Abstract 4145944: Disparities in Cardiovascular Multimorbidity and Mortality among Dual Medicare-Medicaid Beneficiaries: A Nationwide Cohort Study of >2 Million Patients

Introduction/Background: Patients dually eligible for Medicare and Medicaid have higher mortality rates and disparate outcomes for acute cardiovascular conditions. However, the association between dual eligibility and cardiovascular multimorbidity and associated mortality is not well-established. Goals/Aims: To understand differences in cardiovascular disease (CVD) outcomes among patients dually eligible for Medicaid and Medicare. Methods/Approach: We analyzed Medicare claims data from a 5% random sample of fee-for-service beneficiaries (2010-2019). The exposure was Medicaid dual eligibility. The primary outcomes were the development of incident cardiovascular disease or cardiovascular multimorbidity (defined as >=2 of the following conditions: stroke/TIA, myocardial infarction, atrial fibrillation, heart failure, and ischemic heart disease). The secondary outcome was death. Multistate survival models were used to estimate hazards of progression from no CVD to incident CVD, CVD multimorbidity, and death before and after adjustment for demographics and medical comorbidity burden defined using a 1-year lookback window. Results/Data: In total, 2,189,382 patients (12.9% dual-eligible for Medicaid) were included. Compared with non-dual eligible beneficiaries, dual-eligible beneficiaries were more likely to have at least one cardiovascular condition at baseline (23.6% vs. 15.0%). Over a median 5 years of follow-up, dual-eligible beneficiaries spent approximately 1 less year alive and free from CVD than non-dual eligible beneficiaries (4.89 years vs. 5.95 years). Dual-eligible beneficiaries were more likely to develop CVD and multimorbidity and had higher mortality rates before and after adjustment (Table 1 and Figure 2). Conclusions: Dual-eligible beneficiaries had higher rates of incident CVD, cardiovascular multimorbidity and associated mortality, illuminating the critical need for primary and secondary prevention of CVD in this vulnerable population.