Document Type

Dissertation

Degree

Doctor of Philosophy (PhD)

Major/Program

Public Health

First Advisor's Name

Dr. Alejandro Arrieta

First Advisor's Committee Title

Committee chair

Second Advisor's Name

Dr. Noël C. Barengo

Second Advisor's Committee Title

Committee member

Third Advisor's Name

Dr. Boubakari Ibrahimou

Third Advisor's Committee Title

Committee member

Fourth Advisor's Name

Dr. Gilbert Ramirez

Fourth Advisor's Committee Title

Committee member

Keywords

CVD: Cardiovascular Disease, ACS; Acute coronary syndrome, CVH; Cardiovascular Health, LS7: Life’s Simple 7, NH: Non hispanic

Date of Defense

1-23-2023

Abstract

Background: Acute Coronary Syndrome (ACS) causes the most deaths in the United States and accounts for the highest amount of healthcare spending. Cardiovascular Health (CVH) metrics have been widely used in primary prevention, but their benefits in secondary prevention on total healthcare expenditures related to ACS are largely unknown.

Aim: This study aims to quantify the potential significance of ideal CVH scores as a tool in secondary cardiovascular disease prevention.

Methods: We pooled ten years of MEPS data from 2008 to 2018. Initially, we described and compared the variables between people who have had an ACS event with those who had not. We then utilized a Two-part model with log link and gamma distribution. Then conditional on a positive expenditure, the healthcare expenditure amounts were measured as a function of ACS status, socio-demographics, and CVH while controlling for relevant covariates. Finally, we included interactions of ACS variables with CVH metrics, Grouped Charlson’s Comorbidity Index (GCCI), education, and age to allow for variations in the effect of these variables on whether or not you had an ACS event. We also explored the impact of all individual CVH components on annual healthcare costs.

Results: Improvements in CVH scores tended to reduce annual expenditures to a greater degree percentage-wise among ACS subjects compared to non-ACS groups, even though subjects with an ACS diagnosis tended to have approximately twice as big expenditures as similar subjects without an ACS diagnosis. Meanwhile, the financial impact of an ACS event on total expenditure would be approximately $88,500 ([95% CI, $70,200–106,900; p < 0.001]), and a unit improvement in CVH management score would generate savings of approximately $4160 ([95% CI, $5390–2950; p < 0.001]) in total health expenditures.

Conclusion: Effective secondary preventive measures through targeted behavioral endeavors and improved health factors, especially the normalization of hypertension, diabetes mellitus, body mass index, and smoking cessation, have the potential to reduce medical spending for ACS subgroups.

Identifier

FIDC011088

ORCID

https://orcid.org/0000-0002-2653-8605

Download

Share

COinS
 

Rights Statement

Rights Statement

In Copyright. URI: http://rightsstatements.org/vocab/InC/1.0/
This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s).