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Cardiovascular Multimorbidity and Associated Mortality Among Medicare Beneficiaries Dually Eligible for Medicaid
Cheryl Kalapura1, Robert J Mentz2, Stephen J Greene2
1Duke University School of Medicine Durham NC.
Insights
Patients dually eligible for Medicare and Medicaid face higher risks of developing cardiovascular disease (CVD) and multimorbidity, leading to increased mortality rates compared to those with Medicare alone.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Gerontology
Background:
- Dual eligibility for Medicare and Medicaid is linked to poorer outcomes in acute cardiovascular conditions.
- The impact of dual eligibility on the development of cardiovascular disease (CVD) multimorbidity and subsequent mortality requires further investigation.
Purpose of the Study:
- To examine the association between dual Medicare-Medicaid eligibility and the development of incident cardiovascular disease (CVD) or cardiovascular multimorbidity.
- To assess the impact of dual eligibility on subsequent mortality.
Main Methods:
- Analysis of a 5% random sample of Medicare fee-for-service beneficiaries from 2010-2019.
- Primary exposure: Medicaid dual eligibility. Primary outcomes: incident CVD or cardiovascular multimorbidity (≥2 conditions). Secondary outcome: death.
- Multistate survival models were used to estimate progression hazards, adjusted for demographics and comorbidity burden.
Main Results:
- The study included over 2.1 million beneficiaries, with 12.9% dually eligible for Medicaid.
- Over a median of 5 years, dual-eligible beneficiaries had approximately 1 year less survival free from CVD compared to non-dual-eligible beneficiaries (4.89 vs. 5.95 years).
Conclusions:
- Dual-eligible beneficiaries demonstrated a higher likelihood of developing CVD and cardiovascular multimorbidity.
- Higher mortality rates were observed in dual-eligible beneficiaries both before and after statistical adjustments.
Background:
Patients dually eligible for Medicare and Medicaid have higher mortality rates and disparate outcomes for acute cardiovascular conditions compared with those eligible for Medicare alone. However, the association between dual eligibility, cardiovascular disease (CVD) multimorbidity development, and subsequent mortality has not been well characterized in patients dually eligible for Medicare and Medicaid.
Methods:
We analyzed Medicare claims data from a 5% random sample of fee-for-service beneficiaries (2010-2019). Our primary exposure was Medicaid dual eligibility. The primary outcomes were the development of incident CVD or cardiovascular multimorbidity (defined as ≥2 of the following conditions: stroke/transient ischemic attack, myocardial infarction, atrial fibrillation, heart failure, and chronic ischemic heart disease). The secondary outcome was death. Multistate survival models were used to estimate hazards of progression from no CVD comorbidity to incident CVD, CVD multimorbidity, and death before and after adjustment for demographics and medical comorbidity burden.
Results:
In total, 2 189 382 patients (12.9% of whom were dual eligible for Medicaid) were included. Over a median 5 years of follow-up, non-dual-eligible beneficiaries had 1 more year of survival free from CVD than dual-eligible beneficiaries (4.89 versus 5.95 years).
Conclusions:
Dual-eligible beneficiaries were more likely to develop CVD and multimorbidity and had higher mortality rates before and after adjustment.
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