25) Diabetes Care, January, 2004.

Hypertension affects approximately 50 million people in the United States and approximately 1 billion worldwide.21 Thirty-seven million Americans have high blood pressure. Aside from increasing their risk of heart attack the condition can lead to kidney damage or even blindness.(2)

OVERALL COST
An estimated $32.5 billion annually. Most of the costs are for drugs (id="mce_marker"7 billion), with another $8.6 billion spent on doctor visits and outpatient care.(2)

COSTS TO EMPLOYERS
In 2002, hypertension patients in the U.S. made 17.2 million office visits and required 1.2 million hospital outpatient department visits.(20)

CONTROLLABLE RISK FACTORS
The higher the blood pressure, the greater the chance of heart attack, heart failure, stroke and
kidney disease.(21)As the population ages, the prevalence of hypertension will increase even further unless broad and effective preventive measures are implemented. Recent data from the Framingham Heart Study suggest that individuals who are normotensive, (having normal blood pressure), at age 55 have a 90 percent lifetime risk for developing hypertension.(21)PREVENTION WORKS
Lifestyle modifications to manage hypertension include: reducing weight; modify diet to reduce sodium and fat and increase fruits, vegetables and low-fat dairy products; engaging in physical activity, and limiting consumption of alcohol.(21)

SOURCES
(2) Agency for Healthcare Research & Quality, 2002. “The Most Expensive Diseases,” Forbes.com April 14, 2005.
(20) Center for Disease Control. Division of Health Care Statistics, August 26, 2004. Advance Data from Vital and Health Statistics, National Ambulatory Medical Care Survey.
(21) US Department of Health and Human Services. NIH, National Heart Lung and Blood Institute,

Cancer will take the lives of nearly 600,000 Americans in 2005 – more than 1,500 people per day. It’s the second leading cause of death in the United States behind heart disease. In the U.S., cancer causes one of every four deaths.(6)

OVERALL COST
An estimated $48 billion annually. In a recent year, 11 million Americans received cancer care, half as many as were treated for heart conditions, but the costs were nearly as much. The $23 billion spent on hospital stays and $21 billion on outpatient care probably also includes the cost of cancer drugs, most of which are given intravenously.(2)

COSTS TO EMPLOYERS
In a 1997 study of one major employer, approximately 6.5 percent of the corporation’s total
health care costs were spent on incremental care for cancer patients.(7)

CONTROLLABLE RISK FACTORS
Being overweight increases the risk for at least 10 types of cancer, including cancers of the colon,
breast, uterus, kidney, esophagus, pancreas, gallbladder, stomach, ovaries and rectum.8
Although colorectal cancer is one of the most preventable forms of visceral cancer, it remains the second leading cause of cancer death in the United States.(9)

PREVENTION WORKS
Increased physical activity has been associated withreduced risk of colon cancer. Among those studies, about a 50 percent reduction in incidence was observed among those with the highest level of activity.(10)

It is estimated that 20 percent of all cancer deaths could be prevented by eliminating tobacco smoking.(11)

Research involving 74,000 women, over 25 years, found that active women, even those with a family history of breast cancer, lowered their risk of the disease by 18%.(12)

SOURCES
(2) Agency for Healthcare Research & Quality, 2002. “The Most Expensive Diseases,” Forbes.com
April 14, 2005.
(6) American Cancer Society. “Cancer Facts and Figures 2005,” American Cancer Society, Atlanta, GA, 2005.
(7) American Journal of Managed Care. “The cost of cancer to a major employer in the United States,” Vol. 6, Issue II, Nov. 2000.
(8) Colditz, Cannuscio & Frazier. “Physical activity and reduced risk of colon cancer: implications for prevention,” Cancer Causes Control, Vol. 8, No. 4, July 1997.
(9) Goetzel, Hawkins et al. “The Health and Productivity Cost Burden of the ‘Top 10’ Physical and Mental Health Conditions Affecting Six Large U.S. Employers in 1999,” Journal of
Occupational and Environmental Medicine, Vol. 45, No. 1, Jan. 2003.
(10) Pisani, Parkin et al. “Estimates of the worldwide mortality from 25 cancers in 1990,” International Journal of Cancer, Vol. 83, Issue 1, Nov. 1999.
(11) Rex. “Screening for colon cancer and evaluation of chemoprevention with coxibs,” Journal of
Pain Symptom Management, April 2002.
(12) JAMA, September 16, 2003 “Recreational Physical Activity and the Risk of Breast Cancer.”

Thirty-one million Americans suffer from various mental illnesses. Depression and anxiety disorders — the two most common mental illnesses — each affect 19 million American adults annually.(13)OVERALL COST
An estimated $48 billion annually. Most of the related costs are for drugs (id="mce_marker"6 billion) and doctor visits and outpatient care (id="mce_marker"3 billion).(2)

COSTS TO EMPLOYERS
Analysis of claims data for a Fortune 100 corporation showed that insureds (employees or family members) with major depression were responsible for 4.2 times the health care costs of an average insured. In addition, workers treated for depression were 2.5 times as likely to file a disability claim.(14)The majority of costs associated with depressive illness can be traced to lost productivity, and the employer, therefore, bears most of the economic burden.(15)

CONTROLLABLE RISK FACTORS
Men and women with mental disorders are twice as likely to smoke, causing other problems. Health studies have shown that mental health improves with exercise.(16)

PREVENTION WORKS
For some types of depression, exercise is more valuable than medication.(17)

SOURCES
(13) National Mental Health Association. “Did You Know?” Data published online at www.nmha.org, reviewed July 28, 2005.
(14) Goldberg & Steury. “Depression in the Workplace: Costs and Barriers to Treatment, Psychiatric Services,” Vol. 52, No. 12, Dec. 2001.
(15) Sullivan. “Promoting health and productivity for depressed patients in the workplace,”
Journal of Managed Care Pharmacy, April 11, 2005.
(16) Reuters Health and biological Psychiatry, 2004.
(17) British Mental Health Foundation. April, 2005. 

Respiratory ailments afflict 50 million Americans. Asthma accounts for approximately 3 million missed workdays for adults annually. (18)

OVERALL COST
An estimated $45 billion annually. The biggest component of the costs is prescription drugs, which account for id="mce_marker"5 billion. Most of the remaining costs are split between doctor visits and hospital stays (both id="mce_marker"2 billion).(2)

COSTS TO EMPLOYERS
In a study of a major employer, annual per capita expenditures for asthmatic patients were approximately 2.5 times those of other subjects. Among asthmatic employees with disability claims, total costs were approximately 3 times higher than those of other employees’ disability claims. For asthmatic employees, wage-replacement costs for workdays lost as a result of disability and sporadic absenteeism accounted for nearly as much cost as did medical care.(19)

CONTROLLABLE RISK FACTORS
Children and spouses of smokers have more respiratory disorders than those of non-smokers.(26)

PREVENTION WORKS
Stress is a common asthma trigger. Reductions in stress levels result in lower levels of asthma.(27)

SOURCES
(2) Agency for Healthcare Research & Quality, 2002. “The Most Expensive Diseases,” Forbes.com
April 14, 2005.
(18) American Lung Association. Jan. 2001.
(19) Birnbaum, Berger, Greenberg et al. “Direct and indirect costs of asthma to an
employer,” Journal of Allergy and Clinical Immunology, Vol. 109, No. 2, Feb. 2002.
(26) National Institute of Environmental Health Sciences. April 2005.
(27) Department of Education and Health Information.