title: Comorbid diabetes and end-of-life expenditures among Medicare beneficiaries with heart failure.
abstract: BACKGROUND
  Diabetes is associated with increased risk of mortality in heart failure. We examined the association of diabetes with expenditures, hospitalizations, and procedures among Medicare beneficiaries with heart failure during the last 6 months of life.
  
  
  RESULTS
  In a 5% national Medicare sample, the prevalence of diabetes was 41.7% among 16,613 beneficiaries who died in 2007 with a diagnosis of heart failure. Diabetes was associated with higher expenditures during the last 6 months of life (mean $39,042 vs $29,003; P < .001), even after adjusting for covariates, including age, sex, race, geographic location, comorbidities, and preceding hospitalizations (cost ratio 1.08, 95% CI 1.05-1.12). For both diabetic and nondiabetic adults, more than one-half of Medicare expenditures were related to hospitalization costs (mean $22,516 vs $15,721; P < .001). Compared with their counterparts without diabetes, beneficiaries with diabetes had higher rates of hospitalization (adjusted incidence rate ratio 1.09, 95% CI 1.05-1.12) and days spent in the intensive care unit.
  
  
  CONCLUSIONS
  Comorbid diabetes was common in heart failure and associated with higher expenditures, much of which was driven by increased rates of hospitalizations. Programs that focus on prevention of hospitalizations may reduce the substantial costs associated with heart failure near the end of life.
authors.affiliation: Division of General Internal Medicine, New York University School of Medicine, New York, New York 10016, USA. saul.blecker@nyumc.org
authors.forename: Saul
authors.initials: S
authors.lastname: Blecker
authors.forename: Robert
authors.initials: R
authors.lastname: Herbert
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Brancati
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000191:economics* / Q000453:epidemiology; D005006:Ethnicity; D005260:Female; D006299:Health Services for the Aged / Q000191:economics; D006333:Heart Failure / Q000150:complications / Q000191:economics* / Q000453:epidemiology; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007362:Intensive Care Units / Q000191:economics; D007902:Length of Stay / Q000191:economics; D008297:Male; D006278:Medicare / Q000191:economics*; D015995:Prevalence; D013727:Terminal Care / Q000191:economics; D014481:United States / Q000453:epidemiology