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Improved Treatment of Ischemic Heart Disease and Disability and Death in the Elderly

Improved Treatment of Ischemic Heart Disease and Disability and Death in the Elderly. Kate Stewart Mary Beth Landrum David Cutler. Academy Health June 27, 2006. Background. Changes in health/disability among population aged 65+ over the past 20 years:

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Improved Treatment of Ischemic Heart Disease and Disability and Death in the Elderly

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  1. Improved Treatment of Ischemic Heart Disease and Disability and Death in the Elderly Kate Stewart Mary Beth Landrum David Cutler Academy Health June 27, 2006

  2. Background • Changes in health/disability among population aged 65+ over the past 20 years: • Prevalence of chronic diseases increased • Disability decreased

  3. Background • Does medical care explain some of the disability decline? • Focus: Ischemic Heart Disease • Prevalence increases with age • Medical advances reduced mortality by 40-66% between 1968-2000 • Clinical trials: improved survival and quality of life • Little understanding of effect of improved treatment on population disability

  4. Baseline Survey 1989 1994 1999 1984 1989 1994 IHD hospitalization • Health Status at Follow-Up • Disabled • Dead • Alive & • Non-Disabled N = 54,453 N = 3,842 Data: National Long Term Care Survey • Medicare-linked data: hospitalizations & vital status Analytic Cohort:

  5. Data: Medical Treatment • Cardiovascular Cooperative Project (CCP), 1994-1995 • Share of appropriate AMI patients within a hospital referral region (HRR) who received • Aspirin • Ace-Inhibitors • Beta Blockers • Reperfusion within 12 hours after AMI • Invasive procedures variable • Share of respondents with procedures on the heart, pericardium or vessels of the heart

  6. Analytic Strategy • Evaluate whether IHD patients living in HRRs with more intensive treatment had better outcomes • Minimize selection problems • Natural experiment • Exposure = treatment intensity • Estimate decline in disability attributable to improved treatment • Simulate health outcomes by varying levels of care

  7. Multinomial Models Model 1: Yi,j,t = Xi,tβ + λ1Year89 + λ2Year94 Model 2: Yi,j,t = Xi,tβ + λ1Year89 + λ2Year94 + γCCP Txj + δCCP Txj*Year + τProcsj

  8. Results: Multinomial Models ^ ^ ^ *1984 is reference year #p <0.05

  9. Results Simulations by percentiles of care: Number alive & non-disabled relative to observed

  10. Limitations • Potential unmeasured confounding: • Area-level treatment variables • Changes in severity of hospital admissions over time • Differences in claims coding over time • CCP treatment variables measured at 1 time point only

  11. Conclusions • Elderly IHD patients were more likely to be alive & non-disabled over time • Increased treatment explains approx. 50% of the disability decline • 21% more elderly IHD patients would have been alive and non-disabled in 1999, if all lived in high treatment areas • Improved care and outcomes possible through increased use of appropriate IHD treatments

  12. Funding • Funding: • National Institute on Aging (P30 AG12810 and R01AG019805) • Mary Woodard Lasker Charitable Trust • Michael E. DeBakey Foundation

  13. Results: Health Status at Follow-Up *p-value calculated from pearson chi-square test of independence, corrected for the complex survey design. Estimates adjusted to the age and sex distribution of the 1999 population of Medicare beneficiaries

  14. Area-Level Treatment CCP Measures • Percent Invasive Procedures • 10th percentile: 6% in 1984 and 18% by 1994 • 90th percentile: 40% in 1984 and 70% by 1994

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