Healthcare utilization and health expenditures among U.S. adults by cancer and atherosclerotic cardiovascular disease status.

Abstract

e23191 Background: Improvements in cancer prognosis have led to a growing population of cancer survivors who are at increased risk for noncancer comorbidities, particularly atherosclerotic cardiovascular disease (ASCVD). While ASCVD and cancer are major contributors to rising healthcare costs and utilization, less is known about differences in healthcare utilization and health expenditures across individuals with cancer, ASCVD, both conditions, or neither. Methods: Using the Medical Expenditure Panel Survey (2008-2023), we identified adults aged ≥18 years and categorized participants into four groups based on self-reported cancer and ASCVD (myocardial infarction, stroke, coronary heart disease, or angina) status. Healthcare utilization outcomes included ≥2 hospitalizations, emergency department, outpatient, and office-based visits, and any prescription medications purchased or refilled in the past year. Health expenditures reflected annual total direct payments for the same sources of care. Among individuals with any expenditures, annual mean spending was estimated using generalized linear models with a gamma distribution and log link. Multivariable logistic regression models were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for healthcare utilization, adjusting for sociodemographic characteristics. Results: Among 334,240 adults, 2.4% had both cancer and ASCVD (representing 5.5 million individuals annually). Compared to individuals without cancer or ASCVD, those with both conditions had substantially higher healthcare utilization, including hospitalizations (aOR, 6.55 [95% CI, 5.76-7.44]) and emergency department visits (aOR, 4.24 [95% CI, 3.83-4.69]). Individuals with cancer or ASCVD alone also had higher utilization, though estimates were consistently greatest among those with both conditions. Similar gradients were observed for outpatient visits (aOR, 2.70 [95% CI, 2.52-2.89]), office-based visits (aOR, 3.51 [95% CI, 3.16-3.88]), and prescription medication use (aOR, 7.05 [95% CI, 5.87-8.47]) among individuals with both cancer and ASCVD, compared to those without either condition. Mean annual total direct healthcare expenditures increased stepwise across groups, from $3,652 among those without cancer or ASCVD to $7,156 among those with cancer alone, $8,174 among those with ASCVD alone, and $9,992 among those with both conditions (absolute difference: $6,340; p < 0.001). Conclusions: Individuals with co-existing cancer and ASCVD experienced the greatest burden of healthcare utilization and health expenditures compared to those with either condition alone or neither condition. Given the growing population of cancer survivors at increased risk of ASCVD, targeted efforts to manage shared cardiometabolic risk factors may help reduce healthcare utilization and prevent adverse cardiovascular events.