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Medicare Expenditures and Health Care Utilization in a Multiethnic Community-based Population With Dementia From Incidence to Death

Ornstein, Katherine A., PhD, MPH*; Zhu, Carolyn W., PhD*,†; Bollens-Lund, Evan, MA*; Aldridge, Melissa D., PhD*; Andrews, Howard, PhD; Schupf, Nicole, PhD§; Stern, Yaakov, PhD

Alzheimer Disease & Associated Disorders: October-December 2018 - Volume 32 - Issue 4 - p 320–325
doi: 10.1097/WAD.0000000000000259
Original Articles

Introduction: While individuals live with dementia for many years, utilization and expenditures from disease onset through the end-of-life period have not been examined in ethnically diverse samples.

Methods: We used a multiethnic, population-based, prospective study of cognitive aging (Washington Heights-Inwood Columbia Aging Project) linked to Medicare claims to examine total Medicare expenditures and health care utilization among individuals with clinically diagnosed incident dementia from disease onset to death.

Results: High-intensity treatment (hospitalizations, life-sustaining procedures) was common and mean Medicare expenditures per year after diagnosis was $69,000. Non-Hispanic blacks exhibited higher spending relative to Hispanics and non-Hispanic whites 1 year after diagnosis. Non-Hispanic blacks had higher total (mean=$205,000) Medicare expenditures from diagnosis to death compared with non-Hispanic whites (mean=$118,000). Hispanics’ total expenditures and utilization after diagnosis was similar to non-Hispanic whites despite living longer with dementia.

Discussion: Health care spending for patients with dementia after diagnosis through the end-of-life is high and varies by ethnicity.

*Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai

Department of Neurology, Cognitive Neuroscience Division, Columbia University Medical Center, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain

Departments of Biostatistics

§Epidemiology, Mailman School of Public Health, Columbia University, New York

James J Peters VA Medical Center, Bronx, NY

Supported by grants from the National Institute on Aging (AG07370, AG037212). K.A.O. was supported by the National Institute on Aging (K01AG047923). C.W.Z. is also supported by the Department of Veterans Affairs, Veterans Health Administration.

The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

The authors declare no conflicts of interest.

Reprints: Katherine A. Ornstein, PhD, MPH, Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1070, New York, NY 10029 (e-mail:

Received December 27, 2017

Accepted March 29, 2018

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