What Asthma and COPD Cost U.S. Workers, 2011–2015

Asthma and chronic obstructive pulmonary disease (COPD) are costly respiratory conditions, and up to 44% of adult asthma and 50% of adult COPD cases are linked to workplace exposures. CDC used the 2011–2015 Medical Expenditure Panel Survey (MEPS) to estimate what treating them costs among U.S. workers aged 18 and older who had a job at any time in the survey year.

The survey

MEPS interviews a nationally representative sample of the civilian population living in the community each year; response rates ran from 54.9% in 2011 to 47.7% in 2015, and five years were pooled for precision. Participants reported their medical conditions, visits, prescriptions and payments; coders assigned diagnosis codes (ICD-9-CM 493 for asthma; 490, 491, 492 and 496 for COPD). Spending added up payments from Medicaid, Medicare, private insurance, patients and other sources, expressed in 2017 dollars. Workers were sorted into 15 industry groups.

The costs

Of an average 166 million working adults a year, 8 million (5%) had at least one asthma-related medical event and 7 million (4%) a COPD-related one — 21 million asthma events and 15 million COPD events in all. Thirteen percent of workers with asthma events and 24% of those with COPD events were current smokers.

Prescriptions were the most frequent type of event for both conditions (15 million for asthma, 8 million for COPD).

Who spent the most per person: non-Hispanic White workers ($923 for asthma, $742 for COPD), insured workers ($914 and $705) and current nonsmokers ($936 and $692). By age, asthma spending was highest at 45–64 ($1,081) and COPD spending at 65 and older ($1,090).

By industry: public administration workers had the highest per-person costs for both asthma ($1,279) and COPD ($1,819). Next were transportation and utilities workers for asthma ($1,222) and construction workers for COPD ($1,198).

From work itself: using population-attributable fractions of 16% for asthma and 14% for COPD, spending due to workplace exposures topped $1 billion a year for asthma and $700 million for COPD.

What it means

COPD and asthma together were among the five most costly medical conditions for U.S. adults in 2012. Public administration — which includes police officers, correctional officers and jailers, firefighters, and secretaries and administrative assistants — has an estimated 7.4% of workers with asthma and 3.5% with COPD; differences between industries may reflect differences in how common the diseases are, insurance and access to care. Uninsured workers spent less, perhaps because they used free clinics or put off care.

Prescription drugs made up an estimated 67% of asthma spending among workers, compared with 51% seen earlier among all U.S. adults — possibly because of newer, costlier treatments, inflation adjustment, or workers' better insurance coverage. High inpatient costs track with the severity of flare-ups.

The authors called for identifying and reducing risk factors early, including workplace exposure to vapors, gas, dust and fumes, and for proven measures such as smoke-free workplace policies, smoking cessation programs and exposure controls, focused especially on workers with the highest costs, along with continued surveillance of workers with high rates of disease and less reliable access to care.

Limitations: events and spending were self-reported, though such reports match utilization records well; some spending during asthma or COPD visits may have been for other conditions; workers may have changed industries since the spending occurred; and small samples made some estimates unreliable.

Sources

• Syamlal G, Bhattacharya A, Dodd KE. "Medical Expenditures Attributed to Asthma and Chronic Obstructive Pulmonary Disease Among Workers — United States, 2011–2015." MMWR 2020;69(26).