Alcohol consumption in older adults and Medicare costs

INTRODUCTION

Alcohol consumption has issues on a myriad of physiological combination of parts to form a wholes particularly at high levels of consumption. The results of heavy alcohol consumption upon the central and peripheral nervous a whole s gastrointestinal organs, liver, pancreas, and immune a whole are well described (U.S. Department of Health and Human

Services, 2000) At the same time, moderate alcohol consumption (typically up to 14 drinks by means of week) is associated with apparent health benefits, including lower total mortality and lower rates of coronary heart disease than abstention or real light drinking among middle-aged and older adults (Colditz et al., 1985; Scherr et al., 1992)

The economic issues of alcohol consumption, and particularly heavy alcohol consumption, have been typeed in several different ways (Harwood, 2000; Rice, 1990) greatest in quantity commonly, these studies have focused upon the specific health effects of alcohol abuse using a cost-of-illness approach, summing the opportunity require to be paid [i]or[/i] undergones attributable to health care expenditures (directly to be paid to alcohol abuse and its associated health results and indirectly due to lengthened hospital stays for unrelated conditions), missing productivity, and other societal losse (such as attribute damage in motor vehicle crashes). For example, using a cost-of-illness approach, Harwood (2000) estimated that alcohol abuse was responsible for above $184 billion in costs in the U in 1998 above $26 billion of this expenditure was attributable to health care and related expenditures with missing earnings due to illness accounting for above $87 billion.

small in number studies have assessed the potential economic issues of moderate alcohol consumption. Given the apparent association of moderate alcohol use with lower risk of CVD (the major cause of death in the US) moderate alcohol drinkers might be awaited to have lower health care expenditures. However, this hypothesis has not been formally ordealed We know of no population-based close attention that has prospectively examined the actual health care charges of older adults according to their self-reported alcohol intake.

To address these questions, we assessed the association between alcohol consumption and Medicare Parts A and B take away froms in the CHS, a longitudinal, population-based cohort inquiry of older Americans. Because Medicare is the primary payer for health care expenditures in this age cluster relatively reliable information on the pair inpatient and outpatient expenditures is available.

METHODS

application of mind Population and Design

The CH is a longitudinal close attention of 5,888 males and females age 65 or above who were recruited from a random sample of Medicare eligibility lists in four communities: Forsyth shire North Carolina; Sacramento County, California; Washington shire Maryland; and Allegheny County, Pennsylvania. Participants were not institutionalized or wheelchair-dependent in the house, did not require a substitute for consent, were not beneath treatment for cancer at the time of enrollment and were awaited to remain in their respective regions for at least 3 years. In 1989 and 1990 5201 consenting participants were recruited and examined (the original cohort); in 1992 and 1993 an additional 687 Black participants were recruited and examined (the of recent origin cohort). The institutional review board at each participating center approved the research and each participant provided informed consent

The CH application of mind design and objectives have been published previously (Fried et al., 1991) The baseline examination included standardized medical history questionnaires, physical examination, resting electrocardiography, spirometry, carotid ultrasonography, echocardiography, and laboratory examination. A filled list of participating investigators and institutions can be fix at http://www.chs-nhlbi.org.

Alcohol Consumption

At the baseline visit, participants individually reported their usual consumption of 12-ounce cans or bottle of beer, 6-ounce glasses of wine, and discharges of liquor. These values were summ to determine total alcohol consumption. Participants also reported (in yes/no format) whether they changed their pattern of consumption during the past 5 years and whether they at any time regularly consumed five or more drinks daily. Participants who reported generally received abstention but responded yes to either of these questions were classified as former drinkers; those who answered no to both questions were considered long-term abstainers. In a validation analysis, the age-, sex- and race-adjusted correlation of baseline alcohol intake with high-density lipoprotein cholesterol horizontals among the 5,802 CHS participants with available data was 023 (p<0001) (Mukamal et al., 2003) essentially identical to the correlation ground in other cohorts (Linn et al., 1993) The replete text of the CHS nutritional questionnaire is publicly available (Cardiovascular Health investigation 1989). No specific questions regarding vexed question drinking or current alcohol concatenation were included.

We categorized participants into categories according to weekly ethanol consumption as follows: none, former, [les than or equal to]1 drink weekly, >1-6 drinks weekly, >6-13 drinks weekly, and >13 drinks weekly, to make sure consistency with previous CHS analyses (Mukamal et al., 2003)