Fatter, More Smokers = Higher Costs

Americans are fatter and smoke more than Europeans, and the health care system more aggressively screens and treats for disease, especially cancer. Those two factors working in tandem add $150 billion a year to the nation's health care tab and are one reason why health care costs are so much higher here than in the rest of the world, a new study on the Health Affairs website claims.

Lead authored by Emory University public health specialist Ken Thorpe, who is emerging as a lead Health and Human Services secretary candidate for the next Democratic administration, the study takes aim at the conventional wisdom that high prices, high technology and high utilization rates are the main reasons for higher health care costs here.

Chronic disease risk factors such as obesity and smoking rates are higher in the United States than in the ten European countries we examined. According to the self-reported data in 2004, 33.1 percent of U.S. adults age fifty and older were obese, compared with 17.1 percent in ten European countries . . . Obesity prevalence among the European countries ranged from a low of 6.6 percent in France to a high of 23.3 percent in Spain. Cigarette consumption, like obesity, is associated with increased risk of a number of the conditions we examined. According to the (data), 53 percent of Americans age fifty and older had smoked or were current smokers, compared with only 43 percent in the European countries. These results are consistent with historical comparisons of U.S.-European smoking patterns.

As a result, the prevalence of heart disease, hypertension, high cholesterol and diabetes were much higher in the U.S. and cancer rates were shockingly twice the level of the European countries considered (12.2 percent versus 5.4 percent). In part, the authors speculate, that is due to more aggressive care of mild or asymptomatic disease. "Are Americans really more likely to develop malignant tumors, or are they just screened more intensely than Europeans are? Comparisons of breast cancer screening rates and five-year cancer survival rates suggest the latter," they write.

Still, that doesn't account for all of the higher cancer rates here, which, like diabetes and heart disease, are closely associated with obesity rates. Higher U.S. prevalence of obesity-related disease "suggests that measures to design to prevent these conditions could yield lower spending in the U.S."