Determinants of health care costs in the senior elderly: age, comorbidity, impairment, or proximity to death?
Determinants of health care costs in the senior elderly: age, comorbidity, impairment, or proximity to death?
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DOI：
10.1007/s10198-017-0926-2
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发表时间：
2018-07
期刊：
影响因子：
--
通讯作者：
Gulliford MC
中科院分区：
文献类型：
--
作者：
Hazra NC;Rudisill C;Gulliford MC
老龄化被认为是伴随着更大的医疗保健支出，但该协会也被视为“红鲱鱼”。这项研究旨在评估老年人的年龄是否与医疗保健费用相关，使用英国临床实践研究数据链和相关医院事件统计（2010-2014）注册的98，220名80岁及以上参与者的电子健康记录。通过两部分模型估计医疗保健利用的年度成本;采用多个分数多项式模型来评估年龄与预测医疗保健成本的非线性相关性，同时控制合并症、损伤和死亡接近度。年度医疗保健费用从80岁（男性2972英镑，女性2603英镑）增加到97岁（男性; 4721英镑）或98岁（女性; 3963英镑），然后下降。在生命的最后一年，成本显着升高，但这种影响随着年龄的增长而下降，从年轻的百岁老人的10，027英镑到百岁老人的7021英镑。这种下降在患有合并症或损伤的参与者中更为陡峭; 80-84岁的人为14，500英镑，7岁以上的百岁老人为6752英镑。在其他时候，合并症和损伤，而不是年龄，是成本的主要驱动因素。我们的结论是，合并症，损伤和接近死亡的关键介质的年龄相关的医疗保健费用的增加。虽然幸存者的合并症成本通常与年龄无关，但生命最后一年的额外成本随着年龄的增长而下降。本文的在线版本（doi：10.1007/s10198-017-0926-2）包含补充材料，可供授权用户使用。
Ageing is assumed to be accompanied by greater health care expenditures but the association is also viewed as a ‘red herring’. This study aimed to evaluate whether age is associated with health care costs in the senior elderly, using electronic health records for 98,220 participants aged 80 years and over registered with the UK Clinical Practice Research Datalink and linked Hospital Episode Statistics (2010–2014). Annual costs of health care utilization were estimated from a two-part model; multiple fractional polynomial models were employed to evaluate the non-linear association of age with predicted health care costs while also controlling for comorbidities, impairments, and death proximity. Annual health care costs increased from 80 years (£2972 in men, £2603 in women) to 97 (men; £4721) or 98 years (women; £3963), before declining. Costs were significantly elevated in the last year of life but this effect declined with age, from £10,027 in younger octogenarians to £7021 in centenarians. This decline was steeper in participants with comorbidities or impairments; £14,500 for 80–84-year-olds and £6752 for centenarians with 7+ impairments. At other times, comorbidity and impairments, not age, were main drivers of costs. We conclude that comorbidities, impairments, and proximity to death are key mediators of age-related increases in health care costs. While the costs of comorbidity among survivors are not generally associated with age, additional costs in the last year of life decline with age. The online version of this article (doi:10.1007/s10198-017-0926-2) contains supplementary material, which is available to authorized users.
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影响因子：
2.1
作者：
Eckardt, Matthias;Brettschneider, Christian;Koenig, Hans-Helmut
通讯作者：
Koenig, Hans-Helmut
影响因子：
2.1
作者：
Salas, C;Raftery, JP
通讯作者：
Raftery, JP
DOI：
10.1111/j.1532-5415.2008.02015.x
发表时间：
2008-12-01
影响因子：
6.3
作者：
Mody, Lona;Miller, Douglas K.;Studenski, Stephanie
通讯作者：
Studenski, Stephanie
影响因子：
2.1
作者：
Sato, Emi;Fushimi, Kiyohide
通讯作者：
Fushimi, Kiyohide
DOI：
10.1093/pubmed/fdt116
发表时间：
2014-12
期刊：
Journal of public health (Oxford, England)
影响因子：
--
作者：
Mathur R;Bhaskaran K;Chaturvedi N;Leon DA;vanStaa T;Grundy E;Smeeth L
通讯作者：
Smeeth L