title: Co-occurring Chronic Conditions and Economic Burden among Stroke Survivors in the United States: A Propensity Score-Matched Analysis.
abstract: OBJECTIVE
  This study examined the impact of co-occurring chronic conditions on healthcare expenditures among noninstitutionalized older adults (age ≥50 years) with stroke in comparison to non-stroke-matched controls.
  
  
  METHODS
  This study used a retrospective, cross-sectional, matched case-control design using pooled 2002-2012 Medical Expenditure Panel Survey (MEPS) data. Stroke survivors (N = 2913) were compared with matched controls (N = 8739) based on propensity scores. Healthcare expenditures for co-occurring chronic conditions were compared between stroke survivors and matched controls using ordinary least squares (OLS) regressions. All analyses were conducted in SAS 9.4 (SAS Institute Inc., Cary, NC, USA) using survey procedures adjusting for the complex survey design of the MEPS.
  
  
  RESULTS
  The annual mean total healthcare expenditures (expressed in 2012 United States dollars) were significantly higher among stroke survivors compared with matched non-stroke controls ($18,796 versus $14,391, P < .001). OLS regressions revealed that co-occurring chronic conditions partially explained the excess healthcare expenditures among stroke survivors. The annual mean total healthcare expenditures among stroke survivors were significantly higher for most of the co-occurring chronic conditions compared with matched controls (e.g., in presence of hyperlipidemia, stroke survivor expenditures were $18,807 compared to $15,807 among matched controls). Stroke survivors with co-occurring arthritis, diabetes, or hypertension had significantly greater inpatient, emergency room, and prescription expenditures compared with matched controls.
  
  
  CONCLUSIONS
  Stroke survivors experience a high economic burden. Interdisciplinary team-based treatment approaches to provide holistic care may help reduce the burden due to co-occurring chronic medical conditions among stroke survivors.
authors: Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, Arizona.
authors: Chanadda
authors: C
authors: Chinthammit
authors: Neurology Department, College of Medicine, The University of Arizona, Tucson, Arizona.
authors: Bruce M
authors: BM
authors: Coull
authors: Department of Pharmaceutical Care, Chiang Mai University, Chiang Mai, Thailand.
authors: Mantiwee
authors: M
authors: Nimworapan
authors: Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, Arizona. Electronic address: bhattacharjee@pharmacy.arizona.edu.
authors: Sandipan
authors: S
authors: Bhattacharjee
mesh_terms: D000368:Aged; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications* / Q000191:economics*; D017741:Survivors; D014481:United States
keywords: Stroke; co-occurring chronic conditions; expenditures; healthcare; propensity score