title: Increased medical costs in elders with the metabolic syndrome are most evident with hospitalization of men.
abstract: BACKGROUND
  Little is known about health care costs associated with the metabolic syndrome (MetS).
  
  
  OBJECTIVE
  We assessed annualized health care costs and health outcomes for both genders in different health care settings among representative Taiwanese elders.
  
  
  METHODS
  The Nutrition and Health Survey in Taiwan (1999-2000) provided 1378 individuals aged 65 years or older with known MetS status. Nutrition and Health Survey in Taiwan files were linked to National Health Insurance records (1999-2006). Student t tests and multiple regression models were used to assess expenditures in total and in 6 services: inpatient, ambulatory care, dental care, traditional Chinese medicine, emergency care, and contracted pharmacy. The Cox model was used to assess gender effect on all-cause mortality and cardiovascular disease mortality, whereas logistic regression was used for that on cardiovascular disease hospitalization. The 5 MetS component costs were evaluated by multiple regressions.
  
  
  RESULTS
  MetS affected 29% of men and 48% of women. After full adjustment, those with MetS had 1.30 (95% CI, 1.11-1.52), men had 1.43 (95% CI, 1.20-1.70), and women had 1.19 (95% CI, 0.93-1.52) times higher costs than those without MetS. Compared with no MetS, MetS costs were increased 2.94-fold for inpatient care (95% CI, 1.23-7.10) and 1.30-fold for ambulatory care for men (95% CI, 1.12-1.52), whereas ambulatory MetS costs were increased 1.28-fold for women (95% CI, 1.05-1.57). MetS was associated with higher risk of cardiovascular disease hospitalization in men (adjusted odds ratio, 1.76; 95% CI, 1.20-2.58) but not in women (adjusted odds ratio, 1.08; 95% CI, 0.67-1.75). Among those with MetS, all-cause and cardiovascular mortality were comparable between men and women. Of the MetS components, low HDL cholesterol had the greatest affect on costs, more so in men (2.23-fold) than women (1.58-fold).
  
  
  CONCLUSIONS
  In people with MetS, service costs were greater overall, significantly for men, but not women, and these increased costs were evident for men who experienced hospitalization, but not women. At the same time, cardiovascular and all-cause mortalities were not significantly different by gender in regard to MetS in Taiwanese elders.
authors.affiliation: Division of Health Policy Translation, National Health Research Institutes, Miaoli County, Taiwan, Republic of China.
authors.forename: Yu-Hung
authors.initials: YH
authors.lastname: Chang
authors.forename: Rosalind Chia-Yu
authors.initials: RC
authors.lastname: Chen
authors.forename: Meei-Shyuan
authors.initials: MS
authors.lastname: Lee
authors.forename: Mark L
authors.initials: ML
authors.lastname: Wahlqvist
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications / Q000191:economics* / Q000401:mortality; D002423:Cause of Death; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006306:Health Surveys; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000191:economics* / Q000401:mortality; D016016:Proportional Hazards Models; D012307:Risk Factors; D012737:Sex Factors; D011795:Surveys and Questionnaires; D013624:Taiwan