Comparison of Japanese Centenarians’ and Noncentenarians’ Medical Expenditures in the Last Year of Life

Abstract

IMPORTANCEAlthough research has shown that centenarians tend to experience shorter periods of serious illness compared with other age groups, few studies have focused on the medical expenditures of centenarians as a potential indicator of the scale of medical resources used in their last year of life. OBJECTIVE To compare Japanese centenarians' and noncentenarians' monthly medical expenditures during the year before death according to age and sex. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used linked national health and long-term care insurance data collected from April 2013 to March 2018 in Nara Prefecture, Japan, for residents aged 75 years or older who were insured under the Medical Care System for older adults and died between April 2014 and March 2018. Data were analyzed from April 2013 to March 2018. EXPOSURES Age of 100 years or older (centenarians) vs 75 to 99 years (noncentenarians). MAIN OUTCOMES AND MEASURESThe numbers of unique inpatients and outpatients and medical expenditures related to decedents' hospitalization and outpatient care were extracted and analyzed based on sex and age group. The Jonckheere-Terpstra test was used to identify trends in unadjusted medical expenditures by age group, and generalized estimating equations were used to estimate monthly median expenditures by age group with adjustment for comorbidity burden and functional status. RESULTSOf 34 317 patients aged 75 to 109 years (16 202 men [47.2%] and 18 115 women [52.8%]) who died between April 2014 and March 2018, 872 (2.5%) were aged 100 to 104 years (131 men [15.0%] and 741 women [85.0%]) and 78 (0.2%) were aged 105 to 109 years (fewer than 10 were men). The analysis of unadjusted medical expenditures in the last year of life showed a significant trend of lower expenditures for the older age groups; the median adjusted total expenditures during the 30 days before death by age group were $6784

Descriptive and predictive analysis identify centenarians' characteristics from the Basque population

“…The presence of chronic diseases, mainly neoplasms, and cardiovascular and neurodegenerative diseases were identified as significant variables in the descriptive analysis, with centenarians displaying fewer diseases than non-centenarians. These findings are consistent with previous ones found in the analysis of New England long-lived individuals ( 10 ) and Danish ( 34 ) and Japanese centenarians ( 30 ). Interestingly, neoplasms were one of the most relevant variables in both logistic regression and SVM models, with the increase of neoplasms supposing a reduction in the odds of being centenarian.…”

“…There are a few studies that analyzed the features of centenarians and relate them to human aging. Demographic, socioeconomic, cognitive, functional, and clinical data can be retrieved through the use of questionnaires ( 10 , 12 , 29 ), which usually focus on the assessment of vital and behavioral status or the analysis of medical expenditures ( 30 ). However, the number of studies that provide a complete picture of centenarians' profiles based on healthcare records is very scarce ( 31 , 32 ).…”

The Triglyceride-Glucose Index is Independently Associated with Chronic Kidney Disease in the Geriatric Population, Regardless of Obesity and Sex

“…The Jonckheere-Terpstra test generates standardized statistics (SS) that point to the strength of tendencies in variables that increase or decline across groups. [26][27][28] We applied logistic regression to evaluate the obesity-and sex-specific associations between the TyG index and MS CKD. The fully adjusted model was adjusted for potential confounders such as education level, household income, smoking, drinking, handgrip strength, moderate-to-vigorous physical activity, total energy intake, and BMI, which are recognized or suspected factors associated with CKD.…”

Nutritional Management in a 101-Year-Old Woman with Physical Inactivity and General Weakness: A Case Report

“…Tai et al 2021 [ 8 ] showed that centenarians with lower calf circumference were associated with an increased risk of cognitive impairment, and underweight women were predisposed to cognitive impairment [ 5 ]. However, there is wide variation in the currently available data [ 9 , 10 ]. Management of centenarians and older adults differs considerably according to settings (e.g., hospital vs. residential), and strategies to improve muscle mass, muscle function, and quality of life (QOL) in this population have been investigated [ 11 ].…”