Abdominal aortic calcification (AAC) and ankle-brachial index (ABI) predict health care costs and utilization in older men, independent of prevalent clinical cardiovascular disease and each other

BackgroundCKD is associated with higher health care costs that increase with disease progression. However, research is lacking on the type of health care costs associated with CKD across all stages in a general population with a substantial comorbidity burden.MethodsUsing electronic medical records of an integrated delivery system, we evaluated health care costs by expenditure type in general and in patients with CKD by eGFR and presence of comorbidities. We categorized 146,132 patients with eGFR data in 2016 or 2017 and examined nonmutually exclusive groups according to presence of diabetes mellitus, cardiovascular disease, or heart failure. We used 1 year of follow-up data to calculate outpatient, inpatient, emergency, pharmaceutical, dialysis, and total health care costs by eGFR (Kidney Disease Improving Global Outcomes–defined eGFR categories), adjusted for age, sex, and nonwhite race.ResultsMean total health care costs among patients with CKD without comorbidities were 31% higher than among patients without CKD ($7374 versus $5631, respectively). Hospitalizations accounted for 35% of total costs among those with CKD and no comorbidities but up to 55% among patients with CKD and heart failure. The proportion of costs attributable to hospitalizations accelerated with declining kidney function, reaching as high as 66%.ConclusionsPoorer kidney function and the presence of diabetes mellitus, cardiovascular disease, or heart failure drive substantial health care costs and increase the proportion of costs attributable to inpatient care. The large contribution of inpatient costs begins in earlier stages of CKD and escalates as kidney function declines. Additional therapies to reduce CKD incidence, slow CKD progression, and lower hospitalization risk are needed to benefit patients and reduce CKD’s economic burden.

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Reply to: “Increase in health care costs due to aorta calcification and low ABI in older men”

Atherosclerosis ◽

10.1016/j.atherosclerosis.2020.03.017 ◽

2020 ◽

Vol 300 ◽

pp. 56-57

Author(s):

John T. Schousboe ◽

Tien N. Vo ◽

Lisa Langsetmo ◽

Pawel Szulc ◽

Joshua R. Lewis ◽

...

Keyword(s):

Health Care ◽

Health Care Costs ◽

Older Men ◽

Care Costs

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Serum myostatin levels are negatively associated with abdominal aortic calcification in older men: the STRAMBO study

Acta Endocrinologica ◽

10.1530/eje-12-0512 ◽

2012 ◽

Vol 167 (6) ◽

pp. 873-880 ◽

Cited By ~ 10

Author(s):

P Szulc ◽

L C Hofbauer ◽

M Rauner ◽

C Goettsch ◽

R Chapurlat ◽

...

Keyword(s):

Serum Levels ◽

Older Men ◽

Aortic Calcification ◽

Negative Regulator ◽

Total Serum ◽

Abdominal Aortic Calcification ◽

Lateral Spine ◽

Reactive Protein ◽

Atherosclerotic Lesions ◽

Abdominal Aortic

ObjectiveTo assess the association between abdominal aortic calcification (AAC) and serum levels of myostatin, a negative regulator of skeletal muscle mass, which has been implicated in the development of atherosclerotic lesions in mice.Design and patientsWe assessed AAC semiquantitatively from the lateral spine scans obtained using dual energy X-ray absorptiometry in 1071 men aged 20–87 years. Serum myostatin levels were measured by an immunoassay that detects all myostatin forms.ResultsTotal myostatin serum levels did not differ between men with or without self-reported ischemic heart disease, hypertension, or diabetes mellitus. Total serum myostatin levels were higher in men with higher serum calcium levels and lower in men with higher serum concentrations of highly sensitive C-reactive protein. Men with AAC had lower myostatin levels compared with men without AAC. Prevalence of AAC (AAC score >0) was lower in the highest myostatin quartile compared with the three lower quartiles (P<0.05). After adjustment for confounders, odds of AAC (AAC score >0) were lower (OR=0.62; 95% confidence interval (95% CI), 0.45–0.85; P<0.005) for the fourth myostatin quartile vs the three lower quartiles combined. In the sub-analysis of 745 men aged ≥60 years, the results were similar: AAC prevalence was lower in the highest myostatin quartile compared with the three lower quartiles combined (OR=0.54; 95% CI, 0.38–0.78; P<0.001).ConclusionsIn older men, total myostatin serum levels are inversely correlated with AAC. Further studies are needed to investigate mechanisms underlying this association and to assess utility of myostatin as a cardiovascular marker.

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Increase in health care costs due to aorta calcification and low ABI in older men

Atherosclerosis ◽

10.1016/j.atherosclerosis.2020.02.019 ◽

2020 ◽

Vol 300 ◽

pp. 54-55

Author(s):

Ilker Tasci ◽

Mehmet Ilkin Naharci

Keyword(s):

Health Care ◽

Health Care Costs ◽

Older Men ◽

Care Costs

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Abstract MP76: Assessing the Impact of the "Health Bucks" Program on Cardiovascular Disease in New York City: A Modeling Study

Circulation ◽

10.1161/circ.141.suppl_1.mp76 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Heesun Eom ◽

Stella S Yi ◽

Daniel Bu ◽

Rienna Russo ◽

Brandon Bellows ◽

...

Keyword(s):

Cardiovascular Disease ◽

Health Care ◽

New York ◽

New York City ◽

Health Care Costs ◽

York City ◽

Fruits And Vegetables ◽

The Cost ◽

The Impact ◽

Care Costs

Background: Low fruit and vegetable (FV) consumption is considered one of the leading causes of deteriorating health outcomes, and has been linked to obesity, diabetes, and cardiovascular disease. Yet, few adults in New York City (NYC) consume the daily recommended amounts. In order to address the need for fresh and affordable fruits and vegetables, the NYC Department of Health and Mental Hygiene has implemented the “Health Bucks” program, which provides low-income population with coupons that can be used to purchase fruits and vegetetabls. Previous studies have shown the impact of the Health Bucks program on fruit and vegetable consumption; however, it is unclear how the program would influence cardiovascular health and the associated health care costs in the long term. Objective: To estimate the health and economic impact of the Health Bucks program using a validated microsimulation model of cardiovascular disease (CVD) in NYC. Methods: We used the Simulations for Health Improvement and Equity (SHINE) CVD Model to estimate the impact of the Health Bucks program on lifetime CVD events and direct medical costs (2019 USD). We considered different program strengths by assuming the program can reduce the cost of fruits and vegetables by 20%, 30%, and 40%. Population characteristics were estimated based on data from the 2013-2014 NYC Health and Nutrition Examination Survey. CVD risk factor trajectories and risk of incident CVD events were derived from six pooled longitudinal US cohorts. Policy effects were derived from the literature. We run 1,000 simulations to account for uncertainties in the parameter. We discounted costs by 3% and reported health care costs in 2019 dollars. Results: A Health Bucks program that can reduce the cost of fruits and vegetables by 20%, 30%, and 40% would prevent 2,690 (95% CI: -14,793, 20,173), 27,386 (95% CI: 9,967, 44,805), and 50,014 (95% CI: 15,227, 50,014) coronary heart disease events, respectively, over the simulated lifetimes of the NYC population. The program would also prevent 47,469 (95% CI: 35,008, 59,931), 59,127 (95% CI: 46,676, 71,579), and 85,359 (95% CI: 72,902, 97,815) stroke events based on the price reduction level. The program would result in savings in health care costs, ranged from $937 million to $1.8 billion based on the price reduction level over the lifetime or from $19 million to $37 million annually. Conclusions: We projected that the Health Bucks program could prevent a significant number of CVD events among adults in NYC and yield substantial health care cost savings. Public health practitioners and policymakers may consider adopting this program in other locations.

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