College of Pharmacy, The University of Texas at Austin, Austin, TX.
Alzheimer Dis Assoc Disord. 2022;36(3):244-252. doi: 10.1097/WAD.0000000000000504. Epub 2022 Mar 16.
This study examined the extent to which chronic comorbidities contribute to excess health care expenditures between older adults with dementia and propensity score (PS)-matched nondementia controls.
This was a retrospective, cross-sectional, PS-matched case (dementia): control (nondementia) study of older adults (65 y or above) using alternative years data from pooled 2005 to 2015 Medical Expenditure Panel Surveys (MEPS). Chronic comorbidities were identified based on Clinical Classifications System or ICD-9-CM codes. Ordinary least squares regression was utilized to quantify the impact of chronic comorbidities on the excess expenditures with logarithmic transformation. Expenditures were expressed as 2019 US dollars. All analyses accounted for the complex survey design of MEPS.
The mean yearly home health care expenditures were particularly higher among older adults with dementia and co-occurring anemia, eye disorders, hyperlipidemia, and hypertension compared with PS-matched controls. Ordinary least squares regression models revealed that home health care expenditures were 131% higher (β=0.837, P <0.001) among older adults with dementia compared with matched nondementia controls before adjusting for chronic comorbidities. When additionally adjusting for chronic comorbidities, the percentage increase, while still significant ( P <0.001) decreased from 131% to 102%.
The excess home health care expenditures were partially explained by chronic comorbidities among community-dwelling older adults with dementia.
本研究旨在探讨慢性共病在多大程度上导致痴呆症老年患者与倾向评分（PS）匹配的非痴呆对照组之间的医疗保健支出过度。
这是一项回顾性、横断面、PS 匹配病例（痴呆症）：对照组（非痴呆症）研究，使用来自 2005 年至 2015 年 pooled 的医疗支出面板调查（MEPS）的替代年份数据。慢性共病是根据临床分类系统或 ICD-9-CM 代码确定的。利用普通最小二乘法回归来量化慢性共病对对数转换后超额支出的影响。支出以 2019 年美元表示。所有分析均考虑了 MEPS 的复杂调查设计。
与 PS 匹配的对照组相比，患有痴呆症且同时患有贫血、眼部疾病、高血脂和高血压的老年患者的家庭保健护理支出尤其更高。普通最小二乘法回归模型显示，在未调整慢性共病的情况下，与匹配的非痴呆对照组相比，痴呆症老年患者的家庭保健护理支出高出 131%（β=0.837，P<0.001）。当另外调整慢性共病时，尽管仍然显著（P<0.001），但百分比增加从 131%降至 102%。
在社区居住的痴呆症老年患者中，慢性共病部分解释了家庭保健护理支出的过度。
