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. 2019 Mar 7;19(1):69.
doi: 10.1186/s12877-019-1057-7.

The associations of multimorbidity with the sum of annual medical and long-term care expenditures in Japan

Takahiro Mori  1   2   3 , Shota Hamada  4   5 , Satoru Yoshie  4   6   7 , Boyoung Jeon  8 , Xueying Jin  4   9 , Hideto Takahashi  4   9   10 , Katsuya Iijima  6 , Tatsuro Ishizaki  4   9   11 , Nanako Tamiya  4   9
Affiliations

The associations of multimorbidity with the sum of annual medical and long-term care expenditures in Japan

Takahiro Mori et al. BMC Geriatr. .

Abstract

Background: The occurrence of multimorbidity (i.e., the coexistence of multiple chronic diseases) increases with age in older adults and is a growing concern worldwide. Multimorbidity has been reported to be a driving factor in the increase of medical expenditures in OECD countries. However, to the best of our knowledge, there is no published research that has examined the associations between multimorbidity and either long-term care (LTC) expenditure or the sum of medical and LTC expenditures worldwide. We, therefore, aimed to examine the associations of multimorbidity with the sum of medical and LTC expenditures for older adults in Japan.

Methods: Medical insurance claims data for adults ≥75 years were merged with LTC insurance claims data from Kashiwa city, a suburb in the Tokyo metropolitan area, for the period between April 2012 and September 2013 to obtain an estimate of medical and LTC expenditures. We also calculated the 2011 updated and reweighted version of the Charlson Comorbidity Index (CCI) scores. Then, we performed multiple generalized linear regressions to examine the associations of CCI scores (0, 1, 2, 3, 4, or ≥ 5) with the sum of annual medical and LTC expenditures, adjusting for age, sex, and household income level.

Results: The mean sum of annual medical and LTC expenditures was ¥1,086,000 (US$12,340; n = 30,042). Medical and LTC expenditures accounted for 66 and 34% of the sum, respectively. Every increase in one unit of the CCI scores was associated with a ¥257,000 (US$2920); 95% Confidence Interval: ¥242,000, 271,000 (US$2750, 3080) increase in the sum of the expenditures (p < 0.001; n = 29,915).

Conclusions: Using a merged medical and LTC claims dataset, we found that greater CCI scores were associated with a higher sum of annual medical and LTC expenditures for older adults. To the best of our knowledge, this is the first study to examine the associations of multimorbidity with LTC expenditures or the sum of medical and LTC expenditures worldwide. Our study indicated that the economic burden on society caused by multimorbidity could be better evaluated by the sum of medical and LTC expenditures, rather than medical expenditures alone.

Keywords: Charlson comorbidity index; Claims data; Long-term care expenditures; Medical expenditures; Multimorbidity.

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Conflict of interest statement

Authors’ information

TM: MD, MSHS, PhD, associate professor at the University of Tsukuba and staff physician at Eastern Chiba Medical Center. Board certified physician in Geriatrics in Japan and the United States.

SH: DrPH, senior researcher at the Institute for Health Economics and Policy.

SY: RN, PHN, MS, researcher at the University of Tsukuba, the University of Tokyo, and Keio University.

BJ: MPH, PhD, researcher at the National Rehabilitation Center, the Republic of Korea.

XJ: MBA, PhD, researcher at the University of Tsukuba.

HT: PhD, research managing director at the National Institute of Public Health.

KI: MD, PhD, professor at the University of Tokyo.

TI: MD, MPH PhD, team leader at the Human Care Research Team at Tokyo Metropolitan Institute of Gerontology.

NT: MD PhD MSc, professor at the University of Tsukuba and director of the Health Services Research & Development Center at the University of Tsukuba.

Ethics approval and consent to participate

The ethics committee of the University of Tsukuba approved this study (approval number: 1184). Consent to participate was waived as we used anonymized claims data.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart of the study’s sample population
Fig. 2
Fig. 2
The predicted probabilities for long-term care use (n = 29,915). The level of long-term care required consists of seven levels (Support Levels 1–2, and Care Levels 1–5), with Support Level 1 representing the lowest level and Care Level 5 representing the highest level of requirement for long-term care. Error bars represent the 95% Confidence Intervals. Results were obtained by ordinal logistic regressions, adjusting for age, sex, and household income level.
See this image and copyright information in PMC

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