Department of Primary Care and Public Health Sciences, King's College London, Guy's Campus, 3rd Floor Addison House, London, SE1 1UL, UK.
Department of Social Policy, London School of Economics and Political Science, London, UK.
Eur J Health Econ. 2018 Jul;19(6):831-842. doi: 10.1007/s10198-017-0926-2. Epub 2017 Aug 30.
Ageing is assumed to be accompanied by greater health care expenditures but the association is also viewed as a 'red herring'. This study aimed to evaluate whether age is associated with health care costs in the senior elderly, using electronic health records for 98,220 participants aged 80 years and over registered with the UK Clinical Practice Research Datalink and linked Hospital Episode Statistics (2010-2014). Annual costs of health care utilization were estimated from a two-part model; multiple fractional polynomial models were employed to evaluate the non-linear association of age with predicted health care costs while also controlling for comorbidities, impairments, and death proximity. Annual health care costs increased from 80 years (£2972 in men, £2603 in women) to 97 (men; £4721) or 98 years (women; £3963), before declining. Costs were significantly elevated in the last year of life but this effect declined with age, from £10,027 in younger octogenarians to £7021 in centenarians. This decline was steeper in participants with comorbidities or impairments; £14,500 for 80-84-year-olds and £6752 for centenarians with 7+ impairments. At other times, comorbidity and impairments, not age, were main drivers of costs. We conclude that comorbidities, impairments, and proximity to death are key mediators of age-related increases in health care costs. While the costs of comorbidity among survivors are not generally associated with age, additional costs in the last year of life decline with age.
衰老是伴随着更高的医疗保健支出，但这种关联也被视为“转移注意力”。本研究旨在使用英国临床实践研究数据链接和链接的医院事件统计数据（2010-2014 年），评估年龄是否与 80 岁及以上的老年人的医疗保健费用有关。利用两部分模型估算了医疗保健利用的年度费用；采用多元分数多项式模型来评估年龄与预测医疗保健费用之间的非线性关联，同时控制了合并症、残疾和接近死亡的情况。从 80 岁（男性为 2972 英镑，女性为 2603 英镑）到 97 岁（男性为 4721 英镑）或 98 岁（女性为 3963 英镑），年度医疗保健费用逐年增加，然后下降。在生命的最后一年，费用显著增加，但这种影响随着年龄的增长而下降，从较年轻的 80 多岁人群中的 10027 英镑下降到百岁老人中的 7021 英镑。在有合并症或残疾的参与者中，这种下降更为陡峭；80-84 岁的参与者为 14500 英镑，有 7 种以上残疾的参与者为 6752 英镑。在其他时候，合并症和残疾而不是年龄是导致费用增加的主要因素。我们得出结论，合并症、残疾和接近死亡是导致与年龄相关的医疗保健费用增加的关键因素。虽然幸存者的合并症费用通常与年龄无关，但生命最后一年的额外费用随着年龄的增长而下降。
