Abstract 11909: Racial and Gender Differences in Lifetime Healthcare Costs Across Cardiovascular Risk Factors

Abstract

Background: Healthcare costs pose a major challenge, but their assessment is limited to major healthcare events. An understanding of the burden of healthcare costs over the lifetime of individuals, particularly among those with cardiovascular risk factors (CRFs) and among disadvantaged groups based on race and sex, has important implications for health of individuals. Methods: We linked the longitudinal multiethnic Dallas Heart Study that recruited participants in 2000-2002 with inpatient and outpatient claims from all hospitals in the Dallas-Fort Worth metroplex through 2018, capturing encounter costs. Hypertension, diabetes, hyperlipidemia, smoking, and overweight/obesity as CRFs were defined at cohort enrollment. For each individual, costs were indexed to age and cumulated over follow up with missing costs imputed using chained random forests with predictive mean matching. Lifetime costs across race, sex, and CRFs were evaluated as interactions in generalized additive models with costs modeled as a 4 th order function of age landmarked at 40y. Results: 2091 individuals (mean age, 45 [10] y; 62% women, 53% Blacks) were included. Among those with inpatient or outpatient care, median lifetime cumulative healthcare costs at age 40y were $84809 (IQR, $187958, $2777270). Lifetime healthcare costs were significantly higher in Blacks vs non-Blacks ($97401 vs $73918; P < .01), particularly in advanced age (P, age-race interaction <.001). There were modestly higher costs among men. Lifetime costs were progressively higher with more CRFs. After accounting for CRFs, Blacks and men with CRFs had higher lifetime costs than matched non-Blacks and women, respectively (P interaction <.001) ( Figure ). Discussion: Black individuals and men are burdened by higher lifetime healthcare costs, with disproportionately higher costs among Blacks with the same CRFs. Costs differences also emerge in old age, highlighting the need for early prevention of risk factors among Blacks.