JMIR Publications

ABSTRACT

Background:

The long-term economic impact of frailty measured in the beginning of elderhood is unknown.

Objective:

To examine the association between an individual’s frailty index at age 66 years and their healthcare costs and utilization over 10 years.

Methods:

This retrospective cohort study included 215,887 Koreans who attended the National Screening Program for Transitional Ages at age 66 years in 2007-2009. Frailty was defined using a 39-item deficit accumulation frailty index: robust (<0.15), pre-frail (0.15-0.24), and frail (≥0.25). The primary outcome was total healthcare cost per beneficiary per year. The secondary outcomes were inpatient and outpatient healthcare costs per beneficiary per year, inpatient days per beneficiary per year, and number of outpatient visits per beneficiary per year. Generalized estimating equations with a gamma distribution and identity link function were performed to investigate the association between the frailty index and healthcare costs and utilization until December 31, 2019.

Results:

The study population had 53.3% female, 32.9% pre-frailty, and 9.7% frailty. After adjusting for sociodemographic characteristics, the robust group showed an increase in total healthcare costs by an average of $206.2 per beneficiary per year (cost change per year: $206.2, S.E.=$1.2, p<0.0001). The frail group was associated with greater increases in total healthcare costs (cost change per year: $120.9, S.E.=$5.3, p<0.0001), inpatient costs (cost change per year: $102.8, S.E.=$5.2, p<0.0001), outpatient costs (cost change per year: $15.6, S.E.=$1.5, p<0.0001) and inpatient days (change in the number of days per year: 0.9 days, S.E.=0.0 days, p<0.0001) compare to the robust group. Pre-frail group had an increased number of outpatient visits compared to the robust group (change in the number of days per year: 0.1 days, S.E.=0.0 days, p<0.0001).

Conclusions:

Frailty at age 66 was associated with a greater increase in healthcare costs and utilization over 10 years. The long-term high healthcare costs and utilization associated with frailty calls for proactive public health approaches to prevent frailty in aging populations.