Cardiovascular Multimorbidity and Associated Mortality Among Medicare Beneficiaries Dually Eligible for Medicaid.

BACKGROUND: Patients dually eligible for Medicare and Medicaid have higher mortality rates and disparate outcomes for acute cardiovascular conditions compared with those eligible for Medicare alone. However, the association between dual eligibility, cardiovascular disease (CVD) multimorbidity development, and subsequent mortality has not been well characterized in patients dually eligible for Medicare and Medicaid. METHODS: We analyzed Medicare claims data from a 5% random sample of fee-for-service beneficiaries (2010-2019). Our primary exposure was Medicaid dual eligibility. The primary outcomes were the development of incident CVD or cardiovascular multimorbidity (defined as ≥2 of the following conditions: stroke/transient ischemic attack, myocardial infarction, atrial fibrillation, heart failure, and chronic ischemic heart disease). The secondary outcome was death. Multistate survival models were used to estimate hazards of progression from no CVD comorbidity to incident CVD, CVD multimorbidity, and death before and after adjustment for demographics and medical comorbidity burden. RESULTS: In total, 2 189 382 patients (12.9% of whom were dual eligible for Medicaid) were included. Over a median 5 years of follow-up, non-dual-eligible beneficiaries had 1 more year of survival free from CVD than dual-eligible beneficiaries (4.89 versus 5.95 years). CONCLUSIONS: Dual-eligible beneficiaries were more likely to develop CVD and multimorbidity and had higher mortality rates before and after adjustment.

Duke Scholars

Author Emily O'Brien Population Health Sciences

Author Brian C. Mac Grory Neurology, Stroke and Vascular Neurology

Author Ying Xian Neurology, Neurocritical Care

Author Robert John Mentz Medicine, Cardiology

Author Bradley Gordon Hammill Population Health Sciences

Author Stephen Greene Medicine, Cardiology

Author Fan Li Statistical Science