Cardiometabolic risk factors and healthcare cost for a sample of health plan members

Cardiometabolic Risk Factors (CMRFs) are a set of risk factors which, when occurring together, increase a patient's chance for developing diabetes, heart disease, or stroke. Study objectives were to understand and quantify the prevalence and healthcare cost of CMRFs for female Hispanic and non-Hispanic health plan members in a Health Maintenance Organization located in southwestern US. This study used a retrospective database design to determine the prevalence of 6 different groupings of CMRFs among 2578 females (27.6% Hispanic) who had a bone mineral density test during 2003-2004. This population was selected since these patients had, in addition to their DEXA results, an electronic measure of height and weight, allowing us to calculate BMI. The presence of one or more of the following risk factors was used to define CMRF groupings: obesity (measured using BMI), triglycerides, HDL, blood pressure, and fasting glucose. Study analyses identified differences between cohorts of individuals with CMRFs and controls with respect to prevalence and healthcare costs. Generalized linear models were utilized to analyze adjusted costs associated with CMRFs. Results showed that Hispanics had significantly higher prevalence rates compared to non-Hispanics across all CMRF groupings (65.8% vs. 52.3%, respectively, met inclusion criteria for at least one of the 6 CMRF groupings). After adjusting for age and ethnicity, patients with CMRFs had significantly higher total costs (including inpatient, outpatient, emergency, and pharmacy utilization) than controls (p-values < .0001 across all risk groupings). Adjusted mean total costs for patients with CMRFs ranged from $3,923 to $6,056 vs. $3,203 to $3,488 for controls. Further cost analyses showed non-Hispanics had higher costs than Hispanics for all 6 risk groupings (F-values ranged from 5.11 to 6.70, p < .02 in all cases). The adjusted mean total costs for Hispanics ranged from $3130 to $4011 vs. $3648 to $4660 for non-Hispanics, with higher costs for both ethnicities where one of the risk factors was diabetes. Our higher CMRF prevalence rates among female Hispanics compared to non-Hispanics are consistent with earlier studies. The higher cost for those with CMRFs suggests the need for HMOs to address identification and monitoring of patients with CMRFs. Higher costs for non-Hispanics in the face of higher Hispanic CMRF prevalence may indicate under-utilization of healthcare resources for Hispanics. Future research should explore cultural diversity as it relates to CMRFs, including differences between Hispanics and non-Hispanics in access to care and disease management programs.