Abstract 191: Association of Midlife Fitness with Healthcare Charges in Later Life: the Cooper Center Longitudinal Study.

Abstract

Background: The inverse association between cardiorespiratory fitness and mortality is well described. However, the association between midlife fitness in healthy adults and healthcare charges in later life has not been reported. We hypothesized that higher midlife fitness would be associated with lower healthcare charges independent of traditional risk factors. Methods: Linking individual participant data from the Cooper Center Longitudinal Study with Medicare claims files, we studied 20,489 healthy individuals (mean age 51, 21% women) free of prior myocardial infarction, stroke and cancer who survived to receive Medicare coverage through 1999-2009 for a total of 134,070 years of Medicare exposure. Traditional risk factors and fitness were measured at study entry. Fitness was estimated by Balke protocol treadmill time and categorized into age- and sex-specific quintiles, with quintile 1 as low fitness. Healthcare charges were cumulated using Medicare claims files and adjusted for inflation. Associations between midlife fitness and healthcare charges in later life were estimated using a Tobit censored regression model after adjustment for age, body mass index, blood pressure, cholesterol, diabetes, and smoking. Results: Compared to quintile 1 (low fitness), quintiles 4-5 (high fitness) measured at a mean age of 51 were associated with lower median annual healthcare charges at age ≥65 in both men ($3277 vs. $5134, p<0.001) and women ($2755 vs. $4565, p<0.001). The inverse associations between fitness and healthcare charges were consistent across levels of traditional risk factor burden (Figure) and persisted after multivariable adjustment in men [β = -0.34 (95% confidence interval -0.21 to -0.46), p<0.001, quintiles 4-5 vs. quintile 1] and women [β = -0.32 (95% CI -0.09 to -0.54), p<0.01]. Similar findings were observed when fitness was analyzed as a continuous variable (METs) in men [β = -0.07 (95% CI -0.049 to -0.091), p<0.001] and women [β = -0.12 (95% CI -0.076 to -0.16), p<0.001]. Conclusions: Higher fitness in healthy, middle-aged adults is strongly associated with lower healthcare charges decades later in older age, independent of other traditional risk factors.