Early Adult Cardiovascular Health and Later-Life Healthcare Utilization and Costs

Background: Previous evidence suggests that better cardiovascular health earlier in adulthood was associated with a compressed all-cause later-life morbidity and lower medical care costs. In this study, we investigated the association between cardiovascular (CV) health measured earlier in adulthood and medical care utilization and costs at ages 65 and older. In particular, we examine whether the associations differed by care setting, such as acute inpatient care, post-acute care, outpatient care, and other care. Methods: Exposure: baseline cardiovascular health was measured in the Chicago Heart Association Detection Project Industry (CHA) between 1967 and 1973 when the participants were aged between 22 and 77 years (mean age = 42). Cardiovascular risk factors measured included blood pressure, body mass index, diabetes, cholesterol, and cigarette smoking. Following clinical guidelines, participants were grouped into four exclusive baseline CV health strata: all factors were favorable, one or more factors were elevated but none were high, one factor was high, and two or more factors were high. Later-life medical care utilization and costs are from the Medicare Part A and Part B claims from 1991 to 2010, up to 30 and 40 years after baseline CV health was measured. The analysis sample included 18,890 unique CHA participants and a participant had, on average, 9.6 years of Medicare claims, rendering a longitudinal analysis sample of 181,782 person-years. We used a negative binomial estimation method to compare later-life medical care utilization and quantile regressions to compare costs among participants in the four risk strata. We control for baseline age, race, sex, education, current age, year effects, state of residence, and death. Results: We found that poorer CV health earlier in adulthood was associated with higher later-life utilization among all acute, post-acute, and ambulatory care examined. However, intensive and expensive care such as acute inpatient admissions increased by disproportionately more than it did in less expensive care such as post-acute care and ambulatory care. We also found that these differences in utilization increased with age. Moreover, we found that poorer CV health at baseline was associated with higher total costs and cost across all care settings, but the percentage increase was larger for inpatient costs than outpatient costs and costs for professional and other services. Conclusion: Favorable cardiovascular heath earlier in adulthood was associated with lower later-life medical care utilization, implying a decrease in morbidity and severity of illnesses. Our findings suggest substantial long-term savings from early prevention in terms of avoided medical care costs later in life. Potential cost savings were present in all care settings but were relatively larger for more intensive care such as acute inpatient care.