PIH13 Effect of Multimorbidity on Healthcare Expenditures Among Older Adults with Self-Reported PAIN in the United States

Abstract

Older adults with pain commonly have multimorbidity. However, up-to-date estimates of healthcare expenditures among this population are unavailable. This study compared the healthcare expenditures associated with multimorbidity versus no multimorbidity among a nationally representative sample of older United States (US) adults with pain. This retrospective, cross-sectional study involved a sample of US adults aged ≥50 years, alive during the calendar year, with self-reported pain in the past four weeks from the 2018 Medical Expenditure Panel Survey dataset. Adjusted linear regression models were constructed to evaluate differences in 2018 total annual healthcare expenditures between those with multimorbidity (≥2 chronic conditions) and those with no multimorbidity. Secondary analyses were conducted for: inpatient; outpatient; office-based; emergency room; prescription medications; home health; vision; and other expenditures. Expenditure data were logarithmically transformed for analysis. Analyses accounted for the complex survey design and were weighted to produce nationally-representative estimates. The a priori alpha level was 0.05. The weighted population included 57,134,711 older US adults with self-reported pain in the last four weeks, of which 46,996,409 had multimorbidity and 10,138,302 had no multimorbidity. Descriptive statistics indicated multimorbidity was associated with all personal characteristics except gender and smoking status (p>0.05). Compared to no multimorbidity in adjusted analyses, those with a multimorbidity had 75.8% greater annual total health expenditures (β=0.564, p=0.0083), 40.6% greater office-based expenditures (β=340, p=0.0224), 100.6% greater prescription medication costs (β=0.696, p=0.0268), but 47.3% lower inpatient expenditures (β=-0.640, p=0.0158), and 56.6% lower home health expenditures (β=-0.835, p<0.0001). No differences were identified between groups for the remaining expenditures. Adjusted total healthcare expenditures were 76% greater among older US adults with pain and multimorbidity compared to those with no multimorbidity, capturing the financial burden of comorbidity in this population. Specific healthcare expenditures that were greater among those with multimorbidity may be targets for future interventions to reduce healthcare costs.