{"id":17847,"date":"2024-08-25T18:12:46","date_gmt":"2024-08-25T17:12:46","guid":{"rendered":"https:\/\/drugprevent.org.uk\/ppp\/?p=17847"},"modified":"2024-10-05T15:23:15","modified_gmt":"2024-10-05T14:23:15","slug":"the-economic-burden-of-cancer-coronary-heart-disease-dementia-and-stroke-in-england-in-2018","status":"publish","type":"post","link":"https:\/\/drugprevent.org.uk\/ppp\/2024\/08\/the-economic-burden-of-cancer-coronary-heart-disease-dementia-and-stroke-in-england-in-2018\/","title":{"rendered":"England\u2019s 4 biggest killer diseases: \u00a386billion by 2050"},"content":{"rendered":"<div class=\"ux3\" data-widget-def=\"graphQueryWidget\" data-widget-id=\"976622aa-0816-4ece-b3da-25a2b18d03ef\">\n<div id=\"976622aa-0816-4ece-b3da-25a2b18d03ef\" class=\"widget graphQueryWidget none top-padding-handler noMargin widget-none widget-compact-all fonts-loaded\">\n<div class=\"wrapped \">\n<div class=\"widget-body body body-none body-compact-all\">\n<nav id=\"mega-menu-nav\" class=\"mega-menu-nav\" role=\"navigation\">\n<div class=\"mega-menu-nav__wrapper\">\n<div class=\"mega-menu-nav__quick-search\">\n<div class=\"quick-search\" data-widget-id=\"5c9e10b9-1f29-4a3f-851e-330190da5b12\" data-widget-name=\"UX3QuickSearchWidget\">\n<div class=\"dropBlock\"><strong style=\"font-size: 14pt;\">This paper examines the costs to society of\u00a0 illnesses including cancer, coronary heart disease and stroke in England in 2018, it then gives projections to 2050, and concludes with an evaluation of two cohort studies.<\/strong><\/div>\n<div><\/div>\n<div><span style=\"font-size: 14pt;\"><strong>The principal authors of this paper are shown below, and a link to supplementary authors is also given.<\/strong><\/span><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/nav>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<article data-widget-id=\"613c3767-893e-4bf8-99cb-7afbffa7b9ed\" data-widget-name=\"UX3articleContent\" data-pii=\"S2666-7568(24)00108-9\">\n<div id=\"articleHeader\" class=\"article__header low-height\">\n<div class=\"article-header\">\n<div class=\"article-header__wrapper\">\n<div class=\"article-header__top\">\n<div class=\"row\">\n<div class=\"col-md-6\">\n<div class=\"article-header__dropZone pb-dropzone\" data-pb-dropzone=\"articleTools-dropzone\">\n<div class=\"article-tools\" data-widget-id=\"daeead20-90ca-40c7-9a88-59138e573056\" data-widget-name=\"UX3ArticleToolsWidget\">\n<div class=\"article-tools__wrapper\"><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"article-header__middle\">\n<ul class=\"rlist loa inline-bullet-list \" data-number-of-author=\"6\">\n<li class=\"loa__item author\">\n<div class=\"dropBlock article-header__info\"><a class=\"loa__item__name article-header__info__ctrl loa__item__email\" title=\"Correspondence information about the author Filipa Landeiro, DPhil \" href=\"https:\/\/www.thelancet.com\/journals\/lanhl\/article\/PIIS2666-7568(24)00108-9\/fulltext#\" data-db-target-for=\"au10-authorcard\" aria-expanded=\"false\" aria-controls=\"au10\">Filipa Landeiro, DPhil<\/a><\/div>\n<\/li>\n<li class=\"loa__item author\">\n<div class=\"dropBlock article-header__info\"><a class=\"loa__item__name article-header__info__ctrl loa__item__email\" title=\"Correspondence information about the author Callum Harris, MA BMBCH \" href=\"https:\/\/www.thelancet.com\/journals\/lanhl\/article\/PIIS2666-7568(24)00108-9\/fulltext#\" data-db-target-for=\"au20-authorcard\" aria-expanded=\"false\" aria-controls=\"au20\">Callum Harris, MA BMBCH<\/a><\/div>\n<\/li>\n<li class=\"loa__item author\">\n<div class=\"dropBlock article-header__info\"><a class=\"loa__item__name article-header__info__ctrl loa__item__email\" title=\"Correspondence information about the author David Groves, MSc \" href=\"https:\/\/www.thelancet.com\/journals\/lanhl\/article\/PIIS2666-7568(24)00108-9\/fulltext#\" data-db-target-for=\"au30-authorcard\" aria-expanded=\"false\" aria-controls=\"au30\">David Groves, MSc<\/a><\/div>\n<\/li>\n<li class=\"loa__item author\">\n<div class=\"dropBlock article-header__info\"><a class=\"loa__item__name article-header__info__ctrl loa__item__email\" title=\"Correspondence information about the author Samuel O\u2019Neill, MBBS \" href=\"https:\/\/www.thelancet.com\/journals\/lanhl\/article\/PIIS2666-7568(24)00108-9\/fulltext#\" data-db-target-for=\"au40-authorcard\" aria-expanded=\"false\" aria-controls=\"au40\">Samuel O\u2019Neill, MBBS<\/a><\/div>\n<\/li>\n<li class=\"loa__item author\">\n<div class=\"dropBlock article-header__info\"><a class=\"loa__item__name article-header__info__ctrl loa__item__email\" title=\"Correspondence information about the author Kuljinder Singh Jandu, MBChB \" href=\"https:\/\/www.thelancet.com\/journals\/lanhl\/article\/PIIS2666-7568(24)00108-9\/fulltext#\" data-db-target-for=\"au50-authorcard\" aria-expanded=\"false\" aria-controls=\"au50\">Kuljinder Singh Jandu, MBChB<\/a><\/div>\n<\/li>\n<li class=\"loa__item author\">\n<div class=\"dropBlock article-header__info\"><a class=\"loa__item__name article-header__info__ctrl loa__item__email\" title=\"Correspondence information about the author Eliana M C Tacconi, DPhil \" href=\"https:\/\/www.thelancet.com\/journals\/lanhl\/article\/PIIS2666-7568(24)00108-9\/fulltext#\" data-db-target-for=\"au60-authorcard\" aria-expanded=\"false\" aria-controls=\"au60\">Eliana M C Tacconi, DPhil<\/a><\/div>\n<\/li>\n<li class=\"loa__item loa__item__remove-after\"><span class=\"etal-word\">et al.<\/span><\/li>\n<li class=\"loa__item\">\n<div class=\"show-all-author\"><a class=\"loa__item__name show-hide__authors faded read-more\" href=\"https:\/\/www.thelancet.com\/journals\/lanhl\/article\/PIIS2666-7568(24)00108-9\/fulltext#\">Show all authors<\/a><\/div>\n<\/li>\n<\/ul>\n<div class=\"inline-it\"><span class=\"bulleted\"><span class=\"article-header__access\">Open Access: https:\/\/en.wikipedia.org\/wiki\/Open_access<\/span><\/span><\/div>\n<div><\/div>\n<div class=\"inline-it\"><span class=\"article-header__publish-date bulleted\"><span class=\"article-header__publish-date__label\">Published:<\/span><span class=\"article-header__publish-date__value\">July 25, 2024 <\/span><\/span><span class=\"article-header__doi bulleted\"><span class=\"article-header__doi__label\">DOI:<\/span><a class=\"article-header__doi__value\" href=\"https:\/\/doi.org\/10.1016\/S2666-7568(24)00108-9\">https:\/\/doi.org\/10.1016\/S2666-7568(24)00108-9<\/a><\/span><\/div>\n<\/div>\n<div class=\"article-header__bottom clearfix row\">\n<div class=\"col-md-6 static-md\"><\/div>\n<div class=\"col-md-6 static-md\">\n<div class=\"plum-jbs-theme\">\n<div class=\"PlumX-Popup\">The article as uploaded shows link to tables e.g<span style=\"color: #0000ff;\">.(Table X)<\/span> which, for brevity, have been deleted. Please therefore ignore these links!<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"article__body\">\n<div class=\"container\">\n<div class=\"row\">\n<div class=\"col-md-2 col-lg-1 hidden-sm\"><\/div>\n<div class=\"col-md-7 col-lg-9 article__sections\">\n<section>\n<h2 id=\"seccestitle10\" class=\"top\" tabindex=\"-1\" data-left-hand-nav=\"Summary\"><span class=\"top__text\">Summary<\/span><\/h2>\n<div class=\"section-paragraph\">\n<h3>Background<\/h3>\n<div class=\"section-paragraph\">Cancer, coronary heart disease, dementia, and stroke are major contributors to morbidity and mortality in England. We aimed to assess the economic burden (including health-care, social care, and informal care costs, as well as productivity losses) of these four conditions in England in 2018, and forecast this cost to 2050 using population projections.<\/div>\n<h3>Methods<\/h3>\n<div class=\"section-paragraph\">We used individual patient-level data from the Clinical Practice Research Datalink (CPRD) Aurum, which contains primary care electronic health records of patients from 738 general practices in England, to calculate health-care and residential and nursing home resource use, and data from the English Longitudinal Study on Ageing (ELSA) to calculate informal and formal care costs. From CPRD Aurum, we included patients registered on Jan 1, 2018, in a CPRD general practice with Hospital Episode Statistics (HES)-linked records, omitting all children younger than 1 year. From ELSA, we included data collected from wave 9 (2018\u201319). Aggregate English resource use data on morbidity, mortality, and health-care, social care, and informal care were obtained and apportioned, using multivariable regression analyses, to cancer, coronary heart disease, dementia, and stroke.<\/div>\n<h3>Findings<\/h3>\n<div class=\"section-paragraph\">We included 4\u2009161\u2009558 patients from CPRD Aurum with HES-linked data (mean age 41 years [SD 23], with 2\u2009079\u2009679 [50\u00b70%] men and 2\u2009081\u2009879 [50\u00b70%] women) and 8736 patients in ELSA (68 years [11], with 4882 [55\u00b79 %] men and 3854 [44\u00b71%] women). In 2018, the total cost was \u00a318\u00b79 billion (95% CI 18\u00b74\u201319\u00b74) for cancer, \u00a312\u00b77 billion (12\u00b73\u201313\u00b70) for coronary heart disease, \u00a311\u00b77 billion (9\u00b76\u201312\u00b77) for dementia, and \u00a38\u00b76 billion (8\u00b72\u20139\u00b70) for stroke. Using 2050 English population projections, we estimated that costs would rise by 40% (39\u201341) for cancer, 54% (53\u201355) for coronary heart disease, 100% (97\u2013102) for dementia, and 85% (84\u201386) for stroke, for a total of \u00a326\u00b75 billion (25\u00b77\u201327\u00b73), \u00a319\u00b76 billion (18\u00b79\u201320\u00b72), \u00a323\u00b75 billion (19\u00b73\u201325\u00b73), and \u00a316\u00b70 billion (15\u00b73\u201316\u00b76), respectively.<\/div>\n<h3>Interpretation<\/h3>\n<div class=\"section-paragraph\">This study provides contemporary estimates of the wide-ranging impact of the most important chronic conditions on all aspects of the economy in England. The data will help to inform evidence-based polices to reduce the impact of chronic disease, promoting care access, better health outcomes, and economic sustainability.<\/div>\n<\/div>\n<\/section>\n<div class=\"relatedItems-dropzone pb-dropzone\" data-pb-dropzone=\"relatedItems-dropzone\">\n<div data-widget-id=\"6211e606-91ef-4fed-96eb-a6bff90d54e7\" data-widget-name=\"UX3HTMLWidget\">\n<div id=\"related-links-container\">\n<section id=\"related-section\">\n<div id=\"related-message-box\" class=\"section-paragraph\">\n<p id=\"related-message-text\">\n<\/div>\n<\/section>\n<\/div>\n<\/div>\n<\/div>\n<section id=\"cesec10\" tabindex=\"0\" data-locator=\"cesec10\">\n<h2 id=\"seccestitle70\" class=\"top\" tabindex=\"-1\" data-left-hand-nav=\"Introduction\"><span class=\"top__text\">Introduction<\/span><\/h2>\n<div class=\"section-paragraph\">\n<p>Public health initiatives and the development of cardioprotective medications have led to an increase in life expectancy in the past six decades, giving rise to an ageing population.<\/p>\n<div class=\"dropBlock reference-citations\"><\/div>\n<p>This ageing population is suffering from a different set of medical issues than the population a century ago, with cancer, coronary heart disease, dementia, and stroke being the four leading causes for mortality and morbidity in England.<\/p>\n<div class=\"dropBlock reference-citations\"><\/div>\n<p>In 2019, these four conditions accounted for 59% of all deaths and 5\u00b71 million disability-adjusted life-years in England.<\/p>\n<div class=\"dropBlock reference-citations\"><\/div>\n<\/div>\n<div class=\"section-paragraph\">\n<p>Research investment is essential to combat major public health challenges, facilitating the development of new treatments and interventions that can improve rates of prevention, treatment, or management of diseases, enhancing quality of life and reducing their economic burden. However, it is important that the distribution of research funding across diseases is proportionate to their respective impact on society. In 2008, a UK study (Dementia 2010) evaluated the economic costs of, and research investment into dementia, and compared these costs and investments with those for cancer, coronary heart disease, and stroke.<\/p>\n<div class=\"dropBlock reference-citations\"><\/div>\n<p>Such estimates are important to inform health policy and identify diseases in need of greater investment,<\/p>\n<div class=\"dropBlock reference-citations\"><\/div>\n<p>with successive UK Governments having placed a greater priority for research funding in dementia.<\/p>\n<div class=\"dropBlock reference-citations\"><\/div>\n<\/div>\n<div class=\"section-paragraph\">However, previous studies that quantified the costs of these four chronic conditions had several important limitations, including that care resource use for each of the four conditions was apportioned based on assumptions and estimates from the literature, with methods differing between conditions. With representative cohorts from England, we are now able to estimate the economic burden of these conditions using individual patient-level data and a consistent methodology across conditions. Therefore, we aimed to estimate the economic burden of cancer, coronary heart disease, dementia, and stroke in England in 2018, and forecast this cost to 2050 using population projections.<\/div>\n<div><\/div>\n<div class=\"section-paragraph\">\n<div class=\"accordion--textbox\">\n<div id=\"cetextbox10\" class=\"accordion\" tabindex=\"0\">\n<div class=\"accordion__content\"><span style=\"font-size: 18pt;\"><b>Research in context<\/b><\/span><\/div>\n<div class=\"accordion__content\">\n<div><\/div>\n<div class=\"section-paragraph\"><strong>Evidence before this study<\/strong><\/div>\n<div class=\"section-paragraph\">We conducted a systematic review of the literature to identify studies evaluating the costs of dementia. We searched MEDLINE, Embase, Cochrane Database of Systematic Reviews, Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, EconLit, Cost-Effectiveness Analysis Registry, Turning Research Into Practice, NHS Economic Evaluation Database, Science Citation Index, Research Papers in Economics, and OpenGrey Repository from Jan 1, 2000, to Aug 31, 2023. Search terms included \u201cdementia\u201d, \u201cAlzheimer&#8217;s disease\u201d, \u201ccognitive impairment\u201d, \u201ccosts\u201d, and \u201cresources\u201d, among others. Except for one study conducted for the year 2008, we did not find any current study evaluating and contrasting the costs of the four chronic conditions with the highest mortality and morbidity burden in England\u2014namely, cancer, coronary heart disease, dementia, and stroke. This study found that the total costs of dementia in England were \u00a323\u00b74 billion, followed by cancer (\u00a312\u00b70 billion), coronary heart disease (\u00a37\u00b78 billion), and stroke (\u00a35\u00b70 billion). However, these estimates were not estimated concurrently, with methodologies and sources of data varying considerably across conditions, including from generally small studies, which did not capture the impact of comorbidities on the levels of care provided. Therefore, results for each of the four conditions are probably not comparable.<\/div>\n<div class=\"section-paragraph\"><strong>Added value of this study<\/strong><\/div>\n<div class=\"section-paragraph\">Our study assesses the total costs of cancer, coronary heart disease, dementia, and stroke, concurrently using patient-level data from two representative English cohorts: the Clinical Practice Research Datalink Aurum and the English Longitudinal Study on Ageing. We show that cancer, coronary heart disease, and dementia had similar overall health-care and social care costs, but when other costs were included, cancer had the highest overall economic burden. Using age-specific and gender-specific population projections to 2050, we found that the costs of the four conditions increased by 64% due to population ageing alone, with social care costs increasing by 104% between 2018 and 2050.<\/div>\n<div class=\"section-paragraph\"><strong>Implications of all the available evidence<\/strong><\/div>\n<div class=\"section-paragraph\">Our study sheds light on the significant consequences of the four most important chronic conditions in terms of mortality and morbidity in England on various sectors of the economy. The data we present not only emphasise the magnitude of the economic burden caused by cancer, coronary heart disease, dementia, and stroke but also provide valuable insights for public health decision makers. By identifying the specific areas that require targeted interventions, our findings can guide policy makers in implementing strategic measures to alleviate the economic burden of these four conditions. With a projected increase in costs of 64% by 2050, our research findings can aid in directing governmental research expenditure to areas that hold the greatest potential for advancing the prevention, diagnosis, and treatment of disease, further reducing its economic impact on England.<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<section id=\"cesec20\" tabindex=\"0\" data-locator=\"cesec20\">\n<h2 id=\"seccestitle80\" class=\"top\" tabindex=\"-1\" data-left-hand-nav=\"Methods\"><span class=\"top__text\">Methods<\/span><\/h2>\n<section id=\"cesec30\" tabindex=\"0\" data-locator=\"cesec30\">\n<h3 class=\"sectionTitle\"><span class=\"top__text\">Analysis framework and data sources<\/span><\/h3>\n<div class=\"section-paragraph\">We adopted a societal perspective for our analyses, with inclusion of the following costs: health care, social care (defined as residential and nursing home, and formal care costs), informal care, and productivity losses. We used an annual timeframe that included all costs for 2018, irrespective of the time of disease onset. We obtained England-specific aggregate resource use data on health and social care, mortality, morbidity, and prevalence of disease. To apportion aggregate data on health, and residential and nursing home resource use to each of the four conditions, we analysed individual patient-level data from the Clinical Practice Research Datalink (CPRD) Aurum linked to National Health Service Hospital Episode Statistics (HES).<\/div>\n<div class=\"section-paragraph\">\n<p>CPRD Aurum is a large database of routinely recorded primary care electronic health records of patients from 738 general practices in England (10% of practices), covering 13% of the population.<\/p>\n<div class=\"dropBlock reference-citations\"><\/div>\n<p>The database contains information on symptoms, diagnoses, prescriptions, referrals, tests, immunisation, and medical staff. Primary care and secondary care diagnosis codes were used to identify the four conditions of interest. CPRD Aurum codes used to diagnose patients in primary care are reported in the appendix (pp 2\u201355). CPRD records were then linked to secondary care records contained in HES using Aurum (version 2.3) from August, 2019. In secondary care records, cancer was defined by ICD-10 category codes I00\u2013I99, coronary heart disease by codes I20\u2013I25, dementia by codes F00\u2013F03 and G30, and stroke by codes I60\u2013I69. The use of CPRD Aurum for this study was approved by the independent scientific advisory committee for CPRD research (protocol reference CPRD00120051). CPRD obtains annual research ethics approval from the UK&#8217;s Health Research Authority Research Ethics Committee (05\/MRE04\/87) to receive and supply patient data for public health research. No further ethical permissions were required for the analyses of these anonymised patient-level data. The analysis was based on 4\u2009161\u2009588 patients registered on Jan 1, 2018, in a CPRD general practice with HES-linked records, omitting all children younger than 1 year (appendix pp 56\u201357).<\/p>\n<\/div>\n<div class=\"section-paragraph\">\n<p>Informal and formal care information was obtained from the English Longitudinal Study on Ageing (ELSA).<\/p>\n<div class=\"dropBlock reference-citations\"><\/div>\n<p>ELSA collects data from people older than 50 years, with spouses from age 40 years also included, to understand all aspects of ageing in England. More than 18\u2009000 people have taken part in the study since it started in 2002, with the same people re-interviewed every 2 years. For this study, we used information on wave 9 (2018\u201319; appendix pp 58\u201359). Access to ELSA, through the UK Data Service, was obtained as part of the UK Access Management Federation. ELSA has been approved by the National Research Ethics Service (London Multicentre Research Ethics Committee [MREC\/01\/2\/91]).<\/p>\n<\/div>\n<\/section>\n<section id=\"cesec40\" tabindex=\"0\" data-locator=\"cesec40\">\n<h3 class=\"sectionTitle\"><span class=\"top__text\" style=\"font-size: 18pt;\">Health-care resource costs<\/span><\/h3>\n<div class=\"section-paragraph\">Primary care consisted of visits with general practitioners and practice nurses in health-care facilities or in patients\u2019 homes. Accident and emergency care consisted of all hospital emergency visits. Outpatient care consisted of specialist consultations and treatments in outpatient wards, clinics, or patients\u2019 homes. Hospital care consisted of hospital admissions, including day cases and inpatient stays. Pharmaceutical expenditure included the costs of all prescriptions dispensed in the community (eg, pharmacies), but excluded costs of medications administered in secondary care settings, which were included in the costs of inpatient care.<\/div>\n<div class=\"section-paragraph\">We obtained the overall total number of all-cause health-care contacts with each type of service and medication expenditure in England (<a id=\"back-tbl1\" class=\"scroll-into-link\" href=\"https:\/\/www.thelancet.com\/journals\/lanhl\/article\/PIIS2666-7568(24)00108-9\/fulltext#tbl1\">table 1<\/a><strong>;<\/strong> appendix p 60). Patient-level data from CPRD Aurum with HES linkage were then used to apportion all-cause health-care contacts and pharmaceutical expenditure in England to cancer, coronary heart disease, dementia, and stroke. All resource use was valued using relevant unit costs.<\/div>\n<\/section>\n<section id=\"cesec50\" tabindex=\"0\" data-locator=\"cesec50\">\n<h3 class=\"sectionTitle\"><span class=\"top__text\" style=\"font-size: 18pt;\">Nursing and residential care home costs<\/span><\/h3>\n<div class=\"section-paragraph\">We included resources associated with living in a nursing home (requiring 24 h nursing care) or residential home (accommodation supporting people who are not able to manage everyday tasks).<\/div>\n<div class=\"section-paragraph\">\n<p>Of the more than 10 million people in England aged 65 years or older in 2018, 5% were living in a nursing or residential care home.<\/p>\n<div class=\"dropBlock reference-citations\"><\/div>\n<p>Using patient-level data from CPRD Aurum, we apportioned the proportion of people living in a nursing or residential care home in England due to cancer, coronary heart disease, dementia, and stroke (<a id=\"back-tbl1\" class=\"scroll-into-link\" href=\"https:\/\/www.thelancet.com\/journals\/lanhl\/article\/PIIS2666-7568(24)00108-9\/fulltext#tbl1\">table 1<\/a>; appendix pp 65\u201366). Nursing and residential home care home cost was valued at \u00a3837 per week,<\/p>\n<div class=\"dropBlock reference-citations\"><\/div>\n<p>taking into account the relative proportions of people living in nursing and residential homes,<\/p>\n<div class=\"dropBlock reference-citations\"><\/div>\n<p>and the local authority, not-for profit, and profit sector provision case mix.<\/p>\n<div class=\"dropBlock reference-citations\"><\/div>\n<\/div>\n<\/section>\n<section id=\"cesec60\" tabindex=\"0\" data-locator=\"cesec60\">\n<h3 class=\"sectionTitle\"><span class=\"top__text\" style=\"font-size: 18pt;\">Informal and formal care<\/span><\/h3>\n<div class=\"section-paragraph\">\n<p>Informal care costs were equivalent to the opportunity cost of unpaid care (ie, the time [work, leisure, or both] that carers forgo), valued in monetary terms, to provide unpaid care for relatives or friends with cancer, coronary heart disease, dementia, or stroke, and based on the conservative assumption that only patients limited in daily activities received care. We valued informal care using the proxy good method, in which an hour of informal care provided was valued using the labour market price of a close market substitute<\/p>\n<div class=\"dropBlock reference-citations\"><\/div>\n<p>(i,e. the mean hourly wage for a home care assistant [\u00a37\u00b785]).<\/p>\n<div class=\"dropBlock reference-citations\"><\/div>\n<p>Hence, for informal care, we multiplied the age-specific and gender-specific products of age-specific and gender-specific prevalence of cancer, coronary heart disease, dementia, and stroke in England;<\/p>\n<div class=\"dropBlock reference-citations\"><\/div>\n<p>the probability of living in the community (appendix p 66); the probability of being severely limited in daily activities as a result of each of the four conditions under study (appendix p 67); the probability of receiving informal care conditional on being limited in daily activities (appendix p 67); and the hours of informal care received, conditional on being limited in daily activities and receiving informal care (appendix p 67).<\/p>\n<\/div>\n<div class=\"section-paragraph\">\n<p>Formal care costs included the costs associated with paid care for patients living in the community, which was valued at \u00a327\u00b700 per h.<\/p>\n<div class=\"dropBlock reference-citations\"><\/div>\n<p>For formal care, we multiplied the age-specific and gender-specific products of age-specific and gender-specific prevalence of cancer, coronary heart disease, dementia, and stroke in England;<\/p>\n<div class=\"dropBlock reference-citations\"><\/div>\n<p>the probability of living in the community (appendix p 66); the probability of receiving formal care (appendix p 68); and the hours of formal care received, conditional on receiving formal care (appendix p 68).<\/p>\n<\/div>\n<div class=\"section-paragraph\">Given that ELSA had no participants younger than 40 years, care was only estimated for those aged 40 years or older.<\/div>\n<div><\/div>\n<\/section>\n<section id=\"cesec70\" tabindex=\"0\" data-locator=\"cesec70\">\n<h3 class=\"sectionTitle\"><span class=\"top__text\" style=\"font-size: 18pt;\">Morbidity losses<\/span><\/h3>\n<div class=\"section-paragraph\">Morbidity losses were determined to be the cost associated with temporary or permanent absence from work in patients with cancer, coronary heart disease, dementia, or stroke.<\/div>\n<div class=\"section-paragraph\">\n<p>Annual days off sick were obtained from the European Working Conditions Surveys.<\/p>\n<div class=\"dropBlock reference-citations\"><\/div>\n<p>To the total number of days of work due to sickness, we applied the proportion of absence that was attributable to cancer, coronary heart disease, dementia, and stroke, which was obtained from the UK Department of Works and Pensions (personal communication).<\/p>\n<\/div>\n<div class=\"section-paragraph\">\n<p>To calculate permanent absence from work due to sickness or disability, information on the numbers of working-age individuals receiving incapacity or disability benefits and not being able to work was obtained, including recipients of the disability living allowance, employment support allowance (ESA), and incapacity benefit by condition.<\/p>\n<div class=\"dropBlock reference-citations\"><\/div>\n<p>Given that recipients of ESA can work up to 45\u00b782% of their time, we only included the proportion of time that was not worked.<\/p>\n<\/div>\n<div class=\"section-paragraph\">\n<p>Days of absence from work due to sickness or disability were multiplied by mean daily earnings.<\/p>\n<div class=\"dropBlock reference-citations\"><\/div>\n<p>Furthermore, for permanent absence, we used the friction period approach because absent workers are likely to be replaced, whereby only the first 90 days of work absence were counted.<\/p>\n<div class=\"dropBlock reference-citations\"><\/div>\n<\/div>\n<\/section>\n<section id=\"cesec80\" tabindex=\"0\" data-locator=\"cesec80\">\n<h3 class=\"sectionTitle\"><span class=\"top__text\" style=\"font-size: 18pt;\">Mortality losses<\/span><\/h3>\n<div class=\"section-paragraph\">\n<p>We assumed an initial working age of 15 years and a maximum age of retirement of 79 years. Age-specific and gender-specific deaths due to cancer, coronary heart disease, dementia, and stroke were obtained.<\/p>\n<div class=\"dropBlock reference-citations\"><\/div>\n<p>The number of potential working years lost was then estimated as the difference between the age at death and maximum age of retirement. Each lost year of working life was valued using average annual earnings.<\/p>\n<div class=\"dropBlock reference-citations\"><\/div>\n<p>However, not all of the population is economically active until age 79 years; hence, age-specific and gender-specific unemployment and activity rates<\/p>\n<div class=\"dropBlock reference-citations\"><\/div>\n<p>were applied to the potential foregone earnings. Following UK-recommended guidelines, future earnings lost due to mortality were discounted to present values using a 3\u00b75% annual rate.<\/p>\n<div class=\"dropBlock reference-citations\"><\/div>\n<\/div>\n<\/section>\n<section id=\"cesec90\" tabindex=\"0\" data-locator=\"cesec90\">\n<h3 class=\"sectionTitle\"><span class=\"top__text\" style=\"font-size: 18pt;\">Statistical analysis<\/span><\/h3>\n<div class=\"section-paragraph\">CPRD Aurum data analyses informed the age-specific and gender-specific health-care resource use and nursing or residential care home use associated with cancer, coronary heart disease, dementia, and stroke. ELSA data analyses were used to derive the age-specific and gender-specific estimates needed to inform the calculations of informal and formal care received associated with the four conditions. To achieve this, we used regression analyses (Poisson, logistic, and generalised linear models) for each type of resource use, adjusting for history of cancer, coronary heart disease, dementia, or stroke; Elixhauser comorbidity index; age; and gender. Together with data on disease prevalence, we used the derived models to estimate the total costs associated with each condition. For more details, see the appendix (pp 60\u201368).<\/div>\n<div class=\"section-paragraph\">\n<p>Finally, we projected the costs estimated for 2018 to 2050 based on future projections of the population alone,<\/p>\n<div class=\"dropBlock reference-citations\"><\/div>\n<p>excluding other factors such as epidemiological trends of the four conditions under investigation, risk factor prevalence rates, and life expectancy.<\/p>\n<div class=\"dropBlock reference-citations\"><\/div>\n<p>For this, we applied age-specific and gender-specific rates of resource use, prevalence, mortality, and disability observed in 2018 to the predicted distribution of the population in 2050. We valued resource use in 2050 using 2018 costs. For more details, see the appendix (pp 69\u201371).<\/p>\n<\/div>\n<div class=\"section-paragraph\">Total resource use estimates and costs are reported alongside 95% CIs, which were derived using 1000 bootstrap estimates of all resource use regressions undertaken in CPRD Aurum and ELSA. Given that country-wide productivity loss estimates were obtained (eg, disease-specific working days lost, disability claims, and deaths), sampling uncertainty was not required, and these cost estimates are provided as point estimates. Population projections were not provided with uncertainty levels so these are also treated as point estimates. Significance was set at a p value of less than 0\u00b705.<\/div>\n<div class=\"section-paragraph\">All analyses were conducted in STATA (version 15, 64-bit).<\/div>\n<div><\/div>\n<\/section>\n<section id=\"cesec100\" tabindex=\"0\" data-locator=\"cesec100\">\n<h3 class=\"sectionTitle\"><span class=\"top__text\" style=\"font-size: 18pt;\">Role of the funding source<\/span><\/h3>\n<div class=\"section-paragraph\">The funder of the study had no role in the study design; the collection, analysis, and interpretation of data; the writing of the report; or in the decision to submit the paper for publication.<\/div>\n<\/section>\n<\/section>\n<section id=\"cesec110\" tabindex=\"0\" data-locator=\"cesec110\">\n<h2 id=\"seccestitle170\" class=\"top\" tabindex=\"-1\" data-left-hand-nav=\"Results\"><span class=\"top__text\">Results<\/span><\/h2>\n<div class=\"section-paragraph\">The analyses to apportion total all-cause health-care and nursing and residential care home resource use in England to cancer, coronary heart disease, dementia, and stroke was based on 4\u2009161\u2009558 patients in CPRD Aurum with linked HES data (mean age 41 years [SD 23]), with 2\u2009079\u2009679 (50\u00b70%) men and 2\u2009081\u2009879 (50\u00b70%) women. Of these patients, 174\u2009942 (4\u00b72%) had a history of cancer either in primary or secondary care records, 191\u2009603 (4\u00b76%) of coronary heart disease, 52\u2009862 (1\u00b73%) of dementia, and 61\u2009509 (1\u00b75%) of stroke (appendix p 56).<\/div>\n<div><\/div>\n<div class=\"section-paragraph\">To estimate total hours of formal and informal care in England due to cancer, coronary heart disease, dementia, and stroke, analyses were based on 8736 patients in ELSA (mean age 68 years [SD 11]), with 4882 (55\u00b79%) men and 3854 (44\u00b71%) women. Of these patients, 744 (8\u00b75%) had a history of cancer, 423 (4\u00b78%) of coronary heart disease, 211 (2\u00b74%) of dementia, and 313 (3\u00b76%) of stroke (appendix p 58).<\/div>\n<div><\/div>\n<div class=\"section-paragraph\">Of all admissions to hospitals (including day cases and inpatient stays) in 2018, 2\u2009164\u2009000 (95% CI 2\u2009083\u2009000\u20132\u2009243\u2009000) admissions were found to be associated with patients with cancer, followed by coronary heart disease (1\u2009081\u2009000 [1\u2009053\u2009000\u20131\u2009110\u2009000]), stroke (517\u2009000 [497\u2009000\u2013535\u2009000]), and dementia (234\u2009000 [224\u2009000\u2013244\u2009000];\u00a0<a id=\"back-tbl2\" class=\"scroll-into-link\" href=\"https:\/\/www.thelancet.com\/journals\/lanhl\/article\/PIIS2666-7568(24)00108-9\/fulltext#tbl2\">table 2<\/a>). The condition with the highest prescribed pharmaceutical expenditure was coronary heart disease (\u00a3982 million [95% CI 968\u2013998]), followed by cancer (\u00a3925 million [909\u2013940]), stroke (\u00a3451 million [437\u2013464]), and dementia (\u00a3277 million [269\u2013285]). Overall, the health-care costs associated with these conditions in England were \u00a38\u00b71 billion (95% CI 8\u00b70\u20138\u00b72) for cancer, \u00a36\u00b77 billion (6\u00b76\u20136\u00b77) for coronary heart disease, \u00a31\u00b75 billion (1\u00b75\u20131\u00b76) for dementia, and \u00a33\u00b74 billion (3\u00b74\u20133\u00b75) for stroke.<\/div>\n<div><\/div>\n<div class=\"section-paragraph\">About 133\u2009000 (95% CI 126\u2009000\u2013141\u2009000) people older than 65 years with dementia were living in residential or nursing homes in 2018. This estimate was higher than for stroke (75\u2009000 [95% CI 70\u2009000\u201380\u2009000]), coronary heart disease (52\u2009000 [49\u2009000\u201354\u2009000]), and cancer (33\u2009000 [31\u2009000\u201335\u2009000]). Living in residential or nursing homes accounted for costs of \u00a35\u00b78 billion (95% CI 5\u00b75\u20136\u00b71) for dementia, \u00a33\u00b72 billion (3\u00b71\u20133\u00b74) for stroke, \u00a32\u00b72 billion (2\u00b71\u20132\u00b74) for coronary heart disease, and \u00a31\u00b74 billion (1\u00b74\u20131\u00b75) for cancer (<a id=\"back-tbl2\" class=\"scroll-into-link\" href=\"https:\/\/www.thelancet.com\/journals\/lanhl\/article\/PIIS2666-7568(24)00108-9\/fulltext#tbl2\">table 2<\/a>).<\/div>\n<div><\/div>\n<div class=\"section-paragraph\">Overall health-care and social care costs were \u00a39\u00b77 billion (95% CI 9\u00b75\u20139\u00b79) for cancer, \u00a38\u00b79 billion (8\u00b78\u20139\u00b70) for coronary heart disease, \u00a38\u00b70 billion (7\u00b73\u20138\u00b76) for dementia, and \u00a36\u00b79 billion (6\u00b76\u20137\u00b71) for stroke (<a id=\"back-tbl2\" class=\"scroll-into-link\" href=\"https:\/\/www.thelancet.com\/journals\/lanhl\/article\/PIIS2666-7568(24)00108-9\/fulltext#tbl2\">table 2<\/a>). This resulted in costs of \u00a3174 (95% CI 171\u2013178) per capita for cancer, \u00a3162 (158\u2013164) for coronary heart disease, \u00a3144 (132\u2013155) for dementia, and \u00a3124 (120\u2013129) for stroke (appendix p 72). Per person with the condition, the highest health-care and social care costs were associated with stroke at \u00a312\u2009923 (95% CI 12\u2009491\u201313\u2009399), followed by dementia at \u00a311\u2009641 (10\u2009680\u201312\u2009558), cancer at \u00a36660 (6526\u20136803), and coronary heart disease at \u00a35530 (5437\u20135625).<\/div>\n<div><\/div>\n<div class=\"section-paragraph\">Friends and family spent a total of 115 million h (95% CI 62\u2013175) providing informal care for patients with cancer; 95 million h (46\u2013137) for those with coronary heart disease, 461 million h (224\u2013561) for those with dementia, and 75 million h (37\u2013110) for those with stroke (<a id=\"back-tbl2\" class=\"scroll-into-link\" href=\"https:\/\/www.thelancet.com\/journals\/lanhl\/article\/PIIS2666-7568(24)00108-9\/fulltext#tbl2\">table 2<\/a>). Total informal care costs were \u00a3905 million (95% CI 486\u20131374) for cancer, \u00a3748 million (365\u20131758) for coronary heart disease, \u00a33619 million (1758\u20134405) for dementia, and \u00a3587 million (291\u2013865) for stroke.<\/div>\n<div><\/div>\n<div class=\"section-paragraph\">More than 271\u2009000 working years were lost due to cancer, 80\u2009000 due to coronary heart disease, 3000 due to dementia, and 37\u2009000 due to stroke, with corresponding mortality losses of \u00a37\u00b78 billion, \u00a32\u00b76 billion, \u00a30\u00b71 billion, and \u00a30\u00b78 billion, respectively (<a id=\"back-tbl2\" class=\"scroll-into-link\" href=\"https:\/\/www.thelancet.com\/journals\/lanhl\/article\/PIIS2666-7568(24)00108-9\/fulltext#tbl2\">table 2<\/a>). Losses due to temporary and permanent absence from work due to illness and disability for the conditions under study were \u00a3497 million for cancer, \u00a3378 million for coronary heart disease, \u00a349 million for dementia, and \u00a3362 million for stroke. Overall, productivity losses were highest for cancer (\u00a38\u00b73 billion), followed by coronary heart disease (\u00a33\u00b70 billion), stroke (\u00a31\u00b72 billion), and dementia (\u00a30\u00b71 billion).<\/div>\n<div><\/div>\n<div class=\"section-paragraph\">The overall costs in England in 2018 were \u00a318\u00b79 billion (95% CI 18\u00b74\u201319\u00b74) for cancer, \u00a312\u00b77 billion (12\u00b73\u201313\u00b70) for coronary heart disease, \u00a311\u00b77 billion (9\u00b76\u201312\u00b77) for dementia, and \u00a38\u00b76 billion (8\u00b72\u20139\u00b70) for stroke (<a id=\"back-tbl2\" class=\"scroll-into-link\" href=\"https:\/\/www.thelancet.com\/journals\/lanhl\/article\/PIIS2666-7568(24)00108-9\/fulltext#tbl2\">table 2<\/a>). Per case, patients with dementia had the highest costs at \u00a317\u2009145 (95% CI 13\u2009998\u201318\u2009604), followed by stroke at \u00a316\u2009224 (15\u2009482\u201316\u2009954), cancer at \u00a313\u2009031 (12\u2009681\u201313\u2009393), and coronary heart disease at \u00a37857 (7599\u20138068; appendix p 72).<\/div>\n<div class=\"section-paragraph\">The way costs were distributed among cost categories varied considerably by condition (<a id=\"back-tbl2\" class=\"scroll-into-link\" href=\"https:\/\/www.thelancet.com\/journals\/lanhl\/article\/PIIS2666-7568(24)00108-9\/fulltext#tbl2\">table 2<\/a>;\u00a0<a id=\"back-gr1\" class=\"figure-link scroll-into-link\" href=\"https:\/\/www.thelancet.com\/journals\/lanhl\/article\/PIIS2666-7568(24)00108-9\/fulltext#gr1\" data-link=\"modal\" data-target=\"#image-S2666-7568(24)00108-9gr1\" data-locator=\"fig1\">figure 1<\/a>). The proportion of total costs due to health care varied from 52% (\u00a36\u00b77 billion) for coronary heart disease to 13% (\u00a31\u00b75 billion) for dementia. Although productivity losses accounted for 44% (\u00a38\u00b73 billion) of the total costs for cancer, for dementia these accounted for 1% (\u00a3145 million) of total costs.<\/div>\n<div><\/div>\n<div class=\"section-paragraph\">\n<div class=\"floatDisplay\">\n<figure id=\"gr1\" class=\"\" tabindex=\"0\"><a href=\"https:\/\/drugprevent.org.uk\/ppp\/2024\/08\/the-economic-burden-of-cancer-coronary-heart-disease-dementia-and-stroke-in-england-in-2018\/fig1-2\/\" rel=\"attachment wp-att-17850\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-17850\" src=\"https:\/\/drugprevent.org.uk\/ppp\/wp-content\/uploads\/2024\/08\/fig1.png\" alt=\"\" width=\"564\" height=\"491\" srcset=\"https:\/\/drugprevent.org.uk\/ppp\/wp-content\/uploads\/2024\/08\/fig1.png 564w, https:\/\/drugprevent.org.uk\/ppp\/wp-content\/uploads\/2024\/08\/fig1-551x480.png 551w\" sizes=\"auto, (max-width: 564px) 100vw, 564px\" \/><\/a><figcaption>\n<div class=\"figure__caption__body\">\n<div class=\"figure__title\"><span class=\"label figure__label\" data-fv-label=\"Fig. 1\">Figure 1 &#8211; <\/span><span class=\"figure__title__text\">Distribution of total costs in patients with cancer, coronary heart disease, dementia, and stroke in England in 2018<\/span><\/div>\n<p>&nbsp;<\/p>\n<\/div>\n<\/figcaption><\/figure>\n<\/div>\n<\/div>\n<div class=\"section-paragraph\">\n<p>The population of England, excluding those younger than 1 year, is expected to increase from 55 million in 2018 to 65 million in 2050 (18% increase), with the population aged 65 years or older projected to increase by 49% (from 10 million to 15 million).<\/p>\n<div class=\"dropBlock reference-citations\"><\/div>\n<p>Assuming no changes in age-specific and gender-specific prevalence rates, this population increase will increase the number of people with cancer by 39% (2\u00b70 million), coronary heart disease by 45% (2\u00b73 million), dementia by 81% (1\u00b72 million), and stroke by 41% (0\u00b78 million; appendix p 69).<\/p>\n<\/div>\n<div class=\"section-paragraph\">\n<p>These increases in the overall disease prevalence will result in cost increases between 2018 and 2050 of 40% (95% CI 39\u201341) to \u00a326\u00b75 billion (25\u00b77\u201327\u00b73) for cancer, 54% (53\u201355) to \u00a319\u00b76 billion (18\u00b79\u201320\u00b72) for coronary heart disease, 100% (97\u2013102) to \u00a323\u00b75 billion (19\u00b73\u201325\u00b73) for dementia, and 85% (84\u201386) to \u00a316\u00b70 billion (15\u00b73\u201316\u00b76) for stroke (<a id=\"back-tbl3\" class=\"scroll-into-link\" href=\"https:\/\/www.thelancet.com\/journals\/lanhl\/article\/PIIS2666-7568(24)00108-9\/fulltext#tbl3\">table 3<\/a>). Costs with the highest increases are those related to social care, which are projected to rise between 2018 and 2050 by 88% (95% CI 86\u201390) to \u00a32\u00b79 billion (2\u00b77\u20133\u00b73) for cancer, 91% (90\u201392) to \u00a34\u00b74 billion (4\u00b71\u20134\u00b76) for coronary heart disease, 110% (109\u2013111) to \u00a313\u00b75 billion (12\u00b71\u201314\u00b78) for dementia, and 109% (107\u2013108) to \u00a37\u00b71 billion (6\u00b76\u20137\u00b75) for stroke (<a id=\"back-gr2\" class=\"figure-link scroll-into-link\" href=\"https:\/\/www.thelancet.com\/journals\/lanhl\/article\/PIIS2666-7568(24)00108-9\/fulltext#gr2\" data-link=\"modal\" data-target=\"#image-S2666-7568(24)00108-9gr2\" data-locator=\"fig2\">figure 2<\/a>).<\/p>\n<div class=\"floatDisplay\">\n<div id=\"tbl3\" class=\"inline-table\" tabindex=\"0\"><\/div>\n<\/div>\n<div class=\"floatDisplay\">\n<figure id=\"gr2\" class=\"\" tabindex=\"0\"><a href=\"https:\/\/drugprevent.org.uk\/ppp\/2024\/08\/the-economic-burden-of-cancer-coronary-heart-disease-dementia-and-stroke-in-england-in-2018\/fig2-2\/\" rel=\"attachment wp-att-17849\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-17849\" src=\"https:\/\/drugprevent.org.uk\/ppp\/wp-content\/uploads\/2024\/08\/fig2.png\" alt=\"\" width=\"808\" height=\"514\" srcset=\"https:\/\/drugprevent.org.uk\/ppp\/wp-content\/uploads\/2024\/08\/fig2.png 808w, https:\/\/drugprevent.org.uk\/ppp\/wp-content\/uploads\/2024\/08\/fig2-640x407.png 640w, https:\/\/drugprevent.org.uk\/ppp\/wp-content\/uploads\/2024\/08\/fig2-768x489.png 768w\" sizes=\"auto, (max-width: 808px) 100vw, 808px\" \/><\/a><figcaption>\n<div class=\"figure__caption__body\">\n<div class=\"figure__title\"><span class=\"label figure__label\" data-fv-label=\"Fig. 2\">Figure 2 &#8211; <\/span><span class=\"figure__title__text\">Total costs of cancer, coronary heart disease, dementia, and stroke in England in 2018 and the projected costs in 2050 due to demographic change alone<\/span><\/div>\n<\/div>\n<\/figcaption><\/figure>\n<\/div>\n<\/div>\n<\/section>\n<section id=\"cesec120\" tabindex=\"0\" data-locator=\"cesec120\">\n<h2 id=\"seccestitle180\" class=\"top\" tabindex=\"-1\" data-left-hand-nav=\"Discussion\"><span class=\"top__text\">Discussion<\/span><\/h2>\n<div class=\"section-paragraph\">\n<p>Whereas a previous study has assessed the overall costs of chronic conditions,\u00a0our study made use of individual patient-level data to generate more precise cost estimates for cancer, coronary heart disease, dementia, and stroke, using the same methodology and sources across conditions. Previously the total costs of dementia in the UK were calculated as \u00a323\u00b74 billion, followed by cancer (\u00a312\u00b70 billion), coronary heart disease (\u00a37\u00b78 billion), and stroke (\u00a35\u00b70 billion).<\/p>\n<p>These estimates are not comparable with the findings in this study, possibly due to methodologies and sources of data varying considerably across conditions.<\/p>\n<\/div>\n<div class=\"section-paragraph\">\n<p>Our results show that the areas of the economy bearing these costs differed substantially by disease area. For example, health-care costs of dementia accounted for 13% (\u00a31\u00b75 billion) of the total, with most costs being borne by the social care system (\u00a36\u00b74 billion, 55% of total costs). By contrast, in cancer, the majority of costs were borne by the labour market, with \u00a38\u00b73 billion in lost productivity (44% of total costs). These findings are notable in that they further emphasise the need for interventions designed to prevent or screen for early-stage disease. For cancer and, to a lesser extent, coronary heart disease, with so much of the cost borne by the labour market, interventions that prevent the disease will not only increase the health of the population and reduce health-care costs, but also improve labour productivity. However, these findings also raise important questions about perceived fairness and equality.<\/p>\n<p>In the UK, about 90% of hospital cases, which according to our findings is where most of the care of patients with cancer or coronary heart disease takes place, is funded by the government (data are from the <a class=\"inter-ref-link\" href=\"https:\/\/ec.europa.eu\/eurostat\/web\/main\/data\/database\" target=\"_blank\" rel=\"noopener\">Eurostat database<\/a>). By contrast, for dementia and, to a lesser extent, stroke, most of the care takes place in either the social care system, of which 60% is funded by the government, or by relatives and friends through informal care (data are from the Eurostat database). Therefore, patients with dementia and stroke are substantially at higher risk of having to fund their care themselves than those with cancer or coronary heart disease.<\/p>\n<\/div>\n<div class=\"section-paragraph\">\n<p>Our study also shows the effect of the projected population ageing over the coming decades. On the basis of demographic change alone, we project that the costs of cancer will increase by 40%, those of coronary heart disease by 54%, those of dementia by 100%, and those of stroke by 85%. With the population aged 65 years or older projected to increase by 49%, the costs with the fastest projected rise will be, averaged across all four conditions, for social care, with a 104% projected increase in costs, and informal care, with a projected increase of 78%. Therefore, research funding into interventions aimed to prevent, treat, and care for disease are required as a way to help to reduce or mitigate this projected increase in costs and improve health, especially in those conditions\u2014ie, stroke and dementia\u2014seeing the fastest increase in costs, and that historically have received the lowest levels of research funding.<\/p>\n<div class=\"dropBlock reference-citations\"><\/div>\n<\/div>\n<div class=\"section-paragraph\">\n<p>The limitations of this study should be noted. Our results are based on diagnostic coding from both primary and secondary care records, rather than on careful ascertainment of patients through multiple and overlapping methods such as in population-based cohort studies. Therefore, our results might not reflect the absolute prevalence and costs of disease. Given that there is no single and simple diagnostic test for dementia,\u00a0this under-ascertainment of disease in routinely collected health data or surveys might be most prevalent in dementia.<\/p>\n<p>The failure to identify these undiagnosed cases might explain the relatively low levels of health-care resource use identified in CPRD Aurum due to dementia.<\/p>\n<div class=\"dropBlock reference-citations\">For diseases affecting cognitive ability, such as dementia and stroke, supervision will be a major component of any informal care provided.<\/div>\n<\/div>\n<div class=\"section-paragraph\">\n<p>However, in ELSA, respondents were not explicitly asked for supervisory activities received, with our results likely to be an underestimate. We were unable to quantify the costs of formal and informal care in people younger than 40 years. This will, inevitably, have reduced our total estimates of costs, especially for cancer and stroke, where people younger than 40 years account for 6% (110\u2009000) and 8% (60\u2009000) of cases, respectively, compared with 2% (41\u2009000) for coronary heart disease and less than 1% (5000) for dementia.<\/p>\n<div class=\"dropBlock reference-citations\"><\/div>\n<\/div>\n<div class=\"section-paragraph\">\n<p>Finally, our projection of costs from 2018 to 2050 was based on future projections of the population alone, and might be considered simplistic. Our projections did not include other factors, such as epidemiological trends of the four conditions under investigation or the predicted rise in comorbidities predicted for England.<\/p>\n<p>For example, analyses based on ELSA have projected the costs of dementia in the future based on current trends in cardiovascular disease incidence rates.<\/p>\n<p>In addition, new treatments that prevent, slow progression, or successfully treat the four conditions under study, will undoubtedly affect the projected costs estimated in this study.<\/p>\n<\/div>\n<div class=\"section-paragraph\">In conclusion, our study sheds light on the substantial consequences of the four most important chronic conditions in terms of mortality and morbidity in England on various sectors of the economy. These data not only emphasise the magnitude of the economic burden but also provide valuable insights for public health decision makers. By identifying the specific areas that require targeted interventions, our findings can guide policy makers in implementing strategic measures to alleviate the economic burden of these four conditions and improve patient health outcomes. With a projected increase in costs of more than 60% across the four conditions by 2050, our research findings can aid in directing governmental research expenditure in areas that hold the greatest potential for advancing the prevention, diagnosis, and treatment of disease, further reducing its economic impact.<\/div>\n<\/section>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/article>\n<p><strong>Source: https:\/\/www.thelancet.com\/journals\/lanhl\/article\/PIIS2666-7568(24)00108-9\/fulltext<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>This paper examines the costs to society of\u00a0 illnesses including cancer, coronary heart disease and stroke in England in 2018, it then gives projections to 2050, and concludes with an evaluation of two cohort studies. The principal authors of this paper are shown below, and a link to supplementary authors is also given. Filipa Landeiro, [&hellip;]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[68,82,17,36],"tags":[],"class_list":["post-17847","post","type-post","status-publish","format-standard","hentry","category-drug-use-various-effects","category-economic","category-europe-uk","category-treatment-addiction"],"_links":{"self":[{"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/posts\/17847","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/comments?post=17847"}],"version-history":[{"count":0,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/posts\/17847\/revisions"}],"wp:attachment":[{"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/media?parent=17847"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/categories?post=17847"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/tags?post=17847"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}