Assessing healthcare expenditures of older United States adults with pain and poor versus good mental health status: a cross-sectional study

Abstract

Objectives: This study aimed to determine if differences exist in healthcare expenditures of older United States (US) adults with pain based on self-reported mental health status, which is important to know given the prevalence of pain and poor mental health in the USA.

Design: This was a cross-sectional study.

Setting: US Medical Expenditure Panel Survey (MEPS) interviews.

Participants: US adults aged ≥50 years, with self-reported pain in the past 4 weeks and positive healthcare expenditure in the 2018 Medical Expenditure Panel Survey (MEPS). The independent variable was poor versus good mental health status.

Primary and secondary outcome measures: Descriptive statistics compared demographic characteristics (using chi-square tests) and mean healthcare expenditures (using t-tests) between groups. Adjusted linear regression models with logarithmically-transformed expenditures compared differences in: total; inpatient; outpatient; emergency room; office-based; prescription medications and other expenditures. Analyses accounted for the complex MEPS design and were weighted to produce nationally-representative results. The a priori alpha level was 0.05.

Results: The weighted population included 57 134 711 older US adults with self-reported pain (14.4% poor mental health, 85.6% good mental health). Compared with individuals with good mental health, individuals with poor mental health had higher unadjusted total expenditures (US$20 231 vs US$13 379, p<0.0001), higher prescription medication expenditures (US$5924 vs US$3610, p<0.0001) and higher other expenditures (US$4833 vs US$2285, p<0.0001). In adjusted multivariable linear regression models, there were no differences in expenditures between those with poor mental health and those with good mental health status.

Conclusions: There were no statistically significant differences in adjusted annual (2018) positive healthcare expenditures among older US adults with pain and poor versus good mental health status.

Keywords: health economics; mental health; pain management.