The Benefits of Risk Factor Prevention in Americans Aged 51 Years and Older

Dana P. Goldman, PhD; Yuhui Zheng, PhD; Federico Girosi, PhD; Pierre-Carl Michaud, PhD; S. Jay Olshansky, PhD; David Cutler, PhD; John W. Rowe, MD


Am J Public Health. 2009;99(11):2096 

In This Article

Abstract and Introduction


Objectives. We assessed the potential health and economic benefits of reducing common risk factors in older Americans.
Methods. A dynamic simulation model tracked a national cohort of persons 51 and 52 years of age to project their health and medical spending in prevention scenarios for diabetes, hypertension, obesity, and smoking.
Results. The gain in life span from successful treatment of a person aged 51 or 52 years for obesity would be 0.85 years; for hypertension, 2.05 years; and for diabetes, 3.17 years. A 51- or 52-year-old person who quit smoking would gain 3.44 years. Despite living longer, those successfully treated for obesity, hypertension, or diabetes would have lower lifetime medical spending, exclusive of prevention costs. Smoking cessation would lead to increased lifetime spending. We used traditional valuations for a life-year to calculate that successful treatments would be worth, per capita, $198018 (diabetes), $137964 (hypertension), $118946 (smoking), and $51750 (obesity).
Conclusions. Effective prevention could substantially improve the health of older Americans, and—despite increases in longevity—such benefits could be achieved with little or no additional lifetime medical spending.


The rise in life expectancy and improvements in the health status of middle-aged and older Americans during the past half century are indisputable products of investments in medical technologies and successful public health efforts to encourage primary and secondary prevention.[1,2] But with a growing elderly population, and a large baby boom generation approaching retirement, the prevalence of chronic diseases will rise. If current trends continue, health care costs will consume an ever-increasing share of national income. The future liability of the Medicare program alone is estimated to be $24 trillion over the next 75 years, absent any policy changes.[3]

With this renewed national focus on health care costs, policymakers have begun to consider investing more health care dollars in prevention programs and in research to identify better treatment strategies. Medical or public health interventions in the form of primary prevention should, in theory, slow or reduce the rising prevalence of chronic disease and simultaneously attenuate the downstream spending associated with it. Thus, if a solution to the problem of rising health care costs exists now, it may lie in the basic improvements in population health that can be achieved by existing treatments. We modeled the potential health benefits and medical cost savings of successfully treating cardiovascular risk factors (obesity, diabetes, hypertension, and smoking) among middle-aged and older Americans under several hypothetical scenarios.


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