Racial Disparity in Healthcare Expenditure Among Older Adults with Cardiovascular Diseases
Author(s)
Marjan Zakeri, MD, PhD, Sujit S. Sansgiry, MS, PhD;
College of Pharmacy, University of Houston, Pharmaceutical Health Outcomes and Policy, Houston, TX, USA
College of Pharmacy, University of Houston, Pharmaceutical Health Outcomes and Policy, Houston, TX, USA
Presentation Documents
OBJECTIVES: Healthcare expenditures in cardiovascular disease (CVD) are the highest in the US. To evaluate the factors contributing to racial and ethnic disparities in total healthcare expenditure among older adults with CVD.
METHODS: Using data from the Medical Expenditure Panel Survey spanning 2014-2021, total healthcare expenditure was compared among Hispanic, non-Hispanic Black (NHB), and non-Hispanic White (NHW) individuals 65 years and beyond with at least one CVD diagnosis during their lifetime. Total healthcare expenditure (THE) included office-based visits, outpatient visits, hospitalizations, emergency room visits, and prescription medications. Descriptive analysis was followed by a log transformation of THE values and linear regression models. A multivariable model adjusted for biological factors (sex, age at first CVD diagnosis, CVD severity scale, and Elixhauser comorbidity score) was used to evaluate any racial disparity in THE among the cohorts. Next, another multivariable model adjusted for all factors in the study (biological factors, educational attainment, physical limitations, cognitive limitations, income status, insurance status, geographical region, and year of data collection) was used for the evaluation of the association of demographic and socioeconomic factors on THE among different racial and ethnic cohorts.
RESULTS: With a sample of 8,585 (weighted frequency: 11,412,569), the study found that after considering the biological factors in the model, the Hispanic cohort had 26% lower THE (p < 0.001) compared to the NHW. We found no differences in THE between the NHB and NHW cohorts. Key predictors of lower THE among the Hispanic cohort included being female, having lower educational attainment, having physical or cognitive limitations, having lower income, having sole reliance on public insurance, and living in the West, Midwest, and South regions (compared to the Northeast).
CONCLUSIONS: This study highlights the need for targeted interventions to address healthcare disparities and promote health equity among older Hispanic adults with CVD.
METHODS: Using data from the Medical Expenditure Panel Survey spanning 2014-2021, total healthcare expenditure was compared among Hispanic, non-Hispanic Black (NHB), and non-Hispanic White (NHW) individuals 65 years and beyond with at least one CVD diagnosis during their lifetime. Total healthcare expenditure (THE) included office-based visits, outpatient visits, hospitalizations, emergency room visits, and prescription medications. Descriptive analysis was followed by a log transformation of THE values and linear regression models. A multivariable model adjusted for biological factors (sex, age at first CVD diagnosis, CVD severity scale, and Elixhauser comorbidity score) was used to evaluate any racial disparity in THE among the cohorts. Next, another multivariable model adjusted for all factors in the study (biological factors, educational attainment, physical limitations, cognitive limitations, income status, insurance status, geographical region, and year of data collection) was used for the evaluation of the association of demographic and socioeconomic factors on THE among different racial and ethnic cohorts.
RESULTS: With a sample of 8,585 (weighted frequency: 11,412,569), the study found that after considering the biological factors in the model, the Hispanic cohort had 26% lower THE (p < 0.001) compared to the NHW. We found no differences in THE between the NHB and NHW cohorts. Key predictors of lower THE among the Hispanic cohort included being female, having lower educational attainment, having physical or cognitive limitations, having lower income, having sole reliance on public insurance, and living in the West, Midwest, and South regions (compared to the Northeast).
CONCLUSIONS: This study highlights the need for targeted interventions to address healthcare disparities and promote health equity among older Hispanic adults with CVD.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HPR19
Topic
Health Policy & Regulatory
Topic Subcategory
Health Disparities & Equity, Public Spending & National Health Expenditures
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)