Cardiovascular risk profile earlier in life and medicare costs in the last year of life
Cardiovascular risk profile earlier in life and medicare costs in the last year of life
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DOI：
10.1001/archinte.165.9.1028
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发表时间：
2005-05-09
影响因子：
--
通讯作者：
Stamler, J
中科院分区：
文献类型：
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作者：
Daviglus, ML;Liu, K;Stamler, J
背景资料：医疗保健费用通常在死亡前一年最高，并且许多注意力都集中在减少临终关怀的费用上。然而，尚不清楚生命早期的心血管风险状况是否会影响生命最后一年的医疗保健费用。这项研究解决了这个问题。方法：前瞻性队列的成年人从芝加哥心脏协会检测项目在工业包括6582名参与者（40%的妇女），年龄33至64岁的基线检查（1967年至1973年），谁死在66至99岁。医疗保险账单记录（1984 - 2002年）用于获得生命最后一年期间住院和门诊服务的心血管疾病相关费用和总费用（调整为2002年美元）。参与者被归类为所有主要心血管危险因素均处于有利水平（低风险），即血清胆固醇水平低于200 mg/dL（<5.2 mmol/L），血压120/80 mm Hg或更低，未使用抗高血压药物，体重指数（以体重（千克）除以身高（米）的平方计算）低于25岁，无吸烟史，无糖尿病，无心电图异常，结果：在生命的最后一年，低风险人群的平均医疗费用最低。例如，与有4个或更多不利风险因素的患者相比，心血管疾病相关费用和总费用分别低10 367美元和15 318美元;不利风险因素越少，医疗保险费用越低（P趋势
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 (19842002) 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