Lifetime healthcare expenses across demographic and cardiovascular risk groups: The application of a novel modeling strategy in a large multiethnic cohort study.

Healthcare expenses Social determinants of health

Journal

American journal of preventive cardiology
ISSN: 2666-6677
Titre abrégé: Am J Prev Cardiol
Pays: Netherlands
ID NLM: 101769122

Informations de publication

Date de publication:
Jun 2023
Historique:
received: 16 12 2022
revised: 16 03 2023
accepted: 21 03 2023
medline: 3 7 2023
pubmed: 3 7 2023
entrez: 3 7 2023
Statut: epublish

Résumé

To understand the burden of healthcare expenses over the lifetime of individuals and evaluate differences among those with cardiovascular risk factors and among disadvantaged groups based on race/ethnicity and sex. We linked data from the longitudinal multiethnic Dallas Heart Study, which recruited participants between 2000 and 2002, with inpatient and outpatient claims from all hospitals in the Dallas-Fort Worth metroplex through December 2018, capturing encounter expenses. Race/ethnicity and sex, as well as five risk factors, hypertension, diabetes, hyperlipidemia, smoking, and overweight/obesity, were defined at cohort enrollment. For each individual, expenses were indexed to age and cumulated between 40 and 80 years of age. Lifetime expenses across exposures were evaluated as interactions in generalized additive models. A total of 2184 individuals (mean age, 45±10 years; 61% women, 53% Black) were followed between 2000 and 2018. The mean modeled lifetime cumulative healthcare expenses were $442,629 (IQR, $423,850 to $461,408). In models that included 5 risk factors, Black individuals had $21,306 higher lifetime healthcare spending compared with non-Black individuals ( Our study suggests Black individuals have higher lifetime healthcare expenses, exaggerated by the substantially higher prevalence of risk factors, with differences emerging in older age.

Identifiants

DOI: 10.1016/j.ajpc.2023.100493 PMID: 37397263 PMC: PMC10314135
pubmed: 37397263
doi: 10.1016/j.ajpc.2023.100493
pii: S2666-6677(23)00034-X
pmc: PMC10314135
doi:

Types de publication

Journal Article

Langues

eng

Pagination

100493

Informations de copyright

© 2023 The Author(s).

Déclaration de conflit d'intérêts

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr Khera receives support from the National Heart, Lung, and Blood Institute of the National Institutes of Health (under award K23HL153775) and the Doris Duke Charitable Foundation (under award, 2022060). He also receives research support, through Yale, from Bristol-Myers Squibb and Novo Nordisk. He is a coinventor of U.S. Provisional Patent Applications 63/177,117, 63/428,569, and 63/346,610, unrelated to current work. He is also a founder of Evidence2Health, a precision health platform to improve evidence-based care. Dr. Pandey reports financial support was provided by GEMSSTAR Grant 1R03AG067960. Dr. Powell-Wiley reports financial support was provided by Division of Intramural Research of the National Heart, Lung, and Blood Institute and the Intramural Research Program of the National Institute on Minority Health, and Health Disparities of the NIH.

Références

JAMA Intern Med. 2017 Jun 1;177(6):862-868
pubmed: 28395006
J Am Heart Assoc. 2019 Sep 17;8(18):e012729
pubmed: 31514563
J Am Coll Cardiol. 2018 Mar 13;71(10):1078-1089
pubmed: 29519347
N Engl J Med. 2012 Mar 22;366(12):1075-7
pubmed: 22435368
J Am Heart Assoc. 2021 Dec 7;10(23):e020184
pubmed: 34816728
Circulation. 2018 Jan 23;137(4):408-410
pubmed: 29133601
JAMA Netw Open. 2021 Jan 4;4(1):e2032669
pubmed: 33399859
Ann Intern Med. 2021 Oct;174(10):1450-1451
pubmed: 34516269
N Engl J Med. 2018 Jul 19;379(3):260-269
pubmed: 30021090
JACC Heart Fail. 2018 May;6(5):388-397
pubmed: 29655830
J Am Heart Assoc. 2020 Oct 20;9(19):e017793
pubmed: 32924728
Circ Cardiovasc Qual Outcomes. 2020 Jul;13(7):e006231
pubmed: 32552061
Circulation. 2019 Dec 17;140(25):2067-2075
pubmed: 31760784
Circulation. 2021 Feb 23;143(8):e254-e743
pubmed: 33501848
J Am Heart Assoc. 2021 Jul 20;10(14):e022164
pubmed: 33998273
BMJ. 2020 Jan 15;368:l6831
pubmed: 31941686
Circ Cardiovasc Qual Outcomes. 2018 Dec;11(12):e005083
pubmed: 30562071
Health Aff (Millwood). 2015 Aug;34(8):1281-8
pubmed: 26240240
N Engl J Med. 2012 Jan 26;366(4):321-9
pubmed: 22276822
J Am Coll Cardiol. 2019 Feb 19;73(6):727-732
pubmed: 30765039
JAMA. 2021 Nov 9;326(18):1793-1794
pubmed: 34677579
Am Heart J. 2012 Jun;163(6):1037-40
pubmed: 22709758
Circ Cardiovasc Qual Outcomes. 2020 Feb;13(2):e006139
pubmed: 32069093
J Am Heart Assoc. 2017 Aug 4;6(8):
pubmed: 28778943
JAMA Intern Med. 2021 Sep 1;181(9):1207-1215
pubmed: 34309621
Am J Cardiol. 2004 Jun 15;93(12):1473-80
pubmed: 15194016
Arch Intern Med. 2009 Mar 9;169(5):493-501
pubmed: 19273780
Diabetes Care. 2015 Mar;38(3):460-8
pubmed: 25552420
JAMA Netw Open. 2020 Apr 1;3(4):e203359
pubmed: 32320036
JAMA Cardiol. 2018 Aug 1;3(8):729-738
pubmed: 29971325

Auteurs

Rohan Khera (R)

Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, 333 Cedar St, New Haven, CT, United States.
Section of Health Informatics, Department of Biostatistics, Yale School of Public Health, 60 College St, New Haven, CT, United States.
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 195 Church St 5th Floor, New Haven, CT, United States.

Nitin Kondamudi (N)

Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, United States.

Mengni Liu (M)

Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, 333 Cedar St, New Haven, CT, United States.
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 195 Church St 5th Floor, New Haven, CT, United States.

Colby Ayers (C)

Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, United States.

Erica S Spatz (ES)

Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, 333 Cedar St, New Haven, CT, United States.
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 195 Church St 5th Floor, New Haven, CT, United States.

Shreya Rao (S)

Division of Cardiology, Department of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, United States.

Utibe R Essien (UR)

Department of Medicine, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, United States.

Tiffany M Powell-Wiley (TM)

Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, NIH, 3131 Center Drive, Bethesda, MD, United States.
Intramural Research Program, National Institute on Minority Health and Health Disparities, NIH, 6707 Democracy Boulevard, Suite 800, Bethesda, MD, United States.

Khurram Nasir (K)

Department of Cardiology, Houston Methodist, 6565 Fannin St, Houston, TX, United States.

Sandeep R Das (SR)

Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, United States.

Quinn Capers (Q)

Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, United States.

Ambarish Pandey (A)

Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, United States.

Classifications MeSH