title: Medicare Expenditure Correlates of Atrophy and Cerebrovascular Disease in Older Adults.
abstract: Background/Study Context: Magnetic resonance imaging (MRI) markers of cerebrovascular disease and atrophy are common in older adults and are associated with cognitive and medical burden. However, the extent to which they are related to health care expenditures has not been examined. We studied whether increased Medicare expenditures were associated with brain markers of atrophy and cerebrovascular disease in older adults.
  
  
  
  A subset of participants (n = 592; mean age = 80 years; 66% women) from the Washington Heights Inwood Columbia Aging Project (WHICAP), a community-based observational study of aging in upper Manhattan, received high-resolution MRI and had Medicare expenditure data on file. We examined the relationship of common markers of cerebrovascular disease (i.e., white matter hyperintensities and presence of infarcts) and atrophy (i.e., whole brain and hippocampal volume) with Medicare expenditure data averaged over a 10-year period. Main outcome measures were (a) mean Medicare payment per year across the 10-year interval; (b) mean payment for outpatient care per year; and (c) mean payment for inpatient care per year of visit. In addition, we calculated the ratio of mean inpatient spending to mean outpatient spending as well as the ratio of mean inpatient spending to mean total Medicare spending.
  
  
  
  Increased Medicare spending was associated with higher white matter hyperintensity volume, presence of cerebral infarcts, and smaller total brain volume. When examining specific components of Medicare expenditures, we found that inpatient spending was strongly associated with white matter hyperintensity volume and that increased ratios of inpatient to outpatient and inpatient to total spending were associated with infarcts.
  
  
  
  Medicare costs are related to common markers of "silent" cerebrovascular disease and atrophy.
authors.affiliation: a Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons , Columbia University , New York , New York , USA.
authors.forename: Briana S
authors.initials: BS
authors.lastname: Last
authors.affiliation: a Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons , Columbia University , New York , New York , USA.
authors.forename: Maria-José
authors.initials: MJ
authors.lastname: García Rubio
authors.affiliation: b Department of Geriatrics and Palliative Medicine , Icahn School of Medicine at Mount Sinai , New York , New York , USA.|c James J. Peters VA Medical Center , Bronx , New York , USA.
authors.forename: Carolyn W
authors.initials: CW
authors.lastname: Zhu
authors.affiliation: a Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons , Columbia University , New York , New York , USA.|d Gertrude H. Sergievsky Center, College of Physicians and Surgeons , Columbia University , New York , New York , USA.|e Department of Neurology, College of Physicians and Surgeons , Columbia University , New York , New York , USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Cosentino
authors.affiliation: a Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons , Columbia University , New York , New York , USA.|d Gertrude H. Sergievsky Center, College of Physicians and Surgeons , Columbia University , New York , New York , USA.|e Department of Neurology, College of Physicians and Surgeons , Columbia University , New York , New York , USA.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Manly
authors.affiliation: f Department of Neurology , University of California, Davis , Sacramento , California , USA.
authors.forename: Charles
authors.initials: C
authors.lastname: DeCarli
authors.affiliation: a Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons , Columbia University , New York , New York , USA.|d Gertrude H. Sergievsky Center, College of Physicians and Surgeons , Columbia University , New York , New York , USA.|e Department of Neurology, College of Physicians and Surgeons , Columbia University , New York , New York , USA.
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Stern
authors.affiliation: a Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons , Columbia University , New York , New York , USA.|d Gertrude H. Sergievsky Center, College of Physicians and Surgeons , Columbia University , New York , New York , USA.|e Department of Neurology, College of Physicians and Surgeons , Columbia University , New York , New York , USA.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Brickman
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D001284:Atrophy; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology*; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging* / Q000191:economics* / Q000473:pathology; D005260:Female; D005102:Health Expenditures; D006624:Hippocampus / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D014481:United States