title: Cardiovascular risk profile earlier in life and Medicare costs in the last year of life.
abstract: 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 (1984-2002) 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 dollars and 15,318 dollars compared with those with 4 or more unfavorable risk factors; the fewer the unfavorable risk factors, the lower the Medicare charges (P for trends <.001). Analyses by sex showed similar patterns.
  
  
  CONCLUSIONS
  Favorable cardiovascular risk profile earlier in life is associated with lower Medicare charges at the end of life.
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwesten University, Chicago, Ill 60611, USA. daviglus@northwestern.edu
authors.forename: Martha L
authors.initials: ML
authors.lastname: Daviglus
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
authors.forename: Amber
authors.initials: A
authors.lastname: Pirzada
authors.forename: Lijing L
authors.initials: LL
authors.lastname: Yan
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Garside
authors.forename: Philip
authors.initials: P
authors.lastname: Greenland
authors.forename: Larry M
authors.initials: LM
authors.lastname: Manheim
authors.forename: Alan R
authors.initials: AR
authors.lastname: Dyer
authors.forename: Renwei
authors.initials: R
authors.lastname: Wang
authors.forename: James
authors.initials: J
authors.lastname: Lubitz
authors.forename: Willard G
authors.initials: WG
authors.lastname: Manning
authors.forename: James F
authors.initials: JF
authors.lastname: Fries
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Stamler
mesh_terms: D000328:Adult; D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000191:economics* / Q000209:etiology / Q000401:mortality; D002784:Cholesterol / Q000097:blood; D015331:Cohort Studies; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics*; D008875:Middle Aged; D018570:Risk Assessment; D012907:Smoking; D013727:Terminal Care / Q000191:economics*
chemical_list: D002784:Cholesterol