Examining proximity to death and health care expenditure by disease: a Bayesian-based descriptive statistical analysis from the National Health Insurance database in Japan

Background Japan is one of the Organization for Economic Co-operation and Development (OECD) countries where population aging and increasing health care expenditures (HCE) are urgent issues. Recent studies have identified factors other than age, such as proximity to death and morbidity, as contributing factors to the increase in medical costs. It is important to assess HCE by disease and analyze their factors to estimate and improve future HCE. Methods We extracted individual records spanning approximately 2 years prior to the death of persons aged 65 to 95 years from the National Health Insurance data in Japan, and used a Bayesian approach to decompose monthly HCE into five disease groups (circulatory, chronic kidney disease, neoplasms, respiratory, and others). The relationship between the proximity to death and the average HCE in each disease group was stratified by sex and age and analyzed using a descriptive statistical method similar to the two-part model. Results The average HCE increased rapidly as death approached in most disease groups, but the increase-pattern differed greatly among disease groups, sex, and age groups. The effect of proximity to death on average HCE was small for chronic diseases, but large for lethal diseases. When stratified by age and sex, younger and male decedents tended to have higher average HCE, but the extent of this varied by disease group. The two-year cumulative average HCE for neoplasms in the 65–75 years age group was about six times larger than those in the 85–95 years age group. Conclusions In Japan, it was suggested that disease, proximity to death, age, and sex may contribute to HCE. However, these factors interact in a complex manner, and it is important to analyze HCE by disease. In addition, preventing or delaying the severity of diseases with high medical burdens in younger people may be effective in reducing future terminal care costs. These findings have important implications for future projections and improvements of HCE.

Cellular Senescence in Sarcopenia: Possible Mechanisms and Therapeutic Potential

Aging promotes most degenerative pathologies in mammals, which are characterized by progressive decline of function at molecular, cellular, tissue, and organismal levels and account for a host of health care expenditures in both developing and developed nations. Sarcopenia is a prominent age-related disorder in musculoskeletal system. Defined as gradual and generalized chronic skeletal muscle disorder, sarcopenia involves accelerated loss of muscle mass, strength and function, which is associated with increased adverse functional outcomes and evolutionally refers to muscle wasting accompanied by other geriatric syndromes. More efforts have been made to clarify mechanisms underlying sarcopenia and new findings suggest that it may be feasible to delay age-related sarcopenia by modulating fundamental mechanisms such as cellular senescence. Cellular senescence refers to the essentially irreversible growth arrest mainly regulated by p53/p21CIP1 and p16INK4a/pRB pathways as organism ages, possibly detrimentally contributing to sarcopenia via muscle stem cells (MuSCs) dysfunction and the senescence-associated secretory phenotype (SASP) while cellular senescence may have beneficial functions in counteracting cancer progression, tissue regeneration and wound healing. By now diverse studies in mice and humans have established that targeting cellular senescence is a powerful strategy to alleviating sarcopenia. However, the mechanisms through which senescent cells contribute to sarcopenia progression need to be further researched. We review the possible mechanisms involved in muscle stem cells (MuSCs) dysfunction and the SASP resulting from cellular senescence, their associations with sarcopenia, current emerging therapeutic opportunities based on targeting cellular senescence relevant to sarcopenia, and potential paths to developing clinical interventions genetically or pharmacologically.

Newer Treatment Modalities in Urticaria

Wheals (hives), angioedema, or both are symptoms of urticaria, a chronic clinical disorder. Urticaria has a complicated pathogenesis, as well as a large disease burden, a negative effect on health-care expenditures and quality of living. Urticaria could also be a chronic condition that affects up to 1% of the general population at some stage in their lives and can drastically impair quality life. The use of second-generation, non-sedating antihistamines has replaced antihistamines to use as the first-line therapy. However, urticaria can be difficult to manage in some cases; in these cases, alternate treatment approaches must be considered. This article reviews antihistamines, leukotriene antagonists, anti-inflammatory drugs, biologicals, subcutaneous autologous serum therapy, doxepin, cyclosporine ,tranexamic acid and other newer treatment modalities.

Digitalization of healthcare sector as a tool for implementation of competition policy

Competitiveness of modern states is increasingly dependent on the method and scope of using information-communications technologies (ICTs) in the economy and in the implementation of the states' care functions. The application of information-communications technologies (ICTs) in health care is of special importance due to observed dynamic changes taking place in social structures. The main factors contributing to the widespread use of information-communications technologies (ICTs) in health care include demographic changes, the increase in the duration of human life, the increase in health care expenditures, progress in medical science and the increase in patients' ability to use automated devices. The aim of this article is to characterize the main ideas forming the architecture of the Healthcare 4.0 concept and to place this concept in a broader perspective of the Industry 4.0 concept.

Implications of Biological Rates of Aging on Healthcare Expenditures and Morbidity

Understanding biological aging, which entails impeding the progressive decline of biological systems, is important in enabling older adults to live independently. However, the differences in how individuals evolve as they age suggest that aging is a process that does not progress on a single-dimensional trajectory. Moreover, longitudinal studies of aging that follow a cohort of individuals over the course of several years are commonly limited by cost, attrition, and subsequently small sample size. In this study, we used a variational autoencoder to estimate multidimensional rates of aging from cross-sectional routine laboratory data of 1.4 million Americans of at least 40 years of age, collected from 2016 to 2019. We uncovered four aging dimensions that represent the following bodily functions: 1) kidney, 2) thyroid, 3) white blood cells, and 4) liver and heart. We found that fast agers along these dimensions are more likely to develop chronic diseases that are related to these bodily functions. They also had higher health care expenditures compared to the slow agers. K-means clustering of individuals based on the different aging rates revealed that clusters with higher odds of developing morbidity had the highest cost across all types of health care services. Results suggest that cross-sectional laboratory data can be leveraged as an alternative methodology to understand rates of aging along different dimensions, and analysis of their relationships with future costs can aid in the development of interventions to delay disease progression.

State-Level Health Care Expenditures Associated With Disability

This study updated prior (2003) state-level estimates of disability-associated health care expenditures (DAHE). We combined 2013-2015 data from three national data sets to estimate using multivariate regression all state-level DAHE for US adults in total, by payer, and per adult and per (adult) person with disability (PWD). In 2015, DAHE were $868 billion nationally (State range, $1.4 billion to $102.8 billion) accounting for 36% of total health care expenditures (range, 29%-41%). From over a decade ago, total DAHE increased by 65% (range, 35%-125%). DAHE per PWD was $17,431 (range $12,603 to $27,839). From over a decade ago, per-PWD DAHE increased by 13% (range, –20% to 61%). In 2015, Medicare DAHE per PWD ranged from $10,067 to $18,768. Medicaid DAHE per PWD ranged from $9,825 to $43,365. DAHE are substantial and vary by state and payer. Stakeholders can use these results to develop public health programs to support people with disabilities.

Implications of Disability for Functional Trajectory, Service Use, and Expenditures

People with disabilities face a diverse array of health care and support needs. These needs can vary by disability type, degree, and timing of the advent of functional limitations. These differences have implications for needed health care service use and related expenditures. The symposium will open with a Centers for Disease Control and Prevention-sponsored analysis of adult disability-associated health care expenditures, both nationally and by U.S. state, in total, by per adult, by per adult with disability, and by payer, to illustrate the contribution and variation of these expenditures to individual states and the health care system. We will next present a U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Planning and Evaluation effort to identify onset and patterns of reduced functional ability at end of life for older adults with and without dementia as related to other comorbidities. The last paper will present a Commonwealth Foundation study on older adults with functional disabilities and multiple chronic conditions, comparing those with high health care needs versus the subset of those people who are also high cost. Patterns of utilization differed between these two groups, and by state. These findings have implications for the development of care models that might best meet people’s needs. Our discussant will respond to the studies’ findings and discuss the important role that efforts to understand the nature of disability and functional status and the scale and scope of service use and costs have for people with disabilities.