interactive effects of dementia severity and comorbidities on medicare expenditures
Open accessAbstract
Background: Few studies have examined how dementia and comorbidities may interact to affect healthcare expenditures. Objective: To examine whether effects of dementia severity on Medicare expenditures differed for individuals with different levels of comorbidities. Methods: Data are drawn from the Washington Heights-Inwood Columbia Aging Project (WHICAP). Comprehensive clinical assessments of dementia severity were systematically carried out at ∼18 month intervals. Dementia severity was measured by Clinical Dementia Rating (CDR). Comorbidities were measured by a modified Elixhauser comorbidities index. Generalized linear models examined effects of dementia severity, comorbidities, and their interactions on Medicare expenditures (1999–2010). Results: At baseline, 1,280 subjects were dementia free (CDR = 0, 66.4%), 490 had very mild dementia (CDR = 0.5, 25.4%), 108 had mild dementia (CDR = 1, 5.6%), and 49 had moderate/severe dementia (CDR = 2/3, 2.5%). Average annual Medicare expenditures for individuals with moderate/severe dementia were more than twice as high as those who were dementia free (CDR = 0: $9,108, CDR = 0.5/1: $11,664, CDR≥2: $19,604, p < 0.01). Expenditures were approximately 10 times higher among those with≥3 comorbidities than among those with no comorbidities ($2,612 for those with no comorbidities, to $6,109 for those with 1, $10,656 for those with 2, and $30,244 for those with≥3 comorbidities, p < 0.001). Dementia severity was associated with higher expenditures, but comorbidities were the most important predictor of expenditures. We did not find strong interaction effects between number of comorbidities and dementia severity. Conclusions: Increasing dementia severity and higher comorbidities are associated with higher Medicare expenditures. Care of individuals with dementia should focus on management of comorbidities.
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People with dementia have 1.4 to 4 times more hospital admissions than others with similar illnesses.
“People with dementia have 1·4 to 4 times more hospital admissions than others with similar illnesses.266, 268, 269, 270”
From Dementia prevention, intervention, and care: 2020 report of the Lancet Commission (2020) · cites this paper as [266]
The Introduction reports that a study found higher rates of all-cause and preventable hospitalizations associated with dementia, with the effect varying by comorbidity burden. It does not give the claimed 1.4-to-4-fold range or establish that range for people with similar illnesses; this paper’s Results focus on Medicare expenditures, not hospital-admission rates. (LLM, conf=0.83)
Experimental — accuracy not yet measuredHospitalisation in people with dementia is associated with adverse, unintended consequences, including distress, functional and cognitive decline, and high economic costs.
“Hospitalisation in people with dementia is associated with adverse, unintended consequences, including distress, functional and cognitive decline, and high economic costs.265, 266, 267”
From Dementia prevention, intervention, and care: 2020 report of the Lancet Commission (2020) · cites this paper as [266]
The Introduction reports higher hospitalization rates among people with dementia, and the Results report higher Medicare expenditures with greater dementia severity and comorbidity. Neither passage establishes that hospitalization causes high costs, distress, or functional and cognitive decline; the expenditure measure covers all Medicare services, not hospitalization alone. Page numbers were not available in our copy. (LLM, conf=0.84)
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- Authors
- Zhu, C. W., Cosentino, S., Ornstein, K. A., Gu, Y., Andrews, H., & Stern, Y.
- Affiliations
- James J. Peters VA Medical Center (US)
- Columbia University Irving Medical Center (US)
- Icahn School of Medicine at Mount Sinai (US)
- Columbia University (US)
- Corresponding author
- Zhu, Carolyn W.
- Venue
- Journal of Alzheimer’s Disease
- Publisher
- SAGE Publications
- Published
- 2017-02-10
- Volume
- 57
- Issue
- 1
- Pages
- 305-315
- ISSN
- 1387-2877 (ISSN-L)
- 1875-8908
- PMC
- PMC5461168
- OpenAlex
- W2587525693
- Cited by
- 55
- References
- 49
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 10 · 2023: 10 · 2022: 7 · 2021: 2 · 2020: 5 · 2019: 7 · 2018: 5
- FWCI
- 3.82
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Journal of Alzheimer s Disease (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Columbia Academic Commons (Columbia University)
- Funders
- U.S. Department of Veterans Affairs (AG07370)
- National Institutes of Health (5r01ag007370-30)
- National Institute on Aging (AG 07370, AG07370, AG037212, R01AG037212, R01-AG007370, K01AG047923, Z01AG007370, RF1AG054023, AG037212)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Keywords
- dementia severity, comorbidities
- MeSH terms
- Aged, Aged, 80 and over, Dementia, Health Expenditures, Female, Medicare, Humans, Male, Prospective Studies, Regression Analysis, Severity of Illness Index, United States, Comorbidity, Linear Models
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