Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY (S.K.).
The Comparative Health Outcomes, Policy and Economics Institute, School of Pharmacy, University of Washington, Seattle, WA (S.J.).
Circ Heart Fail. 2021 May;14(5):e007763. doi: 10.1161/CIRCHEARTFAILURE.120.007763. Epub 2021 May 13.
Heart failure (HF) constitutes a growing burden for public health and the US health care system. While the prevalence of HF is increasing, differences in health care utilization and expenditures within various sociodemographic groups remain poorly defined.
We used the Medical Expenditure Panel Survey to assess annual health care utilization and expenditures from 2012 to 2017. Health care utilization was based on the annual frequency of various health care encounters. Annual total and out-of-pocket expenditures were evaluated for hospital inpatient stays, emergency room visits, outpatient visits, office-based medical provider visits, prescribed medicines, dental visits, home health aid visits, and other medical expenses. We performed univariable and multivariable regression analysis based on patient characteristics including sociodemographic and comorbidity variables.
Our results showed that total health care expenditures among patients with HF were $21 177 (95% CI, $18 819-$24 736) per year as compared with $5652 (95% CI, $5469-$5837) in those without HF (<0.001). Total expenditures within the population with HF were primarily being driven by expenditures associated with inpatient hospitalizations. Increasing number of comorbid conditions was associated with significant increases in total health care expenditures. Older age, female sex, earlier study years, number of comorbidities, higher level of education, and increasing family income brackets independently raised out-of-pocket expenditures.
Our findings of increased health care utilization and expenditures based on sex, age, increasing number of comorbidities, wealthier income status, and increased education attainment level may be used for efforts aimed at better distributing health care resources to improve health outcomes in HF.
心力衰竭（HF）给公共卫生和美国医疗保健系统带来了越来越大的负担。尽管 HF 的患病率在不断上升，但不同社会人口群体在医疗保健利用和支出方面的差异仍未得到明确界定。
我们使用医疗支出面板调查评估了 2012 年至 2017 年的年度医疗保健利用情况和支出。医疗保健利用基于各种医疗保健就诊的年度频率。评估了住院患者、急诊就诊、门诊就诊、医生办公室就诊、处方药物、牙科就诊、家庭健康援助就诊和其他医疗费用的年度总支出和自付支出。我们根据患者特征（包括社会人口统计学和合并症变量）进行了单变量和多变量回归分析。
与无 HF 的患者相比（<0.001），HF 患者的年总医疗保健支出为 21177 美元（95%CI，18819-24736），而无 HF 的患者为 5652 美元（95%CI，5469-5837）。HF 患者人群中的总支出主要由住院相关支出驱动。合并症数量的增加与总医疗保健支出的显著增加相关。年龄较大、女性、较早的研究年份、合并症数量、较高的教育水平和收入水平较高的家庭收入阶层独立增加了自付支出。
我们发现基于性别、年龄、合并症数量增加、财富状况改善和教育程度提高的医疗保健利用和支出增加的发现，可以用于努力更好地分配医疗保健资源，以改善 HF 的健康结果。
