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Medicare Expenditures and Health Care Utilization in a Multiethnic Community-based Population With Dementia From Incidence to Death

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Introduction:

While individuals live with dementia for many years, utilization and expenditures from disease onset through the end-of-life period have not been examined in ethnically diverse samples.

Methods:

We used a multiethnic, population-based, prospective study of cognitive aging (Washington Heights-Inwood Columbia Aging Project) linked to Medicare claims to examine total Medicare expenditures and health care utilization among individuals with clinically diagnosed incident dementia from disease onset to death.

Results:

High-intensity treatment (hospitalizations, life-sustaining procedures) was common and mean Medicare expenditures per year after diagnosis was $69,000. Non-Hispanic blacks exhibited higher spending relative to Hispanics and non-Hispanic whites 1 year after diagnosis. Non-Hispanic blacks had higher total (mean=$205,000) Medicare expenditures from diagnosis to death compared with non-Hispanic whites (mean=$118,000). Hispanics’ total expenditures and utilization after diagnosis was similar to non-Hispanic whites despite living longer with dementia.

Discussion:

Health care spending for patients with dementia after diagnosis through the end-of-life is high and varies by ethnicity.
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Keywords: Alzheimer disease costs; Hispanics; Medicare expenditures; end-of-life care; ethnicity; health disparities

Document Type: Research Article

Affiliations: 1: Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai 2: Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, James J Peters VA Medical Center, Bronx, NY 3: Departments of Biostatistics 4: Epidemiology, Mailman School of Public Health, Columbia University, New York 5: Department of Neurology, Cognitive Neuroscience Division, Columbia University Medical Center, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain

Publication date: October 1, 2018

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