Cardiovascular Risk Profile Earlier in Life and Medicare Costs in the Last Year of Life

Department of Preventive Medicine, Feinberg School of Medicine, Northwesten University, Chicago, Ill 60611, USA.
Archives of Internal Medicine (Impact Factor: 17.33). 06/2005; 165(9):1028-34. DOI: 10.1001/archinte.165.9.1028
Source: PubMed


Health care costs are generally highest in the year before death, and much attention has been directed toward reducing costs for end-of-life care. However, it is unknown whether cardiovascular risk profile earlier in life influences health care costs in the last year of life. This study addresses this question.
Prospective cohort of adults from the Chicago Heart Association Detection Project in Industry included 6582 participants (40% women), aged 33 to 64 years at baseline examination (1967-1973), who died at ages 66 to 99 years. Medicare billing records (1984-2002) were used to obtain cardiovascular disease-related and total charges (adjusted to year 2002 dollars) for inpatient and outpatient services during the last year of life. Participants were classified as having favorable levels of all major cardiovascular risk factors (low risk), that is, serum cholesterol level lower than 200 mg/dL (<5.2 mmol/L), blood pressure 120/80 mm Hg or lower and no antihypertensive medication, body mass index (calculated as weight in kilograms divided by the square of height in meters) lower than 25, no current smoking, no diabetes, and no electrocardiographic abnormalities, or unfavorable levels of any 1 only, any 2 only, any 3 only, or 4 or more of these risk factors.
In the last year of life, average Medicare charges were lowest for low-risk persons. For example, cardiovascular disease-related and total charges were lower by 10,367 dollars and 15,318 dollars compared with those with 4 or more unfavorable risk factors; the fewer the unfavorable risk factors, the lower the Medicare charges (P for trends <.001). Analyses by sex showed similar patterns.
Favorable cardiovascular risk profile earlier in life is associated with lower Medicare charges at the end of life.

Download full-text


Available from: Daniel B Garside,
46 Reads
  • Source
    • "This demographic shift has resulted in importance being placed on health status trends for older people and how these trends may change in future, due to the anticipated increase in demand for health and social care services [4]. More recently, longer life expectancy has led to discussion of the likely quality of life associated with these additional years [5,6]. 'Quality of ageing' is rapidly becoming one of the most important social, political and health priorities of the early 21st century. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Social isolation affects a significant proportion of older people and is associated with poor health outcomes. The current evidence base regarding the effectiveness of interventions targeting social isolation is poor, and the potential utility of mentoring for this purpose has not previously been rigorously evaluated. The purpose of this study was to examine the effectiveness of a community-based mentoring service for improving mental health, social engagement and physical health for socially isolated older people. This prospective controlled trial compared a sample of mentoring service clients (intervention group) with a matched control group recruited through general practice. One hundred and ninety five participants from each group were matched on mental wellbeing and social activity scores. Assessments were conducted at baseline and at six month follow-up. The primary outcome was the Short Form Health Survey v2 (SF-12) mental health component score (MCS). Secondary outcomes included the SF-12 physical health component score (PCS), EuroQol EQ-5D, Geriatric Depression Score (GDS-10), social activity, social support and morbidities. We found no evidence that mentoring was beneficial across a wide range of participant outcomes measuring health status, social activity and depression. No statistically significant between-group differences were observed at follow-up in the primary outcome (p = 0.48) and in most secondary outcomes. Identifying suitable matched pairs of intervention and control group participants proved challenging. The results of this trial provide no substantial evidence supporting the use of community mentoring as an effective means of alleviating social isolation in older people. Further evidence is needed on the effectiveness of community-based interventions targeting social isolation. When using non-randomised designs, there are considerable challenges in the recruitment of suitable matches from a community sample. SCIE Research Register for Social Care 105923.
    BMC Public Health 04/2011; 11(1):218. DOI:10.1186/1471-2458-11-218 · 2.26 Impact Factor
  • Source
    • "At first glance, the exclusion of beneficiaries enrolled in Medicare MCOs may be seen as a particularly important study limitation. However, other studies of Medicare costs linked to survey data (e.g., Daviglus et al. 2005), including the NLTCS (Taylor, Sloan, and Doraiswamy 2004), have documented minimal bias when MCO enrollees were excluded. We found the excluded MCO group to have similar gender, race, and age-at-death distributions compared with the fee-for-service group under study. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To determine the effect of a diagnosis of Alzheimer's disease or related dementias (ADRD), and the timing of first ADRD diagnosis, on Medicare expenditures at end of life. Monthly Medicare payment data for the 5 years before death linked to the National Long-Term Care Survey (NLTCS) for decedents between 1996 and 2000 (N=4,899). Medicare payment data for the 5 years before death were used to compare 5-year and 6-month intervals of expenditures (total and six subcategories of services) for persons with and without a diagnosis of ADRD during the last 5 years of life, controlling for age, gender, race, education, comorbidities, and nursing home status. Covariate matching was used. On average, ADRD diagnosis was not significantly associated with excess Medicare payments over the last 5 years of life. Regarding the timing of ADRD diagnosis, there were no significant 5-year total expenditure differences for persons diagnosed with dementia more than 1 year before death. Payment differences by 6-month intervals were highly sensitive to timing of ADRD diagnosis, with the highest differences occurring around the time of diagnosis. There were reduced, non-significant, or negative total payment differences after the initial diagnosis for those diagnosed at least 1 year before death. Only those diagnosed with ADRD in the last year of life had significantly higher Medicare payments during the last 12 months of life, primarily for acute care services. ADRD has a smaller impact on total Medicare expenditures than previously reported in controlled studies. The significant differences occur primarily around the time of diagnosis. Although rates of dementia are increasing per se, our results suggest that long-term (1+ year) ADRD diagnoses do not contribute to greater total Medicare costs at the end of life.
    Health Services Research 05/2008; 43(2):714-32. DOI:10.1111/j.1475-6773.2007.00787.x · 2.78 Impact Factor
  • Source
    • "Or, on voit avec Medicare aux États-Unis que les coûts des services médicaux et hospitaliers sont également modulés selon l'état de santé des individus : les dépenses totales à partir de 70 ans et jusqu'au décès sont en effet les mêmes pour les individus en bonne et mauvaise santé à cet âge, et ce en dépit du fait que les aînés en santé auraient eu plus d'années pour accumuler des coûts (Lubitz, 2004). De même, les coûts associés au traitement d'un patient ayant moins de facteurs de risques pour certaines maladies mortelles, telle que les mala-dies du coeur, seraient moindres que ceux associés à une personne ayant beaucoup de facteurs de risque (Daviglus et al., 2005). Enfin, la comorbi-dité entraînerait des coûts plus élevés pour les personnes âgées (Shoenberg et al., 2007). "

    Le privé dans la santé: Les discours et les faits, Edited by François Béland, André-Pierre Contandriopoulos, Amélie Quesnel-Vallée, Lionel Robert, 01/2008: pages 69-77; Presses de l'Université de Montréal.
Show more