Abdominal aortic calcification (AAC) and ankle-brachial index (ABI) predict health care costs and utilization in older men, independent of prevalent clinical cardiovascular disease and each other. (February 2020)

• Record Type: Journal Article
• Authors: Schousboe, John T.; Vo, Tien N.; Langsetmo, Lisa; Adabag, Selcuk; Szulc, Pawel; Lewis, Joshua R.; Kats, Allyson M.; Taylor, Brent C.; Ensrud, Kristine E.
• Is Part Of: Atherosclerosis. Volume 295(2020)
• Page Start: 31
• Page End: 37
• Publication Date: 2020-02
• Subjects: Health care costs -- Abdominal aortic calcification -- Ankle-brachial index -- Peripheral arterial disease -- Atherosclerosis; Arteriosclerosis -- Periodicals; Electronic journals; 616.136
• DOI: 10.1016/j.atherosclerosis.2020.01.012
• Languages: English
• ISSNs: 0021-9150

Abstract

Abstract: Background and aims: Abdominal aortic calcification (AAC) and low ankle-brachial index (ABI) are markers of multisite atherosclerosis. We sought to estimate their associations in older men with health care costs and utilization adjusted for each other, and after accounting for CVD risk factors and prevalent CVD diagnoses. Methods: This was an observational cohort study of 2393 community-dwelling men (mean age 73.6 years) enrolled in the Osteoporotic Fractures in Men (MrOS) study and U.S. Medicare Fee for Service (FFS). AAC was scored on baseline lateral lumbar spine X-rays using a 24-point scale. ABI was measured as the lowest ratio of arm to right or left ankle blood pressure. Health care costs, hospital stays, and SNF stays were identified from Medicare FFS claims over 36 months following the baseline visit. Results: Men with AAC score ≥9 (n = 519 [21.7% of analytic cohort]) had higher annualized total health care costs of $1473 (95% C.I. 293, 2654, 2017 U S. dollars) compared to those with AAC score 0–1, after multivariable adjustment. Men with ABI <0.90 (n = 154 [6.4% of analytic cohort]) had higher annualized total health care costs of $2705 (95% CI 634, 4776) compared to men with normal ABI (≥0.9 and < 1.4), after multivariable adjustment. Conclusions: High levels of AAC and low ABI in older men are associated with higher subsequent health care costs, after accounting for clinical CVD risk factors, prevalent CVD diagnoses, and each other. Further investigations of whether preventing progression of peripheral vascular disease and calcification reduces subsequent health care costs are warranted. Graphical abstract: Image 1 Highlights: Abdominal aortic calcification (AAC) and low ankle-brachial index (ABI) are markers of multisite atherosclerosis. We estimated their multivariable-adjusted associations with health care costs and utilization in older men. Both an AAC 24-point scale score of ≥9 and an ABI value of <0.9 were associated with higher total health care costs. ABI and AAC identify different subsets of those with subclinical CVD who are at risk for high health care costs.