title: Presence of hepatitis C (HCV) infection in Baby Boomers with Medicare is independently associated with mortality and resource utilisation.
abstract: BACKGROUND
  Hepatitis C virus is common among Baby Boomers (BB). As this cohort ages, they will increasingly become Medicare eligible.
  
  
  OBJECTIVE
  To evaluate resource utilisation and mortality of BB-Medicare recipients with HCV.
  
  
  METHODS
  We used in-patient and out-patient Medicare databases (2005-2010). HCV was identified using ICD-9 codes. Outcomes included resource utilisation [payment/case and in-patient length of stay (LOS)] and short-term mortality.
  
  
  RESULTS
  Of 1 153 862 BB Medicare recipients (2005-2010), 3.2% (N = 37 365) had HCV. During this period, in-patient Medicare-BB (39 793-55 235) and their claims (78 924-106 232) increased. Furthermore, their overall mortality increased from 8.94% to 10.25% (P < 0.0001). In multivariate analysis, HCV [OR = 1.23 (1.16-1.29)], older age [OR = 1.98 (1.82-2.14)], male gender [OR = 1.25 (1.22-1.29)], ESRD [OR = 1.31 (1.26-1.36)], Charlson score [OR = 1.41 (1.40-1.42)] and LOS [OR = 1.02 (1.02-1.02)] predicted mortality. LOS decreased from 12.98 to 11.74 days (P < 0.0001), whereas total payments increased from $22 157 to $23 185 (P < .0001). During the study, the number of out-patient Medicare BB patients (123 097-192 110) and claims (863 978-1 340 260) also increased. Furthermore, overall mortality increased from 3.15% to 3.31% (P = 0.0131). Again, HCV [OR = 1.23 (1.16-1.30)], older age [OR = 2.03 (1.89-2.17)], ESRD [OR = 3.40 (3.28-3.51)], disabled status [OR = 1.49 (1.40-1.58)] and Charlson score [OR = 1.39 (1.38-1.40)] predicted mortality. Annual total out-patient payments increased from $3781 to $4001 (P < 0.0001). HCV [36.04% [34.28-37.82%)], 45-49 age [4.21% (3.14-5.28%)], ESRD [966.31% (954.86-977.88%)], disabled status [43.22% (41.67-44.80%)], Charlson score [46.78% (46.31-47.26%)] and study year [2.72% (2.58-2.85%)] independently predicted increases in payments.
  
  
  CONCLUSIONS
  In Baby Boomer Medicare recipients, diagnosis of HCV is independently associated with higher mortality and resource utilisation.
authors.affiliation: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Sayiner
authors.affiliation: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Wymer
authors.affiliation: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.
authors.forename: P
authors.initials: P
authors.lastname: Golabi
authors.affiliation: Department of Medicine, Center for Liver Disease, Inova Fairfax Hospital, Falls Church, VA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Ford
authors.affiliation: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.
authors.forename: I
authors.initials: I
authors.lastname: Srishord
authors.affiliation: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.|Department of Medicine, Center for Liver Disease, Inova Fairfax Hospital, Falls Church, VA, USA.
authors.forename: Z M
authors.initials: ZM
authors.lastname: Younossi
mesh_terms: D017677:Age Distribution; D016208:Databases, Factual; D006233:Persons with Disabilities; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006526:Hepatitis C / Q000191:economics* / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D044469:Racial Groups; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D014481:United States