Abstract 48: Racial and Ethnic Disparities in Cardiovascular Multimorbidity Progression Among Older United States Adults

Abstract

Introduction: There is a knowledge gap in the potential unequal burden and progression of cardiovascular multimorbidity. Understanding the progression of cardiovascular multimorbidity and recognizing racial and ethnic disparities are needed to develop effective strategies to achieve health equity. Our objective is to investigate racial and ethnic disparities in the development and progression of cardiovascular multimorbidity among older adults in the United States and estimate relative life expectancies among patients with severe multimorbidity. Hypothesis: We hypothesized that life expectancy among older adults with severe cardiovascular multimorbidity is inversely related to the number of comorbid conditions and varies by race and ethnicity. Methods: Repeated cross-sectional cohort study of inpatient, outpatient, and carrier claims for a 5% nationwide Medicare sample. We included Medicare beneficiaries aged 65 or older enrolled in Medicare Fee-For-Service program from 2010 to 2020 and living in the continental United States. Multistate life table models were employed to estimate cardiovascular disease (CVD) progression and total life expectancies from ages 65 to 85 years. Progression probabilities and life expectancies were adjusted for age, non-cardiovascular comorbidities, and Medicaid dual eligibility. A microsimulation approach was utilized to derive life tables, and bootstrapping was used to estimate variability. The primary outcome was the development and progression of cardiovascular multimorbidity, defined by the number of major cardiovascular conditions (atrial fibrillation, acute myocardial infarction, heart failure, stroke, and chronic ischemic heart disease). Comorbidities were assessed using validated algorithms based on diagnostic codes billed over a 1-year lookback period, and beneficiaries were followed forward from their index date. Results: Of 2,189,633 beneficiaries, the median age was 69, median follow-up duration was 6 years. The cohort mainly consisted of individuals who are Non-Hispanic White (84.4%, n=1,848,410), followed by individuals who are Non-Hispanic Black (8.2%, n=179,694) and individuals from other racial or ethnic groups (7.4%, n=161,529. Non-Hispanic Black beneficiaries had higher odds of multimorbidity progression compared to Non-Hispanic White beneficiaries. Specifically, those initially with one CVD had elevated odds of developing multiple severe CVDs (OR range: 1.02-1.09). Furthermore, they generally had higher odds of progressing to a greater burden of CVD multimorbidity (OR range: 1.00-1.25). Conclusions: These findings suggest persistent racial and ethnic disparities in cardiovascular multimorbidity progression, identifying a potentially important target for the promotion of health equity.