To assess in four large Chicago population cohorts whether young adult and middle-aged risk factor status has an impact not only on average annual Medicare costs, but also on cumulative and lifetime Medicare costs, to ages 70, 75, 80, >80, including to death, and during the last one to two years of life.

BACKGROUND:

Studies will be conducted on the cumulative lifetime Medicare costs of individuals from four Chicago population cohorts from which prior risk factor data are available. One cohort is from the Western Electric Company Study, with 2107 men who were 40-56 when the follow up began in 1957. For this group a physical exam, ECG and cholesterol measures are available along with data from a quantitative diet history conducted at that time assessing 28 days of intake. It is not clear whether the men themselves or their wives provided this information. Repeat measures are available, but attention is paid to their use in the analyses. Also, information on the availability of the quantitative information at the food level is not provided. Two cohorts are from the Peoples Gas Company Study, one with 1594 men aged 40-59 in 1958 and the second with 1609 men aged 25-39 in 1959 . From both cohorts a total of 1802 men are, based on their ages, currently Medicare eligible.The fourth cohort is the Chicago Heart Disease Detection Association Project (CHA) based on an initial survey of 39,573 men and women conducted in 1967-1973 on whom dietary data are not available.

DESIGN NARRATIVE:

The study assesses the relationships of CVD risk factors measured in young and middle-aged adult men and women to Medicare utilization and charges, from Medicare enrollment to death or attainment of age 70, 75, 80, >80, including in the last one to two years of life. The study determines long-term relationship between earlier low-risk status vs. not-low-risk to subsequent Medicare health care charges. Baseline low risk is all six CVD risk factors favorable: systolic/diastolic pressure 120 mmHg/80 mmHg and no antihypertensive treatment, serum cholesterol <200 mg/dl, not currently smoking, no ECG abnormalities, no history of diabetes or heart attack. The study also determines the relationships between baseline habitual eating patterns and subsequent Medicare utilization and charges. Further statistical methods are developed for optimal analyses of health care expenditures. The database will be extended by obtaining additional years of morbidity-mortality experience and of Medicare charge data to the year 2002.