GSA presentation

The Importance of Health Promotion for the Older Population: 

The Importance of Health Promotion for the Older Population James S. Marks Centers for Disease Control and Prevention

Trends of Elvis Presley Impersonators: 

Trends of Elvis Presley Impersonators 1977 37 1993 48,000 2010 2,500,000,000 Source: Caen H, San Francisco Chronicle; October 27, 1993

Causes of Death Among US Adults Age 65 and Older, 2001: 

Causes of Death Among US Adults Age 65 and Older, 2001 Source: CDC, National Center for Health Statistics, National Vital Statistics Report, 2002

Leading Causes of Disability Among Persons Aged 15 Years and OlderUnited States, 1999: 

Leading Causes of Disability Among Persons Aged 15 Years and Older United States, 1999 Arthritis or rheumatism Back or spine problem Heart trouble Lung or respiratory trouble Stiffness or deformity of limb Diabetes Blindness or other visual impairment Deafness or hearing trouble Stroke Source: CDC. Prevalence of disabilities and associated health conditions among adults—United States,1999. MMWR 2001;50:120–5. Mental or emotional problem

Self-Reported Health Status Among Adults Age 65 and Older, by Race/EthnicityUnited States, 2001: 

Self-Reported Health Status Among Adults Age 65 and Older, by Race/Ethnicity United States, 2001 Source: CDC, National Health Interview Survey, 2001

Total Cardiovascular Disease Deaths, 1999Age-adjusted death rates per 100,000 population: 

Total Cardiovascular Disease Deaths, 1999 Age-adjusted death rates per 100,000 population Source: National Vital Statistics System, National Center for Health Statistics, CDC 190.5–230.8 231.1–250.0 255.5–284.8 285.1–354.9 United States - 172

What Causes State Variation in Heart Disease Rates?: 

What Causes State Variation in Heart Disease Rates? 200% difference between high and low states Coronary heart disease death rate in 45–75-year-old adults adjusted for modifiable risks like tobacco, overweight, high blood pressure, high cholesterol, physical inactivity, and diabetes Nearly 2/3 of the difference in death rates is explained by differences in these modifiable risks Source: Byers et al. Prev Med 1998;27(3):311–16

Age-Adjusted Death Rates for Lung Cancer and Breast Cancer Among WomenUnited States, 1930–1997: 

Age-Adjusted Death Rates for Lung Cancer and Breast Cancer Among Women United States, 1930–1997 Note: Death rates are age-adjusted to the 1970 population. Sources: Parker et al. 1996; National Center for Health Statistics 1999; Ries et al. 2000; American Cancer Society, unpublished data

Annual Deaths from Smoking Compared with Selected Other Causes in the United States: 

Annual Deaths from Smoking Compared with Selected Other Causes in the United States AIDS Number of Deaths (thousands) Alcohol Motor Vehicle Homicide Illicit Drugs Suicide Smoking 440 400 360 320 280 240 200 160 120 80 40 0 Sources: (AIDS) HIV/AIDS Surveillance Report, 1998; (Alcohol) McGinnis MJ, Foege WH. Review: Actual Causes of Death in the United States.JAMA 1993;270:2207-12; (Motor vehicle) National Highway Transportation Safety Administration, 1998; (Homicide, Suicide) NCHS, vital statistics, 1997; (Illicit drugs) NCHS, vital statistics, 1996; (Smoking) SAMMEC, 1995

Costs of Tobacco: 

Costs of Tobacco About 14% of all Medicaid expenditures are related to smoking* Male smokers will generate on average over $14,000 in additional medical expenditures during their lifetime; for women it is over $16,000† Getting one smoker to quit reduces the medical costs associated with acute myocardial infarction and stroke by $853 during the next 7 years‡ For every dollar invested in cessation for pregnant women, $3 is saved in the short run and $6, in the long run§ * CDC, 2002. Tobacco Control State Highlights 2002: Impact and Opportunity † Hodgson, TA. Milbank Q 1992;70(1):81–125 (figures converted to 2001 dollar values) Wagner et al. Arch Intern Med 1995;155(16):1789–95 ‡ Lightwood JM, Glantz SA. Circulation 1997;96(4):1089–96 § Marks et al. Am J Prev Med 1990;6(5):282–9

Obesity* Trends Among U.S. AdultsBRFSS, 1990: 

Obesity* Trends Among U.S. Adults BRFSS, 1990 No Data andlt;10% 10%–14% (*BMI 30, or ~ 30 lbs overweight for 5’4' woman) Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity* Trends Among U.S. AdultsBRFSS, 1992: 

Obesity* Trends Among U.S. Adults BRFSS, 1992 No Data andlt;10% 10%–14% 15%–19% (*BMI 30, or ~ 30 lbs overweight for 5’4' woman) Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity* Trends Among U.S. AdultsBRFSS, 1994: 

Obesity* Trends Among U.S. Adults BRFSS, 1994 No Data andlt;10% 10%–14% 15%–19% (*BMI 30, or ~ 30 lbs overweight for 5’4' woman) Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity* Trends Among U.S. AdultsBRFSS, 1996: 

Obesity* Trends Among U.S. Adults BRFSS, 1996 No Data andlt;10% 10%–14% 15%–19% (*BMI 30, or ~ 30 lbs overweight for 5’4' woman) Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity* Trends Among U.S. AdultsBRFSS, 1998: 

Obesity* Trends Among U.S. Adults BRFSS, 1998 No Data andlt;10% 10%–14% 15%–19% 20% (*BMI 30, or ~ 30 lbs overweight for 5’4' woman) Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity* Trends Among U.S. AdultsBRFSS, 2000: 

Obesity* Trends Among U.S. Adults BRFSS, 2000 No Data andlt;10% 10%–14% 15%–19% 20% (*BMI 30, or ~ 30 lbs overweight for 5’4' woman) Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity* Trends Among U.S. AdultsBRFSS, 2001: 

Obesity* Trends Among U.S. Adults BRFSS, 2001 (*BMI 30, or ~ 30 lbs overweight for 5’4' woman) No Data andlt;10% 10%–14% 15%–19% 20%-24% 25% Source: Behavioral Risk Factor Surveillance System, CDC.

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Age Group 18-29 30-39 40-49 50-59 60-69 1,200 900 600 300 0 per 10,000 people Disability Increases with Age, But at Much Higher Rates Among the Obese* *Data based on 1996 National Health Interview Survey Sources: National Business Group on Health; Rand Corp. Obese Non-Obese

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Diabetes* Trends Among U.S. Adults, BRFSS 1990, 1995, and 2001 * Includes Gestational Diabetes Sources: Mokdad et al., Diabetes Care 2000;23(9):1278–83; JAMA 2001;286(10):1195–2000 1990 1995 2001 No Data andlt;4% 4%–6% 6%–8% 8%–10% andgt;10%

Years of Life Lost Due to Obesity* and Diabetes†: 

Years of Life Lost Due to Obesity* and Diabetes† Severe obesity (BMI andgt;45) lowers years of life by 13 years for white men and 8 years for white women age 20–30. For blacks the loss was 20 years for men and 5 years for women. Diabetes diagnosed at age 40 leads to a loss of 11.6 years in men and 14.3 years in women. More years of life are lost in blacks than in whites. Source: *Fontaine et al. JAMA 2003;289:187–193 †Narayan et al. JAMA 2003;290:1884–1890

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The addition of walking trails can promote physical activity, especially among women.

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Smoker Overweight Inactive Ratio 11% 58% 5.5 Source: Jones et al. Arch Intern Med 2002;162:2565–71 Non Smoker Normal Weight Active Predicted Likelihood of Developing Coronary Heart Disease, Stroke, or Diabetes by Age 65 Men, Aged 50

Health, Life Expectancy, and Healthcare Spending Among the Elderly (70 years old)*: 

Health, Life Expectancy, and Healthcare Spending Among the Elderly (70 years old)* Life expectancy at age 70 was 14.3 years for persons with no limitations vs. 11.6 years for persons with one or more Lifetime healthcare expenditures from age 70 until death: no limitations $136,000 vs. $145,000 for persons with one or more (1998 dollars) Average annual healthcare expenditures for persons with no limitations = $9,500/yr; for persons with one of more = $12,500/yr. About 32% more. *Adapted from White et al NEJM 2003; 349:1048–55.

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Disability Index,* by Age and Health Risk† University of Pennsylvania Alumni 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 0.00 0.05 0.10 0.15 0.20 0.25 0.30 Disability Index Age * Progression of disability was postponed by approximately 7 years in low risk vs. high risk. † Risk based on body mass index, smoking, exercise; 0-3 point scale for each; low = 0–2 points, moderate = 3–4 points, high = 5–9 points. Note: A disability index of 0.1 = minimal disability. Source: Vita et al. N Engl J Med 1998;338(15):1035–41 High risk Moderate risk Low risk

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The Atlanta Journal-Constitution Tuesday, May 15, 2001

Percent of Population Age 65 and OlderUnited States, 2000: 

Percent of Population Age 65 and Older United States, 2000 Source: U.S. Census Bureau, 2003 5.0–9.9 10.0–14.9 15.0–19.9 Percent

Percent of Population Age 65 and OlderUnited States, 2015: 

5.0–9.9 10.0–14.9 15.0–19.9 20.0–30.0 Percent Source: U.S. Census Bureau, 2003 Percent of Population Age 65 and Older United States, 2015

Percent of Population Age 65 and OlderUnited States, 2025: 

5.0–9.9 10.0–14.9 15.0–19.9 20.0–30.0 Percent Source: U.S. Census Bureau, 2003 Percent of Population Age 65 and Older United States, 2025

An Aging PopulationPercentage of U.S. Population over Age 65: 

An Aging Population Percentage of U.S. Population over Age 65 0 5 10 15 20 25 1930 1950 1970 1990 2010 2030 2050 Year Percentage of Population Source: From Baby Boom to Elder Boom: Providing Health Care for an Aging Population. Washington, DC: Watson Wyatt Worldwide, 1996

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Source: From Baby Boom to Elder Boom: Providing Health Care for an Aging Population. Washington, DC: Watson Wyatt Worldwide, 1996 0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 18,000 andgt; 8 0 7 5 - 7 9 7 0 - 7 4 6 0 - 6 4 5 5 - 5 9 5 0 - 5 4 4 5 - 4 9 4 0 - 4 4 3 5 - 3 9 3 0 - 3 4 2 5 - 2 9 2 0 - 2 4 1 5 - 1 9 1 0 - 1 4 0 - 4 5 - 9 6 5 - 6 9 Women Men D o l l a r s Age in Years Estimated Per Capita Health Expenditures, by Age and Sex, 1995

Growth in National Health Expenditures (NHE),1980–2000: 

Growth in National Health Expenditures (NHE), 1980–2000 Sources: Levit et al. Health Aff 2002;21(1):172–181 *Projection from Heffler et al. Health Aff 2002;21(1):207–18 Total NHE (B) Nursing Home and Home Health Costs (B) Per Capita Costs ($) % of GDP 1980 246 20 1,067 8.8 1993 888 88 3,371 13.4 1998 1,150 123 4,177 13.1 2000 1,300 125 4,637 13.2 2011* 2,815 237 9,216 17.0

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Worker-to-Retiree Ratio Drops Source: Eugene Streuerle and Adam Carasso, Urban Institute. Based on data from the 2001 Social Security Trustees Report. USA Today, December 4, 2001 Projected Number of Workers Paying into Social Security Fund Compared with Number of Retirees Withdrawing from the Fund 0 1 2 3 4 5 6 7 8 9 1955 1980 2005 2030 2050 8.6 3.4 2.0 projected

“Population ageing is first and foremost a success story for public health policies as well as social and economic development.”: 

Gro Harlem Brundtland, Director-General World Health Organization 1999 'Population ageing is first and foremost a success story for public health policies as well as social and economic development.'