Cardiovascular health in young and middle adulthood and medical care utilization and costs at older age – The Chicago Heart Association Detection Project Industry (CHA)

Cuiping Schiman, Lei Liu, Ya Chen Tina Shih, Lihui Zhao, Martha L. Daviglus, Kiang Liu, James Fries, Daniel B. Garside, Thanh Huyen T Vu, Jeremiah Stamler, Donald M Lloyd-Jones, Norrina Bai Allen*

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

It is unclear how long-term medical utilization and costs from diverse care settings and their age-related patterns may differ by cardiovascular health (CVH) status earlier in adulthood. We followed 17,195 participants of the Chicago Heart Association Detection Project Industry (1967–1973) with linked Medicare claims (1992 to 2010). Baseline CVH is a composite measure of blood pressure, body mass index, diabetes, cholesterol, and smoking and includes four mutually exclusive strata: all factors were favorable (5.5%), one or more factors were elevated but none high (20.3%), one factor was high (40.9%), and two or more factors were high (33.2%). We assessed differences in the quantities (using negative binomial models) of and costs (using quantile regressions) for inpatient admissions, ambulatory care, home health care, and others between less favorable and all favorable CVH. All analyses adjusted for baseline age, race, sex, education, age at follow-up, year, state of residence, and death. We found that all favorable CVH in earlier adulthood was associated with lower long-term utilization and costs in all settings and the gap widened with age. Compared to all favorable CVH, the annual number of acute inpatient admissions per person was 79% greater (p-value < 0.001) for poor CVH, the median annual Medicare payment per person was $640 greater (41%, p-value < 0.001), and the mean was $4628 greater (67%, p-value < 0.001). The cost differences were greatest for acute inpatient, followed by ambulatory, post-acute inpatient, home health, and other. Early prevention efforts may potentially result in compressed all-cause morbidity in later years of age, along with reductions in resource use and health care costs for associated conditions.

Original languageEnglish (US)
Pages (from-to)87-98
Number of pages12
JournalPreventive Medicine
Volume119
DOIs
StatePublished - Feb 1 2019

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Health Care Costs
Industry
Inpatients
Health
Costs and Cost Analysis
Medicare
Sex Education
Statistical Models
Home Care Services
Ambulatory Care
Health Status
Body Mass Index
Smoking
Cholesterol
Blood Pressure
Morbidity
Delivery of Health Care

Keywords

  • Cardiovascular health
  • Healthcare costs
  • Healthcare utilization

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health

Cite this

@article{2ee4b35f4acf477a9c01934b1faf0a36,
title = "Cardiovascular health in young and middle adulthood and medical care utilization and costs at older age – The Chicago Heart Association Detection Project Industry (CHA)",
abstract = "It is unclear how long-term medical utilization and costs from diverse care settings and their age-related patterns may differ by cardiovascular health (CVH) status earlier in adulthood. We followed 17,195 participants of the Chicago Heart Association Detection Project Industry (1967–1973) with linked Medicare claims (1992 to 2010). Baseline CVH is a composite measure of blood pressure, body mass index, diabetes, cholesterol, and smoking and includes four mutually exclusive strata: all factors were favorable (5.5{\%}), one or more factors were elevated but none high (20.3{\%}), one factor was high (40.9{\%}), and two or more factors were high (33.2{\%}). We assessed differences in the quantities (using negative binomial models) of and costs (using quantile regressions) for inpatient admissions, ambulatory care, home health care, and others between less favorable and all favorable CVH. All analyses adjusted for baseline age, race, sex, education, age at follow-up, year, state of residence, and death. We found that all favorable CVH in earlier adulthood was associated with lower long-term utilization and costs in all settings and the gap widened with age. Compared to all favorable CVH, the annual number of acute inpatient admissions per person was 79{\%} greater (p-value < 0.001) for poor CVH, the median annual Medicare payment per person was $640 greater (41{\%}, p-value < 0.001), and the mean was $4628 greater (67{\%}, p-value < 0.001). The cost differences were greatest for acute inpatient, followed by ambulatory, post-acute inpatient, home health, and other. Early prevention efforts may potentially result in compressed all-cause morbidity in later years of age, along with reductions in resource use and health care costs for associated conditions.",
keywords = "Cardiovascular health, Healthcare costs, Healthcare utilization",
author = "Cuiping Schiman and Lei Liu and Shih, {Ya Chen Tina} and Lihui Zhao and Daviglus, {Martha L.} and Kiang Liu and James Fries and Garside, {Daniel B.} and Vu, {Thanh Huyen T} and Jeremiah Stamler and Lloyd-Jones, {Donald M} and Allen, {Norrina Bai}",
year = "2019",
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doi = "10.1016/j.ypmed.2018.12.024",
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T1 - Cardiovascular health in young and middle adulthood and medical care utilization and costs at older age – The Chicago Heart Association Detection Project Industry (CHA)

AU - Schiman, Cuiping

AU - Liu, Lei

AU - Shih, Ya Chen Tina

AU - Zhao, Lihui

AU - Daviglus, Martha L.

AU - Liu, Kiang

AU - Fries, James

AU - Garside, Daniel B.

AU - Vu, Thanh Huyen T

AU - Stamler, Jeremiah

AU - Lloyd-Jones, Donald M

AU - Allen, Norrina Bai

PY - 2019/2/1

Y1 - 2019/2/1

N2 - It is unclear how long-term medical utilization and costs from diverse care settings and their age-related patterns may differ by cardiovascular health (CVH) status earlier in adulthood. We followed 17,195 participants of the Chicago Heart Association Detection Project Industry (1967–1973) with linked Medicare claims (1992 to 2010). Baseline CVH is a composite measure of blood pressure, body mass index, diabetes, cholesterol, and smoking and includes four mutually exclusive strata: all factors were favorable (5.5%), one or more factors were elevated but none high (20.3%), one factor was high (40.9%), and two or more factors were high (33.2%). We assessed differences in the quantities (using negative binomial models) of and costs (using quantile regressions) for inpatient admissions, ambulatory care, home health care, and others between less favorable and all favorable CVH. All analyses adjusted for baseline age, race, sex, education, age at follow-up, year, state of residence, and death. We found that all favorable CVH in earlier adulthood was associated with lower long-term utilization and costs in all settings and the gap widened with age. Compared to all favorable CVH, the annual number of acute inpatient admissions per person was 79% greater (p-value < 0.001) for poor CVH, the median annual Medicare payment per person was $640 greater (41%, p-value < 0.001), and the mean was $4628 greater (67%, p-value < 0.001). The cost differences were greatest for acute inpatient, followed by ambulatory, post-acute inpatient, home health, and other. Early prevention efforts may potentially result in compressed all-cause morbidity in later years of age, along with reductions in resource use and health care costs for associated conditions.

AB - It is unclear how long-term medical utilization and costs from diverse care settings and their age-related patterns may differ by cardiovascular health (CVH) status earlier in adulthood. We followed 17,195 participants of the Chicago Heart Association Detection Project Industry (1967–1973) with linked Medicare claims (1992 to 2010). Baseline CVH is a composite measure of blood pressure, body mass index, diabetes, cholesterol, and smoking and includes four mutually exclusive strata: all factors were favorable (5.5%), one or more factors were elevated but none high (20.3%), one factor was high (40.9%), and two or more factors were high (33.2%). We assessed differences in the quantities (using negative binomial models) of and costs (using quantile regressions) for inpatient admissions, ambulatory care, home health care, and others between less favorable and all favorable CVH. All analyses adjusted for baseline age, race, sex, education, age at follow-up, year, state of residence, and death. We found that all favorable CVH in earlier adulthood was associated with lower long-term utilization and costs in all settings and the gap widened with age. Compared to all favorable CVH, the annual number of acute inpatient admissions per person was 79% greater (p-value < 0.001) for poor CVH, the median annual Medicare payment per person was $640 greater (41%, p-value < 0.001), and the mean was $4628 greater (67%, p-value < 0.001). The cost differences were greatest for acute inpatient, followed by ambulatory, post-acute inpatient, home health, and other. Early prevention efforts may potentially result in compressed all-cause morbidity in later years of age, along with reductions in resource use and health care costs for associated conditions.

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