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

• Published in: JAMA network open 2021-11, Vol.4 (11), p.e2131884-e2131884
• Main Authors: Nakanishi, Yasuhiro, Tsugihashi, Yukio, Akahane, Manabu, Noda, Tatsuya, Nishioka, Yuichi, Myojin, Tomoya, Kubo, Shinichiro, Higashino, Tsuneyuki, Okuda, Naoko, Robine, Jean-Marie, Imamura, Tomoaki
• Format: Article
• Language: English
• Subjects: Age Distribution; Age groups; Aged; Aged, 80 and over; Centenarians; Centenarians - statistics & numerical data; Cohort Studies; Expenditures; Female; Health Expenditures - statistics & numerical data; Humans; Insurance, Health; Japan; Life Sciences; Male; Oldest old people; Online Only; Original Investigation; Public Health; Retrospective Studies; Sex Distribution
• ISSN: 2574-3805; 2574-3805
• DOI: 10.1001/jamanetworkopen.2021.31884

Although 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. To compare Japanese centenarians' and noncentenarians' monthly medical expenditures during the year before death according to age and sex. 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. Age of 100 years or older (centenarians) vs 75 to 99 years (noncentenarians). The 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. Of 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 (IQR, $4884-$9703) for ages 75 to 79 years, $5894 (IQR, $4292-$8536) for 80 to 84 years, $5069 (IQR, $3676-$7150) for 85 to 89 years, $4205 (IQR, $3085-$5914) for 90 to 94 years, $3522 (IQR, $2626-$4861) for 95 to 99 years, $2898 (IQR, $2241-$3835) for 100 to 104 years, and $2626 (IQR, $1938-$3527) for 105 to 109 years. The proportion of inpatients among all patients in the year before death also decreased with increasing age: 4311 of all 4551 patients aged 75 to 79 years (94.7%); 43 of all 78 patients aged 105 to 109 years (55.1%); 2831 of 2956 men aged 75 to 79 years (95.8%); 50.0% of men aged 105 to 109 years (the number is not reported owing to the