Foreseeing a future of fewer strokes and heart attacks
Increased health care costs in the gray-haired future might be smaller than feared as the incidents of stroke and heart attack are likely to fall in the decades ahead.
The developed world is aging and many have argued that health care costs will go through the roof, especially in the welfare states of Scandinavia. But in Sweden, one of the most rapidly graying countries in the world, some researchers argue that the burden might be smaller than anticipated as the population's general health continues to improve.
Karin Modig at Karolinska Institute and her colleagues calculated how much the incidence of strokes and heart attacks needs to fall in the future to counter the effect of the aging population, and perhaps for the health care costs regarding these diseases to remain about the same as today. They looked as far as to 2050.
Looking back to predict the future
The researchers looked at incidence trends of stroke and heart attacks over the past decades in Sweden. The data shows that the risk of being struck by the diseases has declined for years and in 2012 it is smaller than ever.
"There's nothing to suggest that we've reached the end of it," says Modig.
The positive trend is expected to continue because people's health improves, in part due to healthier lifestyles and access to better medicines and treatments.
"We are getting healthier in many ways," says Modig.
"The lowered rates of cardiovascular diseases is likely to compensate for the effect of population growth and increased age for the number of cardiovascular events."
The population of Sweden is expected to grow from today's 9.5 million to nearly 12 million in 2050, and by 2060 a quarter of the population will be aged 65 or older, according to a separate study.
More than 27 000 Swedes suffered a stroke in 2008. If the incident rate remains the same in the coming decades, the population growth and particularly aging of the population will rise the stroke count by 60 percent, to more than 43 200.
But the risk of suffering stroke has been in steady decline for the past ten years, and the incidence rate has had a yearly average drop of 1.65 percent for women and 1.72 for men. The fall is expected to continue.
Looking at how much the incidence rate will need to fall to counterbalance the effect of a growing and aging population, Modig et al. calculated that it will need to drop on average 1.3 percent for men and 1.0 for women, per year.
Nearly 31 000 Swedes were hit by myocardial infarctions in 2008. If that year's heart attack incidence rate remains the same in 2050, 56 percent more will suffer the same fate.
If the incidence has an average per year drop of 1.2 percent for men and 0.9 percent for women in the decades ahead, however, the improved health and risen average age and population growth will cancel each other out.
In the past ten years the average change in incidence has been -0.6 percent for men, while there has been a 0.26 increase for women, per year.
Modig and her colleagues also looked at cancer. It is difficult to predict whether the necessary decline in this disease group will come about in the years ahead, as the past decades show a mixed picture. The risk of getting some cancers are up, while others are down.
There have also been improvements in screening technology in the past years, so a look at the last decade's cancer statistics suggests that it has been increasing, year by year, while it might in fact be about more people getting the right diagnosis.
59 295 Swedes were diagnosed with cancer in 2008. If the cancer rates remains the same while the population ages and grows in size, the cancer tally will rise to 75 265 people in 2050, up 27 percent.
The cancer incidence will need to decline by about 1 percent for men and 0.6 percent for women to avoid the unpleasant 2050 scenario, per year, but, counting all kinds of cancer as one group, the trend has been heading in the wrong direction in the past ten years -- the counted incidents of cancer increased 1.7 percent per year for men, and 1.23 for women.
A global trend
Sweden is not alone in facing a gray haired future and big public health challenges.
The good news is that the decline of stroke and heart attack rates has been observed in many other parts of the world, and Modig believes the positive trend will continue on a global scale.
"I think it will, absolutely," says Modig. "We see the same trends in most countries."
The message to take away from her study is ultimately positive.
"It doesn't have to be the case that an aging population mean a much greater health burden for society," she says.
- Modig et al., The aging population in Sweden: can declining incidence rates in MI, stroke and cancer counterbalance the future demographic challenges?, European Journal of Epidemiology, 2012