OBJECTIVES: Heart and related cardiovascular diseases (CVD) are the number one cause of death in the US. CVD make up the largest portion of Disability Adjusted Life Years per 1000 population in high-income countries. This study investigates the influence of socio-demographic characteristics on the economic burden (total medical expenditures) of patients with CVD and hypertension. A model of the incremental total medical expenditures for CVD and hypertension by level of income is presented.

METHODS: The data for this project were obtained from the nationally representative Medical Expenditure Panel Survey (MEPS). ICD-9 codes were used to aggregate participants into 3 groups: cardiovascular diseases, hypertension, and no disease. Non-parametric tests were used to assess significant differences in total medical expenditures across socio-economic variables. Generalized linear models were used to predict total medical expenditures by disease group, controlling for potential covariates (employment status, years of education, general health status, marital status, race, gender). Costs were reported in 2015 USD.

RESULTS: The proportions of individuals with CVD and hypertension differed within each socio-demographic variable compared to the no disease group (Rao Scott X² p-value < 0.0001 for all categorical variables, and F_2,2=244.37, p<0.0001 for age). Total medical expenditures also differed across socio-demographic variables (p-value<0.05). The generalized linear regression model indicates that as personal income increases, the incremental total medical expenditures decrease significantly in the CVD group (e.g. mean_{No personal income-$14,999}=$26,125.06, SE=529.34 vs mean_{More than $200,000}=$15,686.79, SE=829.21). The same trend is observed in the hypertension group, although not as pronounced (e.g. mean_{No personal income-$14,999}=$13,314, SE=244.98 vs mean_{More than $200,000}=$11,179.82, SE=909.72).

CONCLUSIONS: This study demonstrates that low income patients with CVD and hypertension incur higher total medical expenditures after controlling for several socio-economic covariates. Healthcare insurance plans and other programs designed for lower-income people should focus on strategies to reduce the CVD and hypertension economic burden.