OBJECTIVES : Healthcare expenditures among older United States (US) adults with pain and negative mental health status have not been well-assessed, but are important to know given the prevalence of pain and negative mental health. This study determined if differences exist in healthcare expenditures of older US adults with pain based on perceived mental health status.

METHODS : This cross-sectional study included US adults alive and aged ≥50 years, with self-reported pain in the past four weeks, and positive healthcare expenditure in the 2018 Medical Expenditure Panel Survey (MEPS). Comparison groups were positive mental health (defined using responses to a question about perceived mental health of excellent/very good/good) and negative mental health (defined as fair/poor). Descriptive analyses compared demographic characteristics (using chi-square tests) and mean healthcare expenditures (using t-tests) between groups. Adjusted linear regression models with logarithmically-transformed expenditure data evaluated differences in: total; inpatient; outpatient; emergency room; office-based; prescription medications; home healthcare; dental; vision; and other expenditures. Analyses accounted for the complex MEPS design and were weighted to produce nationally-representative results. The a priori alpha level was 0.05.

RESULTS : The weighted population included 57,134,711 older US adults with self-reported pain (85.6% positive mental health, 14.4% negative mental health). Compared to individuals with negative mental health, individuals with positive mental health had lower unadjusted total expenditures ($13,379 versus $20,231, p<0.0001), lower prescription medication expenditures ($3,610 versus $5,924, p<0.0001) and lower home healthcare expenditures ($6,968 versus $12,352, p=0.0041). In adjusted multivariable linear regression models, there were no differences in healthcare expenditures between those with positive mental health and those with negative mental health status (p>0.05).

CONCLUSIONS : This study found there were no significant differences in adjusted annual (2018) healthcare expenditures between older US adults with pain and positive versus negative mental health status. This finding suggests that mental health status does not influence healthcare expenditures among this population.