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Observational Study
. 2020 Feb:295:31-37.
doi: 10.1016/j.atherosclerosis.2020.01.012. Epub 2020 Jan 19.

Abdominal aortic calcification (AAC) and ankle-brachial index (ABI) predict health care costs and utilization in older men, independent of prevalent clinical cardiovascular disease and each other

John T Schousboe  1 , Tien N Vo  2 , Lisa Langsetmo  2 , Selcuk Adabag  2 , Pawel Szulc  3 , Joshua R Lewis  4 , Allyson M Kats  2 , Brent C Taylor  5 , Kristine E Ensrud  5
Affiliations
Observational Study

Abdominal aortic calcification (AAC) and ankle-brachial index (ABI) predict health care costs and utilization in older men, independent of prevalent clinical cardiovascular disease and each other

John T Schousboe et al. Atherosclerosis. 2020 Feb.

Abstract

Background and aims: Abdominal aortic calcification (AAC) and low ankle-brachial index (ABI) are markers of multisite atherosclerosis. We sought to estimate their associations in older men with health care costs and utilization adjusted for each other, and after accounting for CVD risk factors and prevalent CVD diagnoses.

Methods: This was an observational cohort study of 2393 community-dwelling men (mean age 73.6 years) enrolled in the Osteoporotic Fractures in Men (MrOS) study and U.S. Medicare Fee for Service (FFS). AAC was scored on baseline lateral lumbar spine X-rays using a 24-point scale. ABI was measured as the lowest ratio of arm to right or left ankle blood pressure. Health care costs, hospital stays, and SNF stays were identified from Medicare FFS claims over 36 months following the baseline visit.

Results: Men with AAC score ≥9 (n = 519 [21.7% of analytic cohort]) had higher annualized total health care costs of $1473 (95% C.I. 293, 2654, 2017 U S. dollars) compared to those with AAC score 0-1, after multivariable adjustment. Men with ABI <0.90 (n = 154 [6.4% of analytic cohort]) had higher annualized total health care costs of $2705 (95% CI 634, 4776) compared to men with normal ABI (≥0.9 and < 1.4), after multivariable adjustment.

Conclusions: High levels of AAC and low ABI in older men are associated with higher subsequent health care costs, after accounting for clinical CVD risk factors, prevalent CVD diagnoses, and each other. Further investigations of whether preventing progression of peripheral vascular disease and calcification reduces subsequent health care costs are warranted.

Keywords: Abdominal aortic calcification; Ankle-brachial index; Atherosclerosis; Health care costs; Peripheral arterial disease.

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Conflict of interest statement

Conflict of Interest Disclosures

Dr. Adabag has received research grant support from the American Heart Association and Medtronic Inc. for work unrelated to this manuscript. All of the other authors have no conflicts of interest to disclose.

Figures

Figure 1:
Figure 1:
Examples of AAC on lateral spine radiographs (black arrows)
See this image and copyright information in PMC

Comment in

References

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