Kerry M Sheets, Howard A Fink, Lisa Langsetmo, Allyson M Kats, John T Schousboe, Kristine Yaffe, Kristine E Ensrud
{"title":"社区居住老年人痴呆和认知障碍的增量医疗费用:一项前瞻性队列研究","authors":"Kerry M Sheets, Howard A Fink, Lisa Langsetmo, Allyson M Kats, John T Schousboe, Kristine Yaffe, Kristine E Ensrud","doi":"10.1093/gerona/glaf030","DOIUrl":null,"url":null,"abstract":"Background Cognitive impairment and dementia are associated with higher healthcare costs; whether these increased costs are attributable to greater comorbidity burden is unknown. We sought to determine associations of cognitive impairment and dementia with subsequent total and sector-specific healthcare costs after accounting for comorbidities and to compare costs by method of case ascertainment. Methods Index examinations (2002-2011) of four prospective cohort studies linked with Medicare claims. 8,165 community-dwelling Medicare fee-for-service beneficiaries (4,318 women; 3,847 men). Cognitive impairment identified by self-or-proxy report of dementia and/or abnormal cognitive testing. Claims-based dementia and comorbidities derived from claims using Chronic Condition Warehouse algorithms. Annualized healthcare costs (2023 dollars) ascertained for 36 months following index examinations. Results 521 women (12.1%) and 418 men (10.9%) met criteria for cognitive impairment; 388 women (9%) and 234 men (6.1%) met criteria for claims-based dementia. After accounting for age, race, geographic region, and comorbidities, mean incremental costs of cognitive impairment versus no cognitive impairment in women (men) were $6,883 ($7,276) for total healthcare costs, $4,160 ($4,047) for inpatient costs, $1,206 ($1,587) for SNF costs, and $689 ($668) for HHC costs. Mean adjusted incremental total and inpatient costs associated with claims-based dementia were smaller in magnitude and not statistically significant. Mean adjusted incremental costs of claims-based dementia versus no claims-based dementia in women (men) were $759 ($1,251) for SNF costs and $582 ($535) for HHC costs. Conclusions Cognitive impairment is independently associated with substantial incremental total and sector-specific healthcare expenditures not fully captured by claims-based dementia or comorbidity burden.","PeriodicalId":22892,"journal":{"name":"The Journals of Gerontology Series A: Biological Sciences and Medical Sciences","volume":"63 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Incremental Healthcare Costs of Dementia and Cognitive Impairment in Community-Dwelling Older Adults: A Prospective Cohort Study\",\"authors\":\"Kerry M Sheets, Howard A Fink, Lisa Langsetmo, Allyson M Kats, John T Schousboe, Kristine Yaffe, Kristine E Ensrud\",\"doi\":\"10.1093/gerona/glaf030\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background Cognitive impairment and dementia are associated with higher healthcare costs; whether these increased costs are attributable to greater comorbidity burden is unknown. We sought to determine associations of cognitive impairment and dementia with subsequent total and sector-specific healthcare costs after accounting for comorbidities and to compare costs by method of case ascertainment. Methods Index examinations (2002-2011) of four prospective cohort studies linked with Medicare claims. 8,165 community-dwelling Medicare fee-for-service beneficiaries (4,318 women; 3,847 men). Cognitive impairment identified by self-or-proxy report of dementia and/or abnormal cognitive testing. Claims-based dementia and comorbidities derived from claims using Chronic Condition Warehouse algorithms. Annualized healthcare costs (2023 dollars) ascertained for 36 months following index examinations. Results 521 women (12.1%) and 418 men (10.9%) met criteria for cognitive impairment; 388 women (9%) and 234 men (6.1%) met criteria for claims-based dementia. After accounting for age, race, geographic region, and comorbidities, mean incremental costs of cognitive impairment versus no cognitive impairment in women (men) were $6,883 ($7,276) for total healthcare costs, $4,160 ($4,047) for inpatient costs, $1,206 ($1,587) for SNF costs, and $689 ($668) for HHC costs. Mean adjusted incremental total and inpatient costs associated with claims-based dementia were smaller in magnitude and not statistically significant. Mean adjusted incremental costs of claims-based dementia versus no claims-based dementia in women (men) were $759 ($1,251) for SNF costs and $582 ($535) for HHC costs. Conclusions Cognitive impairment is independently associated with substantial incremental total and sector-specific healthcare expenditures not fully captured by claims-based dementia or comorbidity burden.\",\"PeriodicalId\":22892,\"journal\":{\"name\":\"The Journals of Gerontology Series A: Biological Sciences and Medical Sciences\",\"volume\":\"63 1\",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-02-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"The Journals of Gerontology Series A: Biological Sciences and Medical Sciences\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1093/gerona/glaf030\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"The Journals of Gerontology Series A: Biological Sciences and Medical Sciences","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1093/gerona/glaf030","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Incremental Healthcare Costs of Dementia and Cognitive Impairment in Community-Dwelling Older Adults: A Prospective Cohort Study
Background Cognitive impairment and dementia are associated with higher healthcare costs; whether these increased costs are attributable to greater comorbidity burden is unknown. We sought to determine associations of cognitive impairment and dementia with subsequent total and sector-specific healthcare costs after accounting for comorbidities and to compare costs by method of case ascertainment. Methods Index examinations (2002-2011) of four prospective cohort studies linked with Medicare claims. 8,165 community-dwelling Medicare fee-for-service beneficiaries (4,318 women; 3,847 men). Cognitive impairment identified by self-or-proxy report of dementia and/or abnormal cognitive testing. Claims-based dementia and comorbidities derived from claims using Chronic Condition Warehouse algorithms. Annualized healthcare costs (2023 dollars) ascertained for 36 months following index examinations. Results 521 women (12.1%) and 418 men (10.9%) met criteria for cognitive impairment; 388 women (9%) and 234 men (6.1%) met criteria for claims-based dementia. After accounting for age, race, geographic region, and comorbidities, mean incremental costs of cognitive impairment versus no cognitive impairment in women (men) were $6,883 ($7,276) for total healthcare costs, $4,160 ($4,047) for inpatient costs, $1,206 ($1,587) for SNF costs, and $689 ($668) for HHC costs. Mean adjusted incremental total and inpatient costs associated with claims-based dementia were smaller in magnitude and not statistically significant. Mean adjusted incremental costs of claims-based dementia versus no claims-based dementia in women (men) were $759 ($1,251) for SNF costs and $582 ($535) for HHC costs. Conclusions Cognitive impairment is independently associated with substantial incremental total and sector-specific healthcare expenditures not fully captured by claims-based dementia or comorbidity burden.