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The relationship between a dementia diagnosis, chronic illness, medicare expenditures, and hospital use
Bynum JP, Rabins PV, Weller W, Niefeld M, Anderson GF, Wu AW.. Journal of the American Geriatrics Society, 2004-02-01
Topic: Risk, prevention and care in population studies
Objectives To determine whether dementia increases medical expenditures, the probability of hospitalization, and potentially preventable hospitalization, controlling for variables including age and comorbidity. Design Cross-sectional analysis of 1 year of claims data comparing usage by patients with claims for dementia with usage by those without dementia. Setting A nationally representative 5% random sample of Medicare beneficiaries in 1999. Participants Medicare beneficiaries aged 65 and older with fee-for-service Medicare Parts A and B coverage for 1999 (N=1,238,895; dementia patients n=103,512). Measurements Per capita expenditures, rate of all-cause hospitalization, rate of preventable hospitalization as defined using ambulatory-care sensitive condition (ACSC) admissions, and dementia identified using International Classification of Diseases, 9th Edition, codes 290, 294, and 331. Results Prevalence of dementia was 8.3%. In a model of expenditures in those who survived the year adjusting for age, sex, race, and comorbidity, dementia was associated with an incremental cost of 6,927 US dollars, or 3.3 times greater total expenditures than in nondementia patients (P Conclusion In a nationally representative sample, higher Medicare expenditures associated with a diagnosis of dementia are in large part due to increased hospitalization. Further study is needed into the factors associated with high rates of hospitalization in dementia patients including aspects of ambulatory management that may be improved.
Key findings
- In a model of expenditures in those who survived the year adjusting for age, sex, race, and comorbidity, dementia was associated with an incremental cost of 6,927 US dollars, or 3.3 times greater total expenditures than in nondementia patients (P<.001), with higher expenditures for each specific type of Medicare service.
- Further study is needed into the factors associated with high rates of hospitalization in dementia patients including aspects of ambulatory management that may be improved.
Why it matters
In a nationally representative sample of Medicare beneficiaries, dementia was linked to higher Medicare expenditures, largely because of increased hospitalization. Further study is needed into the factors behind high hospitalization rates in dementia patients, including aspects of outpatient care that might be improved.
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Study details
- Study designcross-sectional
- Participants1,238,895
- Effect size8.3%; or 3.3
- Evidence strengthLow
How this study scored 60/100
Published in a peer-reviewed journal, and it is a snapshot of people at one point in time. Scored zero for randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of the American Geriatrics Society) |
| Journal's citation record | 3 / 4 | Journal of the American Geriatrics Society: journal h-index 344 (OpenAlex, 2026-10-29) |
| Study design | 4 / 12 | A snapshot of people at one point in time |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2004 — older than 20 years, still counted |
| Sample size | 4 / 4 | 1,238,895 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 6 / 7 | Cited 406 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 16.9 citations a year over 24 year(s) since 2004 |
| Impact for its field and year | 3 / 6 | Cited 5.2× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 3 / 6 | Cited by 21 other studies in this library |
| Still being cited | 2 / 4 | Cited 38 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Albert W. Wu: h-index 105 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | Johns Hopkins University: institution h-index 2,306 (OpenAlex) |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 14728626) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 60 / 100 | — |
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Bynum, J. P., Rabins, P. V., Weller, W., Niefeld, M., Anderson, G. F., & Wu, A. W. (2004). The relationship between a dementia diagnosis, chronic illness, medicare expenditures, and hospital use. Journal of the American Geriatrics Society. https://doi.org/10.1111/j.1532-5415.2004.52054.x
Vancouver
Bynum JP, Rabins PV, Weller W, Niefeld M, Anderson GF, Wu AW. The relationship between a dementia diagnosis, chronic illness, medicare expenditures, and hospital use. Journal of the American Geriatrics Society. 2004. doi:10.1111/j.1532-5415.2004.52054.x. PMID: 14728626.
BibTeX
@article{bynum2004-14728626,
author = {Bynum, J. P. and Rabins, P. V. and Weller, W. and Niefeld, M. and Anderson, G. F. and Wu, A. W.},
title = {{The relationship between a dementia diagnosis, chronic illness, medicare expenditures, and hospital use}},
journal = {Journal of the American Geriatrics Society},
year = {2004},
doi = {10.1111/j.1532-5415.2004.52054.x},
pmid = {14728626},
url = {https://doi.org/10.1111/j.1532-5415.2004.52054.x}
}
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