The studies found that people who had cardiovascular risk factors identified during middle age, had increasing Medicare costs after age 65 and during the last year of their life. Most previous studies have assessed health care costs in the years immediately after risk assessment.
"Even if they live far longer, people who enter middle age with lower heart disease risk factors cost Medicare less money," said lead author of one study Kiang Liu, Ph.D., professor of preventive medicine at the Feinberg School of Medicine at Northwestern University in Chicago.
Liu's study found that Medicare spent an average $18,604 to treat cardiovascular disease in men over age 65 who had none of the six major controllable risk factors when screened at middle age. Costs for men with three or more risk factors in middle age were more than twice as high: $38,044. Those with one to two risk factors had intermediate costs – $28,483 for those with one risk factor and $28,632 for those with two. All costs were adjusted to year 2000 levels and for participants' baseline age, education and body-mass index. Drug costs not covered by Medicare were not included.
Women without any risk factors earlier in life cost Medicare an average $11,711 to treat cardiovascular disease from age 65 until death. Those with one risk factor cost $19,171; those with two cost $24,048; and those with three or more cost $38,059, the researchers reported.
In the two studies, investigators analyzed the Medicare costs before death among people who had been screened for heart disease risk factors when they were much younger.
Liu's study analyzed inpatient and outpatient Medicare costs in 1,246 men and 775 women who enrolled in Medicare from age 65 and died between 1984-2000. Each had participated in the Chicago Heart Association Detection Project, a study of more than 40,000 blue- and white-collar workers. In 1967-73, when the participants were 35- to 52-years-old, they had been screened for high blood pressure, high cholesterol, cigarette smoking, abnormal electrocardiograms and a history of diabetes or previous heart attack.
"There were large variations in costs among individuals, but there was a significant relationship between more risk factors and higher costs to treat cardiovascular disease," Liu said.
There also was a trend toward greater expenditures for all types of illnesses in those with more risk factors, the researchers reported. Total Medicare costs for all illness between age 65 and death were $75,111 for men with no risk factors, and $105,083 in men with three or more. In women, the trend was less striking: total costs for those with no risk factors were $97,123, compared with $101,731 for those with three or more risk factors.
"Medicare costs strongly relate to middle-age risk factors. People need to pay attention to health when they are middle-aged or younger – by the time they are older it could be too late. And if the government and the medical field want to reduce expenses, they should pay attention to prevention," Liu said.
In a companion study, Medicare costs in the last – and usually a person's most expensive – year of life were analyzed in 6,250 participants (2,598 women) in the Chicago Heart Association study. When initially screened, they were between ages 33 and 64; deaths occurred between ages 66 and 96.
Among men, average Medicare charges for all illness in the last year of life were $36,414 for those without heart disease risk factors (i.e., low-risk, at the earlier screening), compared with $50,639 for those with three or more risk factors. Costs to treat cardiovascular disease alone were $8,675 in the low-risk men vs. $20,103 for those with three or more risk factors. The trends were similar in women, with total charges of $36,911 ($7,396 for cardiovascular disease) in low-risk women and $41,769 ($13,721 for cardiovascular disease) in those with three or more risk factors.
"Having no cardiovascular risk factors earlier in life can result in lower costs for medical care in the last year of life," said lead author Martha L. Daviglus, M.D., Ph.D., associate professor of medicine (geriatrics) and preventive medicine at Feinberg School of Medicine.
"This is evidence that being healthier in middle age makes you more likely to have a better health status and better quality of life until very near the end. Instead of dying of an expensive and debilitating chronic illness, those who are healthier earlier in life maintain better health until near the time of death," Daviglus said.
Co-authors for Liu's study are Daviglus; LiJing Yan, Ph.D.; Daniel B. Garside, B.S.; Philip Greenland, M.D.; Larry M. Manheim, Ph.D.; Alan R. Dyer, Ph.D.; and Jeremiah Stamler, M.D. Co-authors for Daviglus' included those researchers plus Renwei Wang, M.D. and Amber Pirzada, M.D.
The National Heart, Lung, and Blood Institute funded the studies.
Note: Presentation time for abstract 3272 Liu is 4:30 p.m. EST, Sunday, Nov. 9, 2003.
Presentation time for abstract 3346 Daviglus is 2:45 p.m. EST Monday, Nov. 10, 2003.