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Cardiovascular Risk Profile Earlier in Life and Medicare Costs in the Last Year of Life
Martha L. Daviglus, MD, PhD;
Kiang Liu, PhD;
Amber Pirzada, MD;
Lijing L. Yan, PhD;
Daniel B. Garside, BS;
Philip Greenland, MD;
Larry M. Manheim, PhD;
Alan R. Dyer, PhD;
Renwei Wang, MD;
James Lubitz, MPH;
Willard G. Manning, PhD;
James F. Fries, MD;
Jeremiah Stamler, MD
Arch Intern Med. 2005;165:1028-1034.
Background 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.
Methods 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.
Results 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 and $15 318 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.
Conclusion Favorable cardiovascular risk profile earlier in life is associated with lower Medicare charges at the end of life.
Author Affiliations: Departments of Preventive Medicine (Drs Daviglus, Liu, Pirzada, Yan, Greenland, Dyer, Wang, and Stamler and Mr Garside), and Medicine, Division of Geriatrics (Drs Daviglus and Liu), and the Institute for Health Services Research and Policy Studies (Dr Manheim), Feinberg School of Medicine, Northwestern University, Chicago, Ill; Department of Health Economics and Management, Guanghua School of Management, Peking University, Beijing, China (Dr Yan); National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Md (Mr Lubitz); Harris School of Public Policy Studies, University of Chicago, Chicago (Dr Manning); and Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif (Dr Fries).
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