Journal of Health Services Research & Policy > Volume 13, Number 1 > Pp. 26-32

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Original research

The effect of age and procedure on resource use for patients with cerebrovascular disease

Kazuaki Kuwabara , Shinya Matsuda ¹, Yuichi Imanaka ², Kiyohide Fushimi ³, Hideki Hashimoto ⁴, Koichi Ishikawa ⁵

Department of Health Care Administration and Management, Graduate School of Medicine, Kyushu University; ¹ Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, Fukuoka; ² Department of Healthcare Economics and Quality Management, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto; ³ Department of Public Healthcare Informatics, Tokyo Medical and Dental University, Tokyo; ⁴ Department of Health Management and Policy, Graduate School of Medicine, Tokyo University, Tokyo; ⁵ Information Systems Divison, National Cancer Center, Tokyo, Japan

Correspondence to: kazu228{at}basil.ocn.ne.jp

Objective: Many studies have described the impact of population ageing on health care expenditures, but few have assessed its impact on specific diseases adjusted for severity and procedure. This study examined the relationship between an ageing population and resource use in patients with cerebrovascular disease (CVD).

Methods: A total of 13,856 CVD patients were treated in 82 academic and 92 community hospitals. Demographic variables, clinical variables, length of stay (LOS) and total charges were analysed by age group (under 65 years, 65–74 years and 75 years or older). The independent effects of age on LOS and total charge were determined using multivariate analysis.

Results: There were 5172 (37%) patients under 65 years of age, 4096 (30%) 65–74 years and 4588 (33%) 75 years or older. Intracranial infarction or ischaemia was diagnosed in 69% of the patients, haemorrhage in 23% and subarachnoid haemorrhage in 9%. The overall mortality was 6% (5% in under 65 years, 5% in 65–74 years and 9% in 75 years or older; P < 0.001). There were significant differences in the proportion of procedures performed in each age category. Age and procedure were significantly associated with LOS, particularly the latter. Age had no significant association with total charge, but procedure was highly associated.

Conclusions: Ageing has no significant impact on total charge. Instead policy-makers should acknowledge the effect of procedures on health care costs, conduct economic evaluations and monitor use of procedures.

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