Prevalence of Chronic Medical Conditions Among Medicare Advantage and Traditional Medicare Beneficiaries.

IF 15.2 1区医学 Q1 MEDICINE, GENERAL & INTERNAL Annals of Internal Medicine Pub Date : 2025-03-01 Epub Date: 2025-02-25 DOI:10.7326/ANNALS-24-01531

Andrew S Oseran, Rahul Aggarwal, Jose Figueroa, Karen E Joynt Maddox, Bruce E Landon, Rishi K Wadhera

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Abstract

Background: The federal government spends billions of dollars per year on payments to Medicare Advantage (MA) plans based, in part, on beneficiaries' risk scores. Despite this, little is known about the true burden of chronic medical conditions among MA beneficiaries compared with those in fee-for-service (FFS) Medicare.

Objective: To determine whether the prevalence of chronic medical conditions is higher among MA compared with FFS beneficiaries.

Design: Cross-sectional.

Setting: Population based.

Participants: Adults aged 65 years or older enrolled in MA or FFS Medicare.

Measurements: Using direct physical examination and laboratory data from the National Health and Nutrition Examination Survey (2015 to 2018), we compared the age- and sex-standardized prevalence of obesity, hypertension, hyperlipidemia, diabetes, and chronic kidney disease between MA and FFS beneficiaries.

Results: The unweighted study population included 2446 respondents corresponding to a weighted total of 45 426 711 adults (34.4% MA, 65.6% FFS Medicare). The prevalence of obesity (41.1% vs. 40.6%; standardized difference [SDiff], 0.48 percentage points [pp] [95% CI, -5.2 to 6.2 pp]), hypertension (70.9% vs. 71.0%; SDiff, -0.05 pp [CI, -5.8 to 5.7 pp]), hyperlipidemia (79.4% vs. 82.3%; SDiff, -2.86 pp [CI, -7.0 to 1.3 pp]), and chronic kidney disease (19.2% vs. 22.8%; SDiff, -3.48 pp [CI, -9.2 to 2.3 pp]) was not higher among MA beneficiaries compared with FFS beneficiaries. However, the prevalence of diabetes was higher in MA (33.3% vs. 26.3%; SDiff, 7.00 pp [CI, 3.3 to 10.7 pp]).

Limitation: Differences in the severity of specific medical conditions between groups could not be assessed.

Conclusion: In this nationally representative study from 2015 to 2018, the prevalence of obesity, hypertension, hyperlipidemia, and chronic kidney disease was not higher among MA compared with FFS beneficiaries; however, the prevalence of diabetes was higher among MA beneficiaries.

Primary funding source: National Heart, Lung, and Blood Institute (NHLBI) and American Heart Association (AHA).

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医疗保险优势和传统医疗保险受益人中慢性疾病的患病率。

背景：联邦政府每年花费数十亿美元支付医疗保险优势（MA）计划，部分基于受益人的风险评分。尽管如此，与按服务收费（FFS）的医疗保险相比，人们对MA受益人的慢性病真正负担知之甚少。目的：确定与FFS受益人相比，MA的慢性疾病患病率是否更高。设计:横断面。设置：基于人口。参与者：参加MA或FFS医疗保险的65岁或以上的成年人。测量方法：利用2015年至2018年全国健康与营养检查调查的直接体格检查和实验室数据，我们比较了MA和FFS受益人之间的年龄和性别标准化的肥胖、高血压、高脂血症、糖尿病和慢性肾病的患病率。结果：未加权的研究人群包括2446名应答者，加权总数为45 426 711名成年人（34.4% MA, 65.6% FFS Medicare）。肥胖患病率(41.1% vs. 40.6%；标准化差异[SDiff]， 0.48个百分点[pp] [95% CI， -5.2至6.2 pp])，高血压(70.9% vs. 71.0%；SDiff, -0.05 pp [CI, -5.8 ~ 5.7 pp])，高脂血症(79.4% vs. 82.3%；SDiff, -2.86 pp [CI, -7.0 ~ 1.3 pp])和慢性肾脏疾病(19.2% vs. 22.8%；与FFS受益人相比，MA受益人的SDiff （-3.48 pp [CI, -9.2至2.3 pp]）并不更高。然而，MA组糖尿病患病率较高(33.3% vs. 26.3%；SDiff, 7.00 pp [CI, 3.3 ~ 10.7 pp])。局限性：无法评估组间特定疾病严重程度的差异。结论：在这项2015 - 2018年具有全国代表性的研究中，与FFS受益人相比，MA中肥胖、高血压、高脂血症和慢性肾脏疾病的患病率并不更高；然而，糖尿病患病率在MA受益人中较高。主要资金来源：国家心肺血液研究所（NHLBI）和美国心脏协会（AHA）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Internal Medicine 医学-医学：内科

CiteScore

23.90

自引率

1.80%

发文量

1136

审稿时长

3-8 weeks

期刊介绍： Established in 1927 by the American College of Physicians (ACP), Annals of Internal Medicine is the premier internal medicine journal. Annals of Internal Medicine’s mission is to promote excellence in medicine, enable physicians and other health care professionals to be well informed members of the medical community and society, advance standards in the conduct and reporting of medical research, and contribute to improving the health of people worldwide. To achieve this mission, the journal publishes a wide variety of original research, review articles, practice guidelines, and commentary relevant to clinical practice, health care delivery, public health, health care policy, medical education, ethics, and research methodology. In addition, the journal publishes personal narratives that convey the feeling and the art of medicine.