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J Am Heart Assoc. 2017 Feb 1;6(2). pii: e005106. doi: 10.1161/JAHA.116.005106.

Cardiovascular Health and Healthcare Utilization and Expenditures Among Medicare Beneficiaries: The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study.

Author information

1
Department of Medicine, University of Alabama at Birmingham, AL kjaaron@uabmc.edu.
2
Department of Epidemiology, University of Alabama at Birmingham, AL.
3
Department of Biostatistics, University of Alabama at Birmingham, AL.
4
Department of Medicine, University of Alabama at Birmingham, AL.
5
Department of Health Care Organization and Policy, University of Alabama at Birmingham, AL.
6
Department of Medicine, Weill Cornell Medical College, New York, NY.
7
Departments of Medicine and Pathology, Larner College of Medicine, University of Vermont, Burlington, VT.

Abstract

BACKGROUND:

Better cardiovascular health is associated with lower cardiovascular disease risk.

METHODS AND RESULTS:

We determined the association between cardiovascular health and healthcare utilization and expenditures in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. We included 6262 participants ≥65 years with Medicare fee-for-service coverage for the year after their baseline study visit in 2003-2007. Cardiovascular health at baseline was assessed using the American Heart Association's Life's Simple 7 (LS7) metric, which includes 7 factors: cigarette smoking, physical activity, diet, body mass index, blood pressure, cholesterol, and glucose. Healthcare utilization and expenditures were ascertained using Medicare claims in the year following baseline. Overall, 17.2%, 31.1%, 29.0%, 16.4% and 6.4% of participants had 0 to 1, 2, 3, 4, and 5 to 7 ideal LS7 factors, respectively. The multivariable-adjusted relative risk (95% confidence interval [CI]) for having any inpatient and outpatient encounters comparing participants with 5 to 7 versus 0 to 1 ideal LS7 factors were 0.55 (0.39, 0.76) and 1.00 (0.98, 1.02), respectively. Among participants with 0 to 1 and 5 to 7 ideal LS7 factors, mean inpatient expenditures were $3995 and $1250, respectively, mean outpatient expenditures were $5166 and $2853, respectively, and mean total expenditures were $9147 and $4111, respectively. After multivariable adjustment, the mean (95% CI) cost difference comparing participants with 5 to 7 versus 0 to 1 ideal LS7 factors was -$2551 (-$3667, -$1435) for inpatient, -$2410 (-$3089, -$1731) for outpatient, and -$5016 (-$6577, -$3454) for total expenditures.

CONCLUSIONS:

Better cardiovascular health is associated with lower risk for inpatient encounters and lower inpatient and outpatient healthcare expenditures.

KEYWORDS:

Life's Simple 7; Medicare; cost; health services research; prevention; risk factor

PMID:
28151403
PMCID:
PMC5523785
DOI:
10.1161/JAHA.116.005106
[Indexed for MEDLINE]
Free PMC Article

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