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

John T. Schousboe, Tien N. Vo, Lisa Langsetmo, Selcuk Adabag, Pawel Szulc, Joshua R. Lewis, Allyson M. Kats, Brent C. Taylor, Kristine E. Ensrud

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)31-37
Number of pages7
JournalAtherosclerosis
Volume295
DOIs
StatePublished - Feb 2020

Bibliographical note

Funding Information:
Dr. Adabag has received research grant support from the American Heart Association and Medtronic Inc . for work unrelated to this manuscript. All of the other authors have no conflicts of interest to disclose.

Funding Information:
The Osteoporotic Fractures in Men (MrOS) Study is supported by National Institutes of Health funding. The following institutes provide support: the National Institute on Aging (NIA) , the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) , the National Center for Advancing Translational Sciences (NCATS) , and NIH Roadmap for Medical Research under the following grant numbers: U01 AG027810 , U01 AG042124 , U01 AG042139 , U01 AG042140 , U01 AG042143 , U01 AG042145 , U01 AG042168 , U01 AR066160 , and UL1 TR000128 .

Funding Information:
The salary of Dr. Lewis is supported by a National Health and Medical Research Council (Australia) Career Development Fellowship (ID: 1107474 ).

Publisher Copyright:
© 2020 Elsevier B.V.

Keywords

  • Abdominal aortic calcification
  • Ankle-brachial index
  • Atherosclerosis
  • Health care costs
  • Peripheral arterial disease

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