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Medicare Expenditure Correlates of Atrophy and Cerebrovascular Disease in Older Adults.

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Title: Medicare Expenditure Correlates of Atrophy and Cerebrovascular Disease in Older Adults.
Authors: Last, Briana S. (AUTHOR), García Rubio, Maria-José (AUTHOR), Zhu, Carolyn W. (AUTHOR), Cosentino, Stephanie (AUTHOR), Manly, Jennifer J. (AUTHOR), DeCarli, Charles (AUTHOR), Stern, Yaakov (AUTHOR), Brickman, Adam M. (AUTHOR)
Source: Experimental Aging Research. Mar/Apr2017, Vol. 43 Issue 2, p149-160. 12p. 3 Charts.
Subjects: Aging, Arousal (Physiology), Attention, Cerebrovascular disease, Emotions, Magnetic resonance imaging, Medicare, Memory, Atrophy
Geographic Terms: United States
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. [ABSTRACT FROM AUTHOR]
Copyright of Experimental Aging Research is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Medicare Expenditure Correlates of Atrophy and Cerebrovascular Disease in Older Adults.
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  Data: <searchLink fieldCode="JN" term="%22Experimental+Aging+Research%22">Experimental Aging Research</searchLink>. Mar/Apr2017, Vol. 43 Issue 2, p149-160. 12p. 3 Charts.
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  Data: <searchLink fieldCode="DE" term="%22Aging%22">Aging</searchLink><br /><searchLink fieldCode="DE" term="%22Arousal+%28Physiology%29%22">Arousal (Physiology)</searchLink><br /><searchLink fieldCode="DE" term="%22Attention%22">Attention</searchLink><br /><searchLink fieldCode="DE" term="%22Cerebrovascular+disease%22">Cerebrovascular disease</searchLink><br /><searchLink fieldCode="DE" term="%22Emotions%22">Emotions</searchLink><br /><searchLink fieldCode="DE" term="%22Magnetic+resonance+imaging%22">Magnetic resonance imaging</searchLink><br /><searchLink fieldCode="DE" term="%22Medicare%22">Medicare</searchLink><br /><searchLink fieldCode="DE" term="%22Memory%22">Memory</searchLink><br /><searchLink fieldCode="DE" term="%22Atrophy%22">Atrophy</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22United+States%22">United States</searchLink>
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  Data: 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. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Experimental Aging Research is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1080/0361073X.2017.1276376
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        Text: English
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        PageCount: 12
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      – SubjectFull: Aging
        Type: general
      – SubjectFull: Arousal (Physiology)
        Type: general
      – SubjectFull: Attention
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      – SubjectFull: Cerebrovascular disease
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      – SubjectFull: Magnetic resonance imaging
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      – SubjectFull: Medicare
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      – SubjectFull: Memory
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      – SubjectFull: Atrophy
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      – SubjectFull: United States
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              Text: Mar/Apr2017
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