Benefit of a Favorable Cardiovascular Risk-Factor Profile in Middle Age with Respect to Medicare Costs

doi:10.1056/NEJM199810153391606

Volume 339:1122-1129		October 15, 1998		Number 16

Benefit of a Favorable Cardiovascular Risk-Factor Profile in Middle Age with Respect to Medicare Costs

Martha L. Daviglus, M.D., Ph.D., Kiang Liu, Ph.D., Philip Greenland, M.D., Alan R. Dyer, Ph.D., Daniel B. Garside, Larry Manheim, Ph.D., Lynn P. Lowe, Ph.D., Miriam Rodin, M.D., Ph.D., James Lubitz, M.P.H., and Jeremiah Stamler, M.D.

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by Russell, L. B.

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ABSTRACT

Background People without major risk factors for cardiovasculardisease in middle age live longer than those with unfavorablerisk-factor profiles. It is not known whether such low-riskstatus also results in lower expenditures for medical care atolder ages. We used data from the Chicago Heart AssociationDetection Project in Industry to assess the relation of a lowrisk of cardiovascular disease in middle age to Medicare expenditureslater in life.

Methods We studied 7039 men and 6757 women who were 40 to 64years of age when surveyed between 1967 and 1973 and who survivedto have at least two years of Medicare coverage in 1984 through1994. Men and women classified as being at low risk for cardiovasculardisease were those who had the following characteristics atthe time they were initially surveyed: serum cholesterol level,<200 mg per deciliter (5.2 mmol per liter); blood pressure, $<=$ 120/80 mm Hg; no current smoking; an absence of electrocardiographicabnormalities; no history of diabetes; and no history of myocardialinfarction. We compared Medicare costs for the 279 men (4.0percent) and 298 women (4.4 percent) who had this low-risk profilewith those for the rest of the study group, who were not atlow risk. Health Care Financing Administration charges for servicesto Medicare beneficiaries were used to estimate average annualhealth care costs (total costs, those for cardiovascular diseases,and those for cancer).

Results Average annual health care charges were much lower forpersons at low risk — the total charges for the men atlow risk were less than two thirds of the charges for the mennot at low risk ($1,615 less); for the women at low risk, thecharges were less than one half of those for the women not atlow risk ($1,885 less). Charges related to cardiovascular diseasewere lower for the low-risk groups of men and women than forthose not at low risk (by $979 and $556, respectively), andcharges related to cancer were also lower (by $134 and $189).

Conclusions People with favorable cardiovascular risk profilesin middle age had lower average annual Medicare charges in olderage. Having optimal status with respect to major cardiovascularrisk factors may result not only in greater longevity but alsoin lower health care costs.

Source Information

From the Department of Preventive Medicine (M.L.D., K.L., P.G., A.R.D., D.B.G., L.P.L., J.S.) and the Department of Medicine, Division of Geriatrics (M.L.D., M.R.), Northwestern University Medical School, Chicago; the Institute for Health Services Research and Policy Studies, Northwestern University, Evanston, Ill. (L.M.); and the Office of Research and Demonstrations, Health Care Financing Administration, Baltimore (J.L.).

Address reprint requests to Dr. Daviglus at the Department of Preventive Medicine, Northwestern University Medical School, 680 N. Lake Shore Dr., Suite 1102, Chicago, IL 60611.

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Russell, L. B. (1998). Prevention and Medicare Costs. NEJM 339: 1158-1160 [Full Text]

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