The relationship between age and healthcare expenditure among persons with diabetes mellitus.

Few studies have examined how a person's age is related to healthcare expenditure among individuals with chronic conditions. The authors reviewed and examined the association between age and healthcare expenditure among persons with diabetes. Crude healthcare expenditure increases with age. Excluding expenditure associated with long-term and home healthcare, medical costs per person peaks at approximately 80 years of age. For males, persons aged 19-34 years had the lowest per-person medical costs, but, for females, those aged 0-18 years had the lowest per-person medical cost. Healthcare expenditure associated with long-term care and home care increased exponentially beyond 65 years of age. There were considerable differences between sexes in terms of the association of age with healthcare expenditure. Age is not a cause for increased healthcare costs; it is the ageing process and the increased likelihood of morbidity and mortality that comes with increasing age that lead to an increase in costs. The three dominant factors that mediate the positive relationship between age and healthcare expenditure are i) the high medical cost associated with death and the increasing likelihood of death with age; ii) increasing long-term and home care with age, particularly among the very elderly; and iii) the rising number and severity of diabetes-related complications with age. A person's age has no effect or a minimal positive effect on a person's demand for healthcare and total healthcare spending, after adjusting other covariates among persons with diabetes. The aging of populations should have a small impact on future healthcare expenditure. Including non-traditional factors in the cost model, such as proximity to death and prevalence of future diabetes-related complications, would improve the prediction of future healthcare expenditure for persons with diabetes.