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One-Hour Postload Plasma Glucose in Middle Age and Medicare Expenditures in Older Age Among Nondiabetic Men and Women

The Chicago Heart Association Detection Project in Industry

¹ Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
² Department of Medicine, Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
³ Institute for Health Services Research and Policy Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
⁴ Harris School of Public Policy Studies, University of Chicago, Chicago, Illinois

Address correspondence and reprint requests to Kiang Liu, PhD, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 North Lake Shore Dr., Suite 1102, Chicago, IL 60611. E-mail: kiangliu{at}northwestern.edu

OBJECTIVE—To examine associations in nondiabetic individuals of 1-h postload plasma glucose measured in young adulthood and middle age with subsequent Medicare expenditures for cardiovascular disease (CVD), diabetes, cancer, and all health care at age 65 years or older using data from the Chicago Heart Association Detection Project in Industry (CHA).

RESEARCH DESIGN AND METHODS—Medicare data (1984–2000) were linked with CHA baseline records (1967–1973) for 8,580 men and 6,723 women ages 33–64 years who were free of coronary heart disease, diabetes, and major electrocardiogram (ECG) abnormalities and who were Medicare eligible (65+ years) for at least 2 years. Participants were classified based on 1-h postload plasma glucose levels <120, 120–199, or 200 mg/dl.

RESULTS—With adjustment for baseline age, cigarette smoking, serum cholesterol, systolic blood pressure, BMI, ethnicity, education, and minor ECG abnormalities, the average annual and cumulative Medicare, total, and diabetes- and CVD-related charges were significantly higher with higher baseline plasma glucose in women, while only diabetes-related charges were significantly higher in men. For example, in women, multivariate-adjusted CVD-related cumulative charges were, respectively, $14,260, $18,909, and $21,183 for the three postload plasma glucose categories (P value for trend = 0.035).

CONCLUSIONS—These findings suggest that maintaining low glucose levels early in life has the potential to reduce health care costs in older age.

Abbreviations: CHA, Chicago Heart Association Detection Project in Industry • CVD, cardiovascular disease • ECG, electrocardiogram

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