Abstract
Ageing is assumed to be accompanied by greater health care expenditures but the association is also viewed as a ‘red herring’. This study aimed to evaluate whether age is associated with health care costs in the senior elderly, using electronic health records for 98,220 participants aged 80 years and over registered with the UK Clinical Practice Research Datalink and linked Hospital Episode Statistics (2010–2014). Annual costs of health care utilization were estimated from a two-part model; multiple fractional polynomial models were employed to evaluate the non-linear association of age with predicted health care costs while also controlling for comorbidities, impairments, and death proximity. Annual health care costs increased from 80 years (£2972 in men, £2603 in women) to 97 (men; £4721) or 98 years (women; £3963), before declining. Costs were significantly elevated in the last year of life but this effect declined with age, from £10,027 in younger octogenarians to £7021 in centenarians. This decline was steeper in participants with comorbidities or impairments; £14,500 for 80–84-year-olds and £6752 for centenarians with 7+ impairments. At other times, comorbidity and impairments, not age, were main drivers of costs. We conclude that comorbidities, impairments, and proximity to death are key mediators of age-related increases in health care costs. While the costs of comorbidity among survivors are not generally associated with age, additional costs in the last year of life decline with age.
Highlights
The senior elderly, aged 80 years and older, represent the fastest-growing age group in the majority of the developed world [19, 23] with the number of centenarians in the United Kingdom (UK) increasing by 65% over the past decade [24]
This study aimed to evaluate whether age is associated with health care costs in the senior elderly, using electronic health records for 98,220 participants aged 80 years and over registered with the UK Clinical Practice Research Datalink and linked Hospital Episode Statistics (2010–2014)
The findings of this study indicate that impairment and comorbidity are stronger drivers of health care costs than increased age alone, with proximity to death being the strongest predictor of high costs
Summary
The senior elderly, aged 80 years and older, represent the fastest-growing age group in the majority of the developed world [19, 23] with the number of centenarians in the United Kingdom (UK) increasing by 65% over the past decade [24]. A high proportion of lifetime health care costs incur towards the end of life [1, 9, 39], being associated with the management of terminal illness [12, 27] and the type of care received at the end of life [30]. This balance of costs across the life-course contributes to a potentially exaggerated assumption that increasing age itself is necessarily a driver of increased costs.
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