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. 2018 Jul;19(6):831-842.
doi: 10.1007/s10198-017-0926-2. Epub 2017 Aug 30.

Determinants of health care costs in the senior elderly: age, comorbidity, impairment, or proximity to death?

Nisha C Hazra  1 , Caroline Rudisill  2 , Martin C Gulliford  3   4
Affiliations

Determinants of health care costs in the senior elderly: age, comorbidity, impairment, or proximity to death?

Nisha C Hazra et al. Eur J Health Econ. 2018 Jul.

Abstract

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.

Keywords: Ageing; Ecological fallacy; Elderly; Electronic health records; Health care costs.

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Conflict of interest statement

Funding

This work was supported in part by the Dunhill Medical Trust [Grant number: R392/1114]. MG was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London.

Conflict of interest

There are no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Proportion with different number of comorbidities and age-related impairments by age
Fig. 2
Fig. 2
Predicted costs of health care utilization by year of age for sub-groups of gender and proximity to death. Estimates were predicted from multiple fractional polynomial model
Fig. 3
Fig. 3
Predicted costs of health care utilization by year of age for sub-groups of proximity to death, comorbidity and impairment category. Estimates were predicted from multiple fractional polynomial model
See this image and copyright information in PMC

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