Experimental Aging Research

An International Journal Devoted to the Scientific Study of the Aging Process

Volume 43, 2017 - Issue 2

135

Views

CrossRef citations to date

Altmetric

Original Articles

Medicare Expenditure Correlates of Atrophy and Cerebrovascular Disease in Older Adults

Briana S. LastTaub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA

Maria-José García RubioTaub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA

Carolyn W. ZhuDepartment of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA;James J. Peters VA Medical Center, Bronx, New York, USA

Stephanie CosentinoTaub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA;Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA;;Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA

Jennifer J. ManlyTaub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA;Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA;;Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA

Charles DeCarliDepartment of Neurology, University of California, Davis, Sacramento, California, USA

Yaakov SternTaub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA;Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA;;Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA

Adam M. BrickmanTaub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA;Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA;;Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USACorrespondence[email protected]

show all

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.

Methods: 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.

Results: 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.

Conclusion: Medicare costs are related to common markers of “silent” cerebrovascular disease and atrophy.

Funding

This work was supported by NIH grants AG037212, AG007232, AG034189, AG029949, and AG007370.

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Order Reprints Request Corporate Permissions

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

Request Academic Permissions

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.

Medicare Expenditure Correlates of Atrophy and Cerebrovascular Disease in Older Adults

Information for

Open access

Opportunities

Help and information

Medicare Expenditure Correlates of Atrophy and Cerebrovascular Disease in Older Adults

Abstract

Funding

Reprints and Corporate Permissions

Academic Permissions

Related research

To cite this article:

Download citation

Information for

Open access

Opportunities

Help and information

Keep up to date

Your download is now in progress and you may close this window

Login or register to access this feature