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STATISTICAL BRIEF #531:
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July 2020 | ||||||||||||||||||||||||||||||||||||||||
Pradip K. Muhuri, PhD
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Highlights
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IntroductionIn 2017, heart disease accounted for 23.0 percent of total deaths in the United States,¹ and about 7.0 percent of total annual healthcare expenditures were for heart disease treatment in adults.² Heart disease as defined for this Statistical Brief includes coronary artery disease, angina, heart attacks, dysrhythmias, and heart failure. For more than two decades, the Medical Expenditure Panel Survey-Household Component (MEPS-HC) has been a major data source for national estimates of healthcare expenses for the U.S. civilian noninstitutionalized population. This Statistical Brief presents estimates for healthcare expenditures for the treatment of heart disease by selected characteristics among adults based on the 2017 MEPS-HC. All analyses use MEPS full-year person-level sampling weights, which take disproportionate sampling and survey nonresponse into account. Only differences between estimates that are statistically significant at the 0.05 level are mentioned in the text of this Statistical Brief. |
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FindingsExpenditures for heart disease treatment by selected characteristics (figures 1 and 2)In 2017, an estimated 8.3 percent of adults age 18 years and older in the U.S. civilian noninstitutionalized population (about 20.9 million adults) had some healthcare expenditures for the treatment of heart disease (figure 1). The percentage with expenses was highest for adults age 65 and older (24.5 percent) followed by age 45–64 (7.4 percent) and age 18–44 (1.6 percent). About 1 of every 10 non-Hispanic white adults (9.9 percent) had expenditures for the treatment of heart disease, while a lower percentage of non-Hispanic blacks (6.8 percent), non-Hispanic Asians (5.1 percent), and Hispanics (4.5 percent) had healthcare expenses for this condition (figure 1). Men were more likely than women to have had expenses for heart disease treatment (9.6 versus 7.1 percent) (figure 1). A higher percentage of adults in poor and low-income families had expenditures for heart disease (9.8 and 10.9 percent, respectively) than in families with middle or high incomes (7.6 and 7.5 percent, respectively) (figure 2). About 9 percent of adults had healthcare expenses for the treatment of heart disease in each geographic region except the West, where only 6.4 percent had expenses for this condition. Expenditures for heart disease treatment by type of services (figures 3–5) Among all adults with any expense for the treatment of heart disease, nearly three-quarters (71.5 percent) had prescription drug expenses, and two-thirds (67.0 percent) had expenses for medical providers’ office-based care (figure 3). Smaller proportions had expenses for outpatient hospital visits (15.2 percent), emergency room visits (13.6 percent), inpatient hospital stays (12.7 percent), and home health visits (6.0 percent). Among adults with reported expenses for the treatment of heart disease, median annual total expenditures per adult for treatment of the condition were $691, and the mean was $5,216 (figure 4). Of the six service types, median inpatient expenses for heart disease treatment among adults with expenses for inpatient stays for the condition were highest ($11,716). The next highest service type was home healthcare, for which median expenses for heart disease treatment among adults with expenses for home health visits for that condition were $3,975. Median expenses for prescription medicines for treatment of heart disease among those with any expense for these medicines were lowest ($153). Across service categories, mean expenses were 1.9 to 5.5 times higher than median expenses because a relatively small proportion of adults had very high expenses. In 2017, an estimated $108.7 billion was spent for treatment of heart disease among adults in the U.S. civilian noninstitutionalized population (figure 5). The largest portion (54.8 percent) of this spending was for inpatient hospital care. The remaining distribution of total spending was 12.0 percent for medical providers’ office-based visits, 11.6 percent for prescription drugs, 9.8 percent for home health visits, 7.5 percent for outpatient hospital care, and 4.3 percent for emergency department care. |
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Data SourceThe estimates reported in this Brief are based on data from the following 2017 MEPS data files:
http://www.meps.ahrq.gov/mepsweb/survey_comp/Insurance.jsp . |
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DefinitionsHeart diseaseIn the MEPS-HC, the medical conditions reported by respondents are recorded by the interviewer as verbatim text. Since 2016, medical conditions have been coded to fully specified International Classification of Disease, 10th Revision, Clinical Modification (ICD-10-CM) codes (ICD-9-CM codes that were used in prior years were phased out). For this Brief, conditions were regrouped into categories labeled as Clinical Classifications Software Refined (CCSR), which were designed to be as clinically homogeneous as possible. The following CCSR categories were used to identify heart disease.³
Expenditures In the MEPS, expenditures on treatment are defined as payments from all sources for prescribed medicines and for care provided in medical providers’ offices, hospital outpatient departments, emergency departments, hospitals (inpatient), and patients’ homes (home health) (six service types). Payments for over-the-counter drugs are not included in MEPS total expenditures. Sources of payment include direct payments from private insurance, Medicare, Medicaid, out-of-pocket payments, and miscellaneous other sources. Expenses reported in this Brief were considered to be associated with heart disease if a visit, stay, or purchase of a prescribed medicine was for one of the conditions listed above. Expenditures related to the treatment of heart disease may include expenses associated with other conditions as well if the person received care for multiple conditions concurrently. For each of the six service-specific expenditure categories, the event-level expenditures associated with the treatment of heart disease for each person were summed to create a person-level total. Age Individuals were classified into three age groups (age 18–44, age 45–64, and age 65 and older) based on their age at the last time they were eligible for data collection during the year (usually the end of the year). Race/ethnicity MEPS respondents were asked if each family member was Hispanic or Latino and about each member’s race. Based on this information, categories of race and Hispanic origin were constructed as follows: 1) Hispanic; 2) white non-Hispanic, with no other race reported; 3) black non-Hispanic, with no other race reported; and 4) Asian non-Hispanic, with no other race reported. The "other/multiple races, non-Hispanic" category is not shown separately in this Brief due to small sample sizes or failure to meet minimum precision requirements. However, data from individuals in this category are included in the overall total. Income Income was classified based on the percentage of the federal poverty level for total family income, adjusted for family size and composition. A four-category income variable was used: poor (less than 100 percent of the federal poverty level), low-income (100 percent to less than 200 percent), middle-income (200 percent to less than 400 percent), and high-income (greater than or equal to 400 percent) in the year of the data collection. Census region The Census region variable was based on the location of the household at the end of the year. If missing, the most recent location available was used.
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About MEPSThe Medical Expenditure Panel Survey Household Component (MEPS-HC) collects nationally representative data on healthcare use, expenditures, sources of payment, and insurance coverage for the U.S. civilian noninstitutionalized population. The MEPS-HC is co-sponsored by the Agency for Healthcare Research and Quality (AHRQ) and the National Center for Health Statistics (NCHS). More information about the MEPS-HC can be found athttp://www.meps.ahrq.gov. |
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ReferencesFor a detailed description of the MEPS-HC survey design, sample design, and methods used to minimize sources of nonsampling error, see the following publications:Chowdhury, S.R., Machlin, S.R., and Gwet, K.L. Sample Designs of the Medical Expenditure Panel Survey Household Component, 1996–2006 and 2007–2016. Medical Expenditure Panel Survey Methodology Report No. 33. January 2019. Agency for Healthcare Research and Quality, Rockville, MD. https://meps.ahrq.gov/data_files/publications/mr33/mr33.shtml Cohen, J. Design and Methods of the Medical Expenditure Panel Survey Household Component. Medical Expenditure Panel Survey Methodology Report No. 1; Agency for Health Care Policy and Research (AHCPR) Pub. No. 97-0026. 1997. AHCPR, Rockville, MD. https://meps.ahrq.gov/data_files/publications/mr1/mr1.shtml |
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Suggested CitationMuhuri, P.K. Healthcare Expenditures for Heart Disease among Adults Age 18 and Older in the U.S. Civilian Noninstitutionalized Population, 2017. Statistical Brief #531. July 2020. Agency for Healthcare Research and Quality, Rockville, MD. https://www.meps.ahrq.gov/mepsweb/data_files/publications/st531/stat531.shtmlAHRQ welcomes questions and comments from readers of this publication who are interested in obtaining more information about access, cost, use, financing, and quality of health care in the United States. We also invite you to tell us how you are using this Statistical Brief and other MEPS data and tools and to share suggestions on how MEPS products might be enhanced to further meet your needs. Please email us at MEPSProjectDirector@ahrq.hhs.gov or send a letter to the address below: Joel Cohen, PhD, Director Center for Financing, Access, and Cost Trends Agency for Healthcare Research and Quality 5600 Fishers Lane Rockville, MD 20857 |
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1Heron, M. Deaths: Leading Causes for 2017. National Vital Statistics Reports, vol. 68, no. 6. 2019. National Center for Health Statistics, Hyattsville, MD. 2Percentage equals direct medical spending for the treatment of heart disease ($108.7 billion) multiplied by 100, over total healthcare expenditures ($1,543.8 billion) for adults age 18 years and older in the U.S. civilian noninstitutionalized population (Medical Expenditure Panel Survey-Household Component, 2017). 3The CCSR codes are not available in the public use version of the 2017 Medical Conditions file. However, both CCSR codes and 3-character ICD-10 codes will be in the 2018 public use file. 4Uberoi, N. and Cohen, J. Expenditures for Heart Disease among Adults Age 18 and Older: Estimates for the U.S. Civilian Noninstitutionalized Population, 2009. Statistical Brief #393. October 2012. Agency for Healthcare Research and Quality, Rockville, MD. |
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Source: Agency for Healthcare Research and Quality, Center for Financing, Access, and Cost Trends, Medical Expenditure Panel Survey, Household Component, 2017. |
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Source: Agency for Healthcare Research and Quality, Center for Financing, Access, and Cost Trends, Medical Expenditure Panel Survey, Household Component, 2017. |
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Source: Agency for Healthcare Research and Quality, Center for Financing, Access, and Cost Trends, Medical Expenditure Panel Survey, Household Component, 2017. |
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Source: Agency for Healthcare Research and Quality, Center for Financing, Access, and Cost Trends, Medical Expenditure Panel Survey, Household Component, 2017.
Notes: CI = confidence interval. For each service type, the mean/median annual expenditures for heart disease treatment are for adults with any expense associated with heart disease treatment for that service type; the N for this calculation varies by service type. |
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Source: Agency for Healthcare Research and Quality, Center for Financing, Access, and Cost Trends, Medical Expenditure Panel Survey, Household Component, 2017. |
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