Relationship of fruit and vegetable consumption in middle-aged men to medicare expenditures in older age: The Chicago western electric study

Background: High fruit and vegetable intake is associated with lower risk of hypertension, cardiovascular disease, and cancer. Little is known about the relationship of fruit and vegetable intake to health care expenditures. Objective: Examine whether fruit and vegetable intake among middle-aged adults is related to Medicare charges - total, cardiovascular disease, cancer-related - in older age. Design: Participants were grouped into one of three strata according to fruit and vegetable intake, determined from detailed dietary history (1958-1959): less than 14 cups per month, 14 to 42 cups per month, or more than 42 cups per month. Combined intake was classified as low, medium, or high. Medicare claims data (1984-2000) were used to estimate mean annual spending for eligible surviving participants (65 years and older) from the Chicago Western Electric Study: 1,063 men age 40 to 55 and without coronary heart disease, diabetes, and cancer at baseline (1957-1958). Cumulative charges before death (n=401) were also calculated. Results: Higher fruit and fruit plus vegetable intakes were associated with lower mean annual and cumulative Medicare charges (P values for trend .019 to .862). For example, with adjustment for baseline age, education, total energy intake, and multiple baseline risk factors, annual cardiovascular disease-related charges were $3,128 vs $4,223 for men with high vs low intake of fruit plus vegetables. Corresponding figures were $1,352 vs $1,640 for cancer-related charges and $10,024 vs $12,211 for total charges. Results were generally similar for vegetable intake. Conclusion: These findings, albeit mostly not statistically significant, suggest that for men high intake of fruits and fruits plus vegetables earlier in life has potential not only for better health status but also for lower health care costs in older age.