Middle-age healthcare spending and utilization at the intersection of comorbidities, functional limitation, and...

Middle age is a pivotal developmental life stage marked by health transitions, including the onset of major chronic diseases and functional limitations. Social determinants of health, particularly race/ethnicity, can play a significant role in accentuating the effects of comorbidity and functional limitations. This study examines how comorbidity, functional limitations, and race/ethnicity influence patterns of health services use and spending among middle-aged adults.

We used pooled yearly cross-sectional data (Medical Expenditure Panel Survey, 2008-2022; excluding 2020) from middle-aged adults (ages 50-64). We derived comorbidity phenotypes using latent class analyses (LCA) and generalized linear regression to examine their associations with health services outcomes, considering the vulnerabilities introduced by functional limitations and race/ethnicity.

LCA supported a 3-class solution: low prevalence of chronic conditions (63.4%), hypertensive/arthritis/joint pain (29.3%), and complex cardiovascular (C-CVD, 7.3%). Individuals with C-CVD had elevated levels of healthcare spending and use, including problematically high levels of emergency department and inpatient hospitalizations, despite higher use of office-based visits (OBVs). We found that Non-Hispanic Black adults (NHBs) and Hispanic adults had lower health spending compared to Non-Hispanic White adults (NHWs) and were less likely to use OBVs. NHBs had a higher propensity for ED use, whereas Hispanic adults were less likely to be hospitalized. Physical and instrumental/activities of daily living (I/ADL) limitations increased OBVs for both NHBs and NHWs, while I/ADLs increased hospitalizations among Hispanic adults.

These findings underscore the importance of targeted healthcare for high-risk patient populations for mitigating excess health burdens.