Cardiovascular Health and Healthcare Utilization and Expenditures Among Medicare Beneficiaries: The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study.
Better cardiovascular health is associated with lower cardiovascular disease risk.



We determined the association between cardiovascular health and healthcare utilization and expenditures in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. We included 6262 participants ≥65 years with Medicare fee-for-service coverage for the year after their baseline study visit in 2003-2007. Cardiovascular health at baseline was assessed using the American Heart Association's Life's Simple 7 (LS7) metric, which includes 7 factors: cigarette smoking, physical activity, diet, body mass index, blood pressure, cholesterol, and glucose. Healthcare utilization and expenditures were ascertained using Medicare claims in the year following baseline. Overall, 17.2%, 31.1%, 29.0%, 16.4% and 6.4% of participants had 0 to 1, 2, 3, 4, and 5 to 7 ideal LS7 factors, respectively. The multivariable-adjusted relative risk (95% confidence interval [CI]) for having any inpatient and outpatient encounters comparing participants with 5 to 7 versus 0 to 1 ideal LS7 factors were 0.55 (0.39, 0.76) and 1.00 (0.98, 1.02), respectively. Among participants with 0 to 1 and 5 to 7 ideal LS7 factors, mean inpatient expenditures were $3995 and $1250, respectively, mean outpatient expenditures were $5166 and $2853, respectively, and mean total expenditures were $9147 and $4111, respectively. After multivariable adjustment, the mean (95% CI) cost difference comparing participants with 5 to 7 versus 0 to 1 ideal LS7 factors was -$2551 (-$3667, -$1435) for inpatient, -$2410 (-$3089, -$1731) for outpatient, and -$5016 (-$6577, -$3454) for total expenditures.



Better cardiovascular health is associated with lower risk for inpatient encounters and lower inpatient and outpatient healthcare expenditures.
Department of Medicine, University of Alabama at Birmingham, AL kjaaron@uabmc.edu.
Kristal J
KJ
Aaron
Department of Epidemiology, University of Alabama at Birmingham, AL.
Lisandro D
LD
Colantonio
Department of Epidemiology, University of Alabama at Birmingham, AL.
Luqin
L
Deng
Department of Biostatistics, University of Alabama at Birmingham, AL.
Suzanne E
SE
Judd
Department of Medicine, University of Alabama at Birmingham, AL.|Department of Health Care Organization and Policy, University of Alabama at Birmingham, AL.
Julie L
JL
Locher
Department of Medicine, University of Alabama at Birmingham, AL.|Department of Medicine, Weill Cornell Medical College, New York, NY.
Monika M
MM
Safford
Departments of Medicine and Pathology, Larner College of Medicine, University of Vermont, Burlington, VT.
Mary
M
Cushman
Department of Health Care Organization and Policy, University of Alabama at Birmingham, AL.
Meredith L
ML
Kilgore
Department of Health Care Organization and Policy, University of Alabama at Birmingham, AL.
David J
DJ
Becker
Department of Epidemiology, University of Alabama at Birmingham, AL.
Paul
P
Muntner
D000368:Aged; D002318:Cardiovascular Diseases / Q000191:economics* / Q000208:ethnology; D005260:Female; D005102:Health Expenditures / Q000639:trends*; D006304:Health Status; D006306:Health Surveys / Q000379:methods*; D006801:Humans; D015994:Incidence; D008019:Life Style; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D015995:Prevalence; D044469:Racial Groups / Q000208:ethnology*; D012307:Risk Factors; D020521:Stroke / Q000191:economics / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
Life's Simple 7; Medicare; cost; health services research; prevention; risk factor