Jennifer Lloyd

Mortgage Delinquency and Changes in Access to Health Resources and Depressive Symptoms in a Nationally Representative Cohort of Americans Older Than 50 Years

OBJECTIVES We evaluated associations between mortgage delinquency and changes in health and health-relevant resources over 2 years, with data from the Health and Retirement Study, a longitudinal survey representative of US adults older than 50 years. METHODS In 2008, participants reported whether they had fallen behind on mortgage payments since 2006 (n = 2474). We used logistic regression to compare changes in health (incidence of elevated depressive symptoms, major declines in self-rated health) and access to health-relevant resources (food, prescription medications) between participants who fell behind on their mortgage payments and those who did not. RESULTS Compared with nondelinquent participants, the mortgage-delinquent group had worse health status and less access to health-relevant resources at baseline. They were also significantly more likely to develop incident depressive symptoms (odds ratio [OR] = 8.60; 95% confidence interval [CI] = 3.38, 21.85), food insecurity (OR = 7.53; 95% CI = 3.01, 18.84), and cost-related medication nonadherence (OR = 8.66; 95% CI = 3.72, 20.16) during follow-up. CONCLUSIONS Mortgage delinquency was associated with significant elevations in the incidence of mental health impairments and health-relevant material disadvantage. Widespread mortgage default may have important public health implications.

Increased persistency in medication use by U.S. Medicare beneficiaries with diabetes is associated with lower hospitalization rates and cost savings.

OBJECTIVE To assess the relationship between annual fills for antidiabetes medications, ACE inhibitors, angiotensin II receptor blockers (ARBs), and lipid-lowering agents on hospitalization and Medicare spending for beneficiaries with diabetes. RESEARCH DESIGN AND METHODS Using Medicare Current Beneficiary Survey data from 1997 to 2004, we identified 7,441 community-dwelling beneficiaries with diabetes, who contributed 14,317 person-years of data for the analysis. We used multivariate regression analysis to estimate the effect of persistency in medication fills on hospitalization risk, hospital days, and Medicare spending. RESULTS For users of older oral antidiabetes agents, ACE inhibitors, ARBs, and statins, each additional prescription fill was associated with significantly lower risk of hospitalization, fewer hospital days, and lower Medicare spending. CONCLUSIONS These results suggest an economic case for promoting greater persistency in use of drugs with approved indications by Medicare beneficiaries with diabetes; however, additional research is needed to corroborate the studys cross-sectional findings.

Does Medication Adherence Lower Medicare Spending Among Beneficiaries with Diabetes

OBJECTIVE To measure 3-year medication possession ratios (MPRs) for renin-angiotensin-aldosterone system (RAAS) inhibitors and statins for Medicare beneficiaries with diabetes, and to assess whether better adherence is associated with lower spending on traditional Medicare services controlling for biases common to previous adherence studies. DATA SOURCE Medicare Current Beneficiary Survey data from 1997 to 2005. STUDY DESIGN Longitudinal study of RAAS-inhibitor and statin utilization over 3 years. DATA COLLECTION The relationship between MPR and Medicare costs was tested in multivariate models with extensive behavioral variables to control for indication bias and healthy adherer bias. PRINCIPAL FINDINGS Over 3 years, median MPR values were 0.88 for RAAS-I users and 0.77 for statin users. Higher adherence was strongly associated with lower Medicare spending in the multivariate analysis. A 10 percentage point increase in statin MPR was associated with U.S.

Obesity, disease burden, and prescription spending by community-dwelling Medicare beneficiaries

832 lower Medicare spending (SE=219; p<.01). A 10 percentage point increase in MPR for RAAS-Is was associated with U.S.

Does influenza vaccination of older adult Medicare beneficiaries lower treatment costs for acute and chronic respiratory disease

285 lower Medicare costs (SE=114; p<.05). CONCLUSIONS Higher adherence with RAAS-Is and statins by Medicare beneficiaries with diabetes results in lower cumulative Medicare spending over 3 years. At the margin, Medicare savings exceed the cost of the drugs.

Medication adherence and Medicare expenditure among beneficiaries with heart failure.

ABSTRACT Objectives: To assess drug utilization and cost patterns by body mass index (BMI) for Medicare beneficiaries including cohorts diagnosed with diseases resulting from, or aggravated by, obesity. Research design: We used data from the 2003 Medicare Current Beneficiary Survey to characterize the community-dwelling Medicare population by BMI class and to assess the following outcomes: (1) prevalence of drugs recommended in treating obesity-related chronic diseases, (2) annual spending on these medications by disease cohort, and (3) spending for all medications for the full study sample. Linear regression techniques were used to assess the conditional association of BMI class with drug spending controlling for sociodemographic characteristics, prescription drug coverage, health status, and comorbidities. Results: Annual drug spending in 2003 was significantly higher (p < 0.05) for obese class I (

Can Obesity Account for Cross-National Differences in Life-Expectancy Trends?

2374) and class III (

Simulated Value-Based Insurance Design Applied to Statin Use by Medicare Beneficiaries with Diabetes

2976) compared to normal-weight beneficiaries (

The Impact of Enhanced Critical Care Training and 24/7 (Tele-ICU) Support on Medicare Spending and Postdischarge Utilization Patterns

1764). Obese individuals also had higher utilization rates for selected medications used to treat diabetes, hypertension, ischemic heart disease, heart failure, hyperlipidemia, and osteoarthritis. Regression results indicate that chronic disease is the main reason why drug spending is higher among the obese, but prescription drug coverage is also a significant factor. Conclusions: Obesity is associated with significantly higher drug spending among Medicare beneficiaries. The combination of growing numbers of obese beneficiaries, high rates of chronic disease, and greater than average prescription spending per condition will all contribute to higher future Part D and overall Medicare program costs. Limitations of the study include: self-reported data on height, weight, and drug use/spending; small sample size; and pre-Part D data.

Persistence in health behaviors among Medicare beneficiaries

BACKGROUND Influenza accounts for a large proportion of hospitalizations and deaths among older adults, resulting in substantial health care expenses. Influenza vaccinations are effective in reducing respiratory infections in younger populations, but it is less certain whether they reduce costs associated with respiratory infections among older adults. OBJECTIVE The purpose of this study was to determine whether influenza vaccination of older adult Medicare beneficiaries reduced costs associated with acute and chronic respiratory conditions during 3 recent influenza seasons. METHODS This study analyzed the relationship between influenza vaccination and costs for respiratory conditions among Medicare beneficiaries >or=55 years of age in influenza seasons (October-May) between 2002 and 2005 using data from the Medicare Current Beneficiary Survey. Two-part multiple regressions of vaccination status were estimated on the probability and cost of treating respiratory conditions in each influenza season controlling for influenza risk factors and other covariates. Various sensitivity tests were conducted by type of service, subgroup analysis for specific population risk segments, propensity score-matched comparisons, and difference equations. RESULTS The study sample included 13,402 Medicare beneficiaries for the 3 influenza seasons examined. Vaccination rates varied between 67.3% and 74.9% over the 3 influenza seasons. In unadjusted comparisons, no significant difference in the cost of treating respiratory conditions was found between vaccinated and unvaccinated beneficiaries in 2002/2003 (-